UltraRapid Withdrawal No Easier: Study Finds
BY LORI WHITTEN, NIDA Notes Staff Writer
Heroin-addicted patients who undergo so-called ultrarapid, anesthesia-assisted detoxification suffer withdrawal symptoms as severe as those endured by patients in detoxification by traditional methods, according to a NIDA-funded clinical trial. Researchers Dr. Eric Collins and colleagues at the College of Physicians and Surgeons of Columbia University concluded that there is no compelling reason to use general anesthesia in the treatment of opiate dependence, especially as it presents particular safety concerns. The new findings corroborate those of three international studies.
The ultrarapid detox technique, developed about 15 years ago by clinicians who hoped to mitigate the discomfort of withdrawal and speed the initiation of relapse prevention therapy, relies on a general anesthetic to sedate the patient for several hours while an opiate blocker precipitates withdrawal.The method is not covered by insurance, which makes it difficult to determine how many patients have received anesthesia-assisted detox.
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“Although providers advertise anesthesia-assisted detox as a fast and painless method to kick opiate addiction, the evidence does not support those statements,” says Dr. Collins. “Patients should consider the many risks associated with this approach, including fluid accumulation in the lungs, metabolic complications of diabetes, and a worsening of underlying bipolar illness, as well as other potentially serious adverse events,” he says. Those with preexisting medical conditions—including some psychiatric disorders, elevated blood sugar, insulin-dependent diabetes, prior pneumonias, hepatitis, heart disease, and AIDS—are particularly at risk for anesthesia-related adverse events. “Careful screening is essential with the anesthesia-assisted method, because the thought of sleeping through withdrawal is so compelling that some patients may conceal their medical histories,” says Dr. Collins.
“We now have several rigorous studies indicating that anesthesia-assisted detox— a costly and risky approach—offers no advantage over other methods,” says Dr. Ivan Montoya of NIDA’s Division of Pharmacotherapies and Medical Consequences of Drug Abuse. Dr. Montoya notes, “The low retention of patients in subsequent outpatient treatment in the present study, which is not unusual for the opiate-addicted population, highlights the need to engage people in long-term recovery after detoxification.” Naltrexone can help motivated patients stay off opiates, but many do not stick to the regimen of daily tablets because of the medication’s side effects of anxiety and restlessness. Long-acting monthly injections of naltrexone, which are now available for alcoholism treatment, may work better for patients and show promise in NIDA-supported clinical trials.
Dr. Montoya also points out that with the current epidemic of prescription painkiller abuse, clinicians need more research on costeffective detox methods for these opiates (see “2003 Survey Reveals Increase in Prescription Drug Abuse, Sharp Drop in Abuse of Hallucinogens“). Some clinics are using buprenorphine for this purpose, and NIDA-funded investigators are studying various methods to improve prescription opiate detox and help patients engage in longer term treatment.
SOURCE
Collins, E.D., et al. Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: A randomized trial. Journal of the American Medical Association 294(8):903-913, 2005. [Abstract]
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