Rapid Detox: Detoxification under anesthesia

It sounds great. It should work. Go to sleep under anesthesia, and wake up drug-free. The appeal of this idea is obvious: the addict doesn’t have to go through any painful withdrawal. While the patient is under anesthesia, the opioid antagonist drug naloxone (or one similar) is given, putting the body into withdrawal. Hours later, the patient is brought out of anesthesia, and according to treatment centers that do this type of treatment, the patient has no further withdrawal.
However, it’s more complicated than that. Several studies show that post-procedure symptoms of nausea, vomiting, and insomnia can continue for days afterward, and the outcomes for patients aren’t any better with this treatment than with the usual inpatient buprenorphine taper. (1) Plus, ultrarapid detox costs much more; in many places the procedure costs tens of thousands of dollars. (2)
Treatment centers that perform rapid detox advertise claims of “100%” success, speaking of numbers of patients that complete treatment – but if the patient is under anesthesia, of course 100% will complete the treatment. They aren’t going anywhere! Many proponents of rapid detox exaggerate and inflate success rates in this way. But studies show that at one year, success rates with rapid detox under anesthesia compared to detox with a short course of buprenorphine are equal – equally dismal, that is, with only 20% of the addicts still abstinent from all opioids. (3)
Most reputable treatment centers no longer use this expensive and relatively riskier method of detoxification under general anesthesia. Since the studies don’t show greater abstinence rates with this method, it’s difficult to justify its expense and risk. (2)
However, there may be some patients for whom this is an acceptable treatment. Perhaps if ultra-rapid detox is the only treatment option that an addict is willing to try, the potential benefits may outweigh risks, since we know that active addiction is very risky.
This method of detox may be most successful with a very motivated addict who, for whatever reason, has a deadline they want to meet for detoxification. Even though there’s less than a 20% chance that of abstinence at one year after the procedure, that addict will still be introduced to the idea of addiction treatment, and possibly more willing to participate in another form of treatment.
References:
1. Singh j, Ultra-rapid opioid detoxification: Current status and controversies, Journal of Postgraduate Medicine 2004; 50:227-232.
2. Collins ED, Kleber HD, Whittington RA, Heitler NE, Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: A randomized trial, Journal of the American Medical Association, 2005; 294 (8) 903-913.
3. Cucchia AT, Monnat M, et.al; Ultra-rapid opiate detoxification using deep sedation with oral midazolam: short and long-term results. The authors conclude that patients still had withdrawal symptoms after the detoxification procedure, and 80% had relapsed back to opioid use at the six month follow up. Drug and Alcohol Dependence, 1998; 52(3) 243-250.

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