Research studies have shown that use of general anesthesia for heroin detoxification is no better when compared to other methods of detoxification. The study, which came in the latest issue of JAMA, also points out the fact that use of general anesthesia in these circumstances can also lead to adverse life threatening events.
Medically supervised heroin withdrawal remains plagued by patient discomfort and high dropout rates. Many patients fear the physical discomfort of withdrawal and either avoid treatment or leave it prematurely. Even those who complete the detoxification process have high relapse rates, partly due to the absence of continuing treatment.
AdvertisementThese problems have given rise, in the past 15 years, to ultra-rapid, or anesthesia-assisted opioid detoxification, which involves administering an opioid antagonist drug to neutralize the effects of heroin while the patient is unconscious from general anesthesia.
This has been publicized as a fast, painless way to withdraw from heroin. However, this treatment is expensive, not covered by insurance, and lacks good evidence to support efficacy. There are also significant concerns about health risks. The detoxification procedure is usually followed by longer-term treatment with an antagonist drug such as naltrexone to block the effects of any subsequent heroin use.
Researchers from Columbia University, New York, had conducted a randomized controlled trial between 2000 and 2003 to evaluate the safety, tolerability, and efficacy of anesthesia-assisted rapid opioid detoxification compared with two other inpatient withdrawal and naltrexone treatment procedures.
The researchers found that average withdrawal severities were comparable across the 3 treatments. Treatment retention over 12 weeks was low and not significantly different among the three groups. Overall, only 11 percent of patients continued in treatment for 12 weeks and had less than two opioid-positive urine tests, indicating a high rate of relapse to heroin use. The anesthesia procedure was associated with 3 potentially life-threatening adverse events: severe pulmonary edema and aspiration pneumonia, diabetic ketoacidosis, and a bipolar mixed state requiring hospitalization.
Researchers feel that the study demonstrates no benefit of anesthesia over a safer, cheaper, and potentially outpatient alternative using buprenorphine as a bridge to naltrexone treatment. Taken together with the results of earlier studies, the findings suggest that general anesthesia for rapid antagonist induction does not currently have a meaningful role to play in the treatment of opioid dependence
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