Recent Deaths From Rapid Detox

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The Centers for Disease Control and Prevention (the CDC), announced in this week’s Morbidity and Mortality Weekly that an anesthesia-assisted rapid opioid detox center in New York City had a spate of deaths and other severe adverse events in patients treated at their center during 2012. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a1.htm?s_cid=mm6238a1_w)

Seventy-five opioid-addicted patients were treated during a nine-month period at this detox facility from January 2012 until September of 2012. Two patients died and five others had serious complications requiring hospitalization. The CDC’s report described in detail what happened that caused these two deaths, and the nature of the complications. Because of these complications, all occurring at this single rapid detox facility, New York State Department of Health issued a health alert, to warn providers against using this form of treatment.

Rapid detox from opioids is a procedure where the opioid addict is put under anesthesia and then given the opioid blocker naloxone, which puts the body into immediate opioid withdrawal. The naloxone throws opioids off the opioid receptors and would cause severe suffering if the patient were awake, so the general anesthesia keeps the addict comfortable. 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.

It’s easy to see why addicts and their families like the idea of rapid detox.. Go to sleep under anesthesia, and wake up drug-free. The addict doesn’t have to go through any painful withdrawal, and the family hopes their loved one is fixed forever.

If only it were so easy. Most opioid addicts and their families have found out – the hard way – that getting off opioids is a very different problem than staying off opioids. Addiction is a chronic disease, and an addict who has had opioids removed from his body still has the disease of addiction. Unless some form of intense counseling treatment is given quickly, the addict is highly likely to relapse.

Besides, patients who undergo rapid detox don’t always feel back to normal after the procedure. Several studies show that post-procedure symptoms of nausea, vomiting, and insomnia can continue for days. Outcomes for patients aren’t any better with rapid detox than with the usual inpatient buprenorphine taper. Plus, rapid detox costs much more; in many places the procedure costs tens of thousands of dollars. (1)

Most reputable treatment centers no longer use this expensive and relatively riskier method of detoxification under general anesthesia since a landmark study was published in 2005 in the Journal of the American Medical Society. Since the studies don’t show greater abstinence rates with this method, it’s difficult to justify its expense and risk. (2)

Studies show that at one year, success rates with rapid detox under anesthesia compared to detox with a short course of buprenorphine are equally dismal, with fewer than 20% of the addicts still abstinent from all opioids at sox month follow up. This underlines the importance of viewing detox as only the preliminary step of drug-free opioid addiction treatment. (3)

Even with the appallingly high incidence of complications at this one rapid detox center, I don’t advocate a complete ban of all rapid detox procedures. The risk for an average patient exceeds the benefits, but there may be special circumstances or patients for whom it’s still a reasonable option. However, in view of the high risk of serious adverse medical events, the patient should be in good health and should be fully informed of the risks. There should be compelling reasons for using this method which has serious medical risks.

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. Drug and Alcohol Dependence, 1998; 52(3) 243-250.

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19 responses to this post.

  1. Rapid Opioid Detox Can Be Safe & Effective When Safety Protocols Are Followed http://goo.gl/9K9ZfD

    Reply

  2. That other comment is just SPAM. He wrote that whole article because of that procedure getting bad publicity because of the reactions those other people had from that one facility. Might hurt his business. It must cost a fortune considering he keeps saying you have to be admitted a day before and spend a few days there along with many medical checks etc. Notice how the article was perfect timing to come out. The story broke on Sept. 27th and he writes that on Sept. 28th. Don’t worry Doc, nobody is going to take away your meal ticket. There are plenty of junkies whose family are wealthy enough to pay for your overly priced procedure. I say get rid of that SPAM comment. Read the whole website. This is a country club joint. Check out this quote “we Assist and allow patients to regain physical and mental strength without being subject to labeling of traditional programs.” Labeling of traditional programs? What do you mean by that?

    Reply

  3. Posted by kevin on October 3, 2013 at 2:39 pm

    Dr Burson, I was just wondering after reading your blog about rapid detox I may be wrong but I couldnt really grasp how you feel on the subject rapid detox. Do you feel that its 100% unsafe, safe in certain settings, or safe with certain medications. I have heard about this quite a bit and always thought about it in the back of my mind. Even though I will never be able to afford it but if I ever could have I can’t say I might not have done it. Which brings me to my previous question. Is it EVER safe?

    Reply

    • No, I don’t think it’s ever as safe as more traditional detoxes.

      I am saying there may be some situations where a patient would be willing to take the extra risk and expense. For example, if an addict had to go to jail in a few days, and knew he wouldn’t be allowed continued on his usual dose of prescribed methadone…in such a situation, if the addict could afford this procedure, he may be willing to accept the risk, to avoid feeling so bad while incarcerated with minimal medical care available.

      Of course, the logical solution to such a situation SHOULD be that the person in a maintenance program be allowed to remain on their medication as prescribed by a doctor, but that does not happen in my part of the world, sadly.

      Or if a patient on methadone is suddenly scheduled to go to russia for a few months…no methadone or Suboxone available there…if time is too short to do a more traditional taper he may decide the risk is worth the benefit.

      These are extreme situations, and in my opinion rapid detox should only be used for extreme situations and only with a fully informed patient.

