title: Use of ultra rapid opioid detoxification in the treatment of US military burn casualties.
abstract: BACKGROUND
  The purpose of this case series was to review the management of burn patients who requested ultrarapid opioid detoxification under anesthesia after extended duration of narcotic use for chronic pain related to burn injury.
  
  
  METHODS
  The treatment plan of six opioid-dependent burn patients was analyzed to assess the effectiveness of our detoxification practice to date. Demographic and clinical information was used to characterize the patient population served: age, burn size, injury severity, duration of narcotic use before detoxification intervention, and length of hospitalization stay. Daily narcotic consumption, in morphine equivalent units, was noted both before and after detoxification.
  
  
  RESULTS
  Six burn patients (average age, 31 years) underwent detoxification at the Burn Center during a hospitalization lasting between 1 day and 2 days. Average burn size was 38% total body surface area (range, 17-65); average Injury Severity Score was 30 (range, 25-38). Mean duration of narcotic use was 672 days (range, 239-1,156 days); average use of narcotics at time of detoxification was >200 units daily. Mean outpatient consumption for opioids after the intervention was minimal (<25 units/d). No complications were noted during any procedures.
  
  
  CONCLUSIONS
  The results of ultrarapid opioid detoxification under anesthesia suggests that it is safe and effective for treating opioid addiction in military burn casualties when a coordinated, multidisciplinary approach is used. Safety and effectiveness to date validate current practice and supports incorporation into clinical practice guidelines. Further clinical research is warranted to identify those patients who may benefit most from detoxification and to determine the timing of such treatment.
authors.affiliation: United States Army Institute of Surgical Research and Burn Center at Brooke Army Medical Center, Fort Sam, Houston, Texas, USA. Christopher.Maani@us.army.mil
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Maani
authors.forename: Peter A
authors.initials: PA
authors.lastname: DeSocio
authors.forename: Richard K
authors.initials: RK
authors.lastname: Jansen
authors.forename: Jason D
authors.initials: JD
authors.lastname: Merrell
authors.forename: Laura L
authors.initials: LL
authors.lastname: McGhee
authors.forename: Alan
authors.initials: A
authors.lastname: Young
authors.forename: James F
authors.initials: JF
authors.lastname: Williams
authors.forename: Katie
authors.initials: K
authors.lastname: Tyrell
authors.forename: Bonnie A
authors.initials: BA
authors.lastname: Jackson
authors.forename: Maria L
authors.initials: ML
authors.lastname: Serio-Melvin
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D002056:Burns / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008889:Military Personnel; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone