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


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


RESULTS
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.


CONCLUSIONS
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.
Kaye
Alan D
AD
Department of Anesthesiology, Texas Tech University School of Medicine, Lubbock, Texas, USA. alan.kaye@ttuhsc.edu
Gevirtz
Clifford
C
Bosscher
Hemmo A
HA
Duke
Joe B
JB
Frost
Elizabeth A M
EA
Richards
Todd A
TA
Fields
Aaron M
AM
D000768:Anesthesia, General; D003000:Clonidine / Q000627:therapeutic use; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D007362:Intensive Care Units; D009271:Naltrexone / Q000009:adverse effects / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D013565:Sympatholytics / Q000627:therapeutic use
D009292:Narcotic Antagonists; D013565:Sympatholytics; D009271:Naltrexone; D003000:Clonidine