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Is rapid opiate detox worthwhile?

For patients addicted to opiates, detoxification and withdrawal can be highly unpleasant. During my years in addiction medicine, I've watched many detoxification schemes wax and wane in popularity.

At first, we let patients detox on their own. Then we discovered that clonidine could attenuate withdrawal symptoms. Then naltrexone came along, and we discovered that this drug shortens the detoxification process and throws patients into immediate withdrawal. Because this was quite hard on the patients, we started sedating them. Then we started sedating them and giving them both clonidine and naltrexone to help them detox even quicker, in less than 1 day.

As one might imagine, managed care loved this approach--but the patients didn't. They often experienced nausea and vomiting, and found the procedure aversive.

The next logical step was general anesthesia. Now, clinics across the country advertise rapid opiate detox under general anesthesia directly to patients. I see these ads frequently in the alternative weekly newspapers available for free in most big cities.

But only a limited number of facilities have any business offering this treatment. General anesthesia is not without its risks, and several deaths have been attributed to this procedure.

Furthermore, rapid detox is sold to patients as being easy and quick--no muss, no fuss. Come in one day, go to sleep, and wake up with your addiction cured.

Unfortunately, it's not that simple. When patients who have been heavy opiate users for many years emerge from this rapid detox procedure, they are not exactly happy campers. They're not all detoxed and ready to go. Some of them emerge from the procedure extremely miserable and ill.

In addition, it's important to recognize that detoxification alone does not cure a patient of his or her addiction. It's unacceptable to provide rapid detox without also enrolling the patient in a treatment plan that helps the patient get at the root of the addiction.

My impression is that we as physicians love the idea of rapid detox simply because it's something we can do. But treating dependence and addiction is much more difficult than simply detoxifying a patient, so we can't offer detox and pretend that we've treated the addiction.

Rapid opiate detox is certainly not a cure, and it may well be worse than the disease.

DR. MICHAEL E. SCOTT, a specialist in addiction psychiatry, is medical director of Sierra Tucson, a treatment center in Arizona specializing in dual disorders.
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Author:Scott, Michael E.
Publication:Internal Medicine News
Article Type:Editorial
Date:Nov 15, 2003
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