      Reply

  4. I’m no Doctor but do your own research. I sure did and it is very safe if you go to a good Doctor. Just stay away from Dr Chang in Newark, NJ. He is not a good doctor. Walk in that office and you’ll be really afraid. Anyway, you will feel like crap when you wake up and you will go through everything a junkie detoxing goes through, not sleeping, horrible anxiety etc.

    Reply

  5. Posted by Mike Rock on October 3, 2013 at 3:16 pm

    After reading this article, and watching my 21 year old son go thru the Waismann procedure, I take exception with this article. First, my son never was under anesthesia. He was sedated, similar to have a wisdom tooth pulled. He was sedated for less than 2 hours, and yes, the withdrawal discomforts occurred during the sedation, which he has no recollection of. I did my homework prior to sending him for rapid detox. I think you will find that deaths occurring from rapid detox happen where the patient is in a surgery center not an accredited hospital ICU unit, and where the patient is sent directly to a hotel rather than a recovery center with medical supervision. My son has a successful procedure and outcome, and is opiate free today, 18 months later. After trying to detox on his own, I found this to be the most successful and humane way to detox.

    Reply

    • I’m glad your son is doing well.
      That’s one experience, though. Data collected on outcomes show that this type of detox doesn’t give better outcomes than traditional detox, and is more expensive and more dangerous.

      Reply

      • Posted by Ellen Joy on December 3, 2013 at 10:39 pm

        That’s because those who collect data collect it in aggregate and lump all providers in the same bucket when there are safer ways to perform rapid detox. Some providers put their patients under anesthesia for 8 hours, while others use sedation in 60-90 minutes. They way rapid detox is done affects the outcome.

    • Posted by rapid detox on December 3, 2013 at 9:57 pm

      Im very happy your son is a result of responsible rapid detox. Patients that are addicted to drugs deserve the same respect and humane treatments as patients with other physical illnesses. Lets stop judging and start treating!!!

      Reply

    • can you tell me where you son went for his rapid detox? I’m looking into this for my daughter and of course want to go to someone reputable.

      Reply

  6. Posted by rapid detox on December 3, 2013 at 9:54 pm

    I tend to disagree. Rapid detox when is done responsibly is way safer than any non medical rehab detox.
    How can you say that being in a hospital under medical care through withdrawal is more dangerous than in a rehab with no medical recourse.
    Rapid detox is dangerous when done in an outpatient basis or with old protocols that uses general anesthesia for hours. Medicine progresses , so does rapid detox. Some doctors choose to cut corners, but that you can find in any field of medicine.

    Reply

    • I say rapid detox is more dangerous because that’s what I read in the scientific literature. Please read the references I gave at the end of the article, repeated here:

      Singh j, Ultra-rapid opioid detoxification: Current status and controversies, Journal of Postgraduate Medicine 2004; 50:227-232.
      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.
      Cucchia AT, Monnat M, et.al; Ultra-rapid opiate detoxification using deep sedation with oral midazolam: short and long-term results. Drug and Alcohol Dependence, 1998; 52(3) 243-250.

      After the JAMA article of 2005, most reputable recovery centers stopped doing rapid detox.

      Reply

  7. Let me share my story. I am also a daughter of an alcoholic… I was 17 years old then and pretty much aware of my surroundings. I knew that my dad was an alcoholic. I grew up watching him drunk, and I tend to ask him, “Do you Love me dad?”, “Do you Love this Family?” he answered me with tears… and every drop of it breaks my heart. I saw him suffered although I didn’t know the reason why. And because I really love him, I started browsing the internet and searched for reliable, effective websites that will help me find a solution to my dad’s alcohol problem and ask for other’s suggestions and advices… Yes! At first, it’s not that easy, but I have faith that there are answers in every problem that we have. One day my friend which is a doctor referred me this Addiction Center Boise. After a 3 month treatment, my dad survived and came back home clean and alcohol free. He promised me and to the whole family that he will continue his life without getting back the past and he assured us that he will become a better person. And now, he decided to continue his work. I am certified proud daughter because my dad now is an alcohol free for almost 5 years. He drinks alcohol/ liquor moderately. He is now totally healthy and alive. He told me that he will convert all his experiences in the past into a positive way to move his life positively.

    Reply

  8. Posted by Mike Rock on May 29, 2014 at 5:36 pm

    It bothers me that articles like these scare away people that can benefit from this procedure. I sent my 21 year old son to the Waismann Method in California after a considerable amount of research. I saw prices from $6,000 to $20,000, which was a good indicator that all rapid detox procedures are not alike. What I found is: 1) The best procedures are done in an accredited hospital, preferable in their intensive care unit, rather than at a surgery center; 2) The best procedures are not done with anesthesia, but with sedation similar to what you get for a colonoscopy; 3) The best procedures include an aftercare center, where you are medically and psychologically monitored for several days, rather than be sent to a hotel room with a bag of medications and written instructions… My son received attentive and incredible medical care from the moment of his arrival to his departure a week later. Never once was he on his own, and he was not discharged from care until such time as he was physically and mentally ready. I have come to understand that the horrible treatments I read about are often provided in states that don’t have the strict medical regulations required in California. Choose wisely, it works, and its your life!

    Reply

  9. Posted by Mike Rock on May 29, 2014 at 5:39 pm

    FYI- My first post on this site was 8 months ago…My son is doing great!

    Reply

  10. Posted by Naomi on November 17, 2016 at 5:33 pm

    Is this something you continue to follow? Deaths due to rapid detox?

    Reply

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