Outpatient opiate detoxification with clonidine.

The finding that clonidine has significant withdrawal-suppressing effects in opiate addicts has led to clinical testing of its utility as a non-opiate treatment for opiate detoxification. Our outpatient studies have shown that clonidine can be used safely and effectively to detoxify opiate-dependent patients without hospitalization. Because of sedative and hypotensive side effects as well as varying sensitivity to the drug, clonidine doses must be individualized according to each patient's blood pressure and symptoms. Clonidine seems best suited for clinical use as a transitional treatment between opiate dependence and naltrexone. Our 10-day outpatient clonidine detoxification procedure has been extremely effective in allowing patients abruptly to discontinue the use of opiates and stay opiate-free long enough to initiate naltrexone treatment. Clonidine's side effects of sedation and hypotension have limited its clinical usefulness, particularly with outpatients, suggesting that other alpha-2 noradrenergic agonists might be found to have similar antiwithdrawal efficacy but without clonidine's undesirable side effects. Initial outpatient testing of lofexidine, a structural analog of clonidine, indicates that this drug may be as effective as clonidine for opiate detoxification and might be more suitable for outpatient treatment if it is found to lack the sedative and hypotensive side effects sometimes found with clonidine.