Canadian Journal of Anaesthesia

, Volume 50, Issue 7, pp 663–671

Ultrarapid opiate detoxification: a review

  • Alan D. Kaye
  • Clifford Gevirtz
  • Hemmo A. Bosscher
  • Joe B. Duke
  • Elizabeth A. M. Frost
  • Todd A. Richards
  • Aaron M. Fields
General Anesthesia
  • 851 Downloads

Abstract

Purpose

This review on ultrarapid detoxification examines the pharmacology, techniques, and efficacy of this potentially promising technique and contrasts it with conventional treatment modalities.

Source

The information found here is derived from experiences at the Texas Tech University, government reports, and peer reviewed journals.

Principal findings

Incidence and prevalence of heroin use is on the rise. Social and treatment costs suggest that this problem is staggering. Approximately 400,000 patients are enrolled in or are actively seeking methadone therapy. While many of these individuals want to undergo detoxification, traditional techniques, including methadone tapering are usually unsuccessful. The withdrawal syndrome is extremely unpleasant, may be fatal, and deters patients from completing the detoxification process. Ultrarapid detoxification entails general anesthesia in conjunction with large boluses of narcotic antagonists. This combination allows the individual to completely withdraw from the opiate without suffering the discomfort of the withdrawal syndrome. Unless performed properly, this procedure can be dangerous due to the sympathetic outflow. However, with proper support, this danger can be mitigated.

Conclusion

Ultrarapid opiate detoxification, performed under the proper circumstances, is associated with few adverse events and is relatively comfortable for patients who seek treatment for their addition.

Désintoxication opiacée ultrarapide: une revue

Résumé

Objectif

La présente étude portant sur la désintoxication ultrarapide revoit la pharmacologie, les techniques et l’efficacité de cette technique potentiellement prometteuse et la compare avec les modalités thérapeutiques traditionnelles.

Source

Nos informations sont tirées des expériences à la Texas Tech University, des rapports officiels et des journaux scientifiques. Constatations principales : L’incidence et la prévalence de l’usage d’héroïne sont en hausse. Les coûts sociaux et thérapeutiques de ce problème sont renversants. Environ 400 000 patients suivent, ou cherchent activement, un traitement à la méthadone. Beaucoup acceptent une désintoxication, mais les techniques traditionnelles, incluant l’approche dégressive avec la méthadone, sont habituellement infructueuses. Le syndrome de sevrage est très désagréable, peut être fatal et décourage les patients d’aller jusqu’au bout. La désintoxication ultrarapide nécessite une anesthésie générale conjointement avec d’importants bolus d’antagonistes narcotiques. Cette combinaison permet la suppression complète des opiacés sans subir l’inconfort du syndrome de sevrage. Si elle n’est pas réalisée correctement, cette intervention comporte un danger, lié à l’influx sympathique, danger réduit par une assistance appropriée.

Conclusion

La désintoxication ultrarapide aux opiacés, réalisée dans des conditions appropriées, est associée à peu d’événements indésirables et est relativement confortable pour les patients qui cherchent un traitement à leur dépendance.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Alan D. Kaye
    • 1
  • Clifford Gevirtz
    • 3
  • Hemmo A. Bosscher
    • 1
    • 4
  • Joe B. Duke
    • 1
    • 4
  • Elizabeth A. M. Frost
    • 3
  • Todd A. Richards
    • 1
    • 4
  • Aaron M. Fields
    • 1
    • 4
  1. 1.Departments of AnesthesiologyTexas Tech University School of MedicineLubbock
  2. 2.Departments of PharmacologyTexas Tech University School of MedicineLubbock
  3. 3.Department of AnesthesiologyMount Sinai School of MedicineNew YorkUSA
  4. 4.Department of AnesthesiologyLubbockUSA

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