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Ultrarapid opiate detoxification: a review

[Désintoxication opiacée ultrarapide : une revue]

Alan D. Kaye, MD PhD^*, Clifford Gevirtz, MD, Hemmo A. Bosscher, MD, Joe B. Duke, MED, Elizabeth A.M. Frost, MD, Todd A. Richards, MD and Aaron M. Fields, MD

^* From the Departments of Anesthesiology,
and Pharmacology, Texas Tech University School of Medicine, Lubbock, Texas;
and the Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York, USA.

Address correspondence to: Dr. Alan D. Kaye, Department of Anesthesiology, Room 1C-282, 3601 4th Street STOP 8182, Lubbock, TX 79430-8182, USA. Phone: 806-743-4176; Fax: 806-743-2982; E-mail: alan.kaye{at}ttuhsc.edu

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.

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