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Archive for Wednesday, August 24, 2005

Anesthesia may not be effective detox method for heroin addicts

August 24, 2005

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Using general anesthesia to help detoxify heroin addicts is no more effective than other treatments and potentially much more dangerous, according to a study published today by Columbia University researchers.

The method - going by names such as "rapid detox" and "detox in a day" - has been promoted as a quick and easy way to relieve the stress and pain of withdrawal from heroin, as well as more easily accessible narcotics containing opium, such as Vicodin and Oxycontin.

Dr. Eric D. Collins, an assistant professor of medicine at Columbia University, studied 106 addicts, who were divided into three groups.

One group was put under general anesthesia for about five hours and given a high dose of naltrexone, a drug used to neutralize heroin's effects. Another was temporarily given a heroin substitute called buprenorphine and then eased onto naltrexone. A third group was given the antihypertensive drug clonidine, which lessens withdrawal symptoms.

All patients were then offered 12 weeks of additional naltrexone therapy and psychotherapy designed to prevent a relapse into heroin use.

None of the methods was very successful. The results showed high relapse rates, with only 11 percent of the patients finishing treatment and achieving two clean urine tests.

But three patients who underwent general anesthesia nearly died. One suffered a severe buildup of fluids in the lungs and pneumonia, while another had a diabetic episode. A third patient entered a bipolar mental state that required hospitalization. All of the incidents were related to the use of general anesthesia.

The benefits of the method "were limited to the few hours when patients were under general anesthesia, and they came at the expense of risks that should be intolerable," said Collins, lead author of the study published in the Journal of the American Medical Assn.

Jake Epperly, the clinical director of the Midwest Rapid Opiate Detox Center, which has clinics nationwide, disputed the study's findings, saying the Columbia physicians were inexperienced with using general anesthesia as a detoxification method.

"Our anesthesiologists have done 400 or 500 procedures on average," he said. "Experience is everything."

In an editorial accompanying the study, Dr. Patrick G. O'Connor, a professor at the Yale School of Medicine, said the low success rate with all three methods shows that the best therapy is still weaning patients with the long-term use of a heroin substitute, such as methadone.

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