The naloxone test for opiate dependence

Naloxone tests for opiate dependence were given to 296 applicants for treatment with the surrogate opiate levomethadyl acetate (LAAM, levo-alpha-acetylmethadol) and to 103 applicants for treatment with the opiate antagonist naltrexone. Thirty-five of the 296 LAAM applicants applied first for LAAM, then following detoxification, for naltrexone. There was a dramatic decrease in withdrawal signs and symptoms when the subject went from opiate-dependent to a nondependent state. From our experience, we devised a scoring guide and testing procedure based on objective signs. We propose a 2-step test, with an initial intramuscular dose, then (if necessary) an intravenous dose, to determine an applicant's eligibility for surrogate opiate or narcotic antagonist treatment.