Substance abuse costs American society upwards of 600 billion annually, as published by the National Institute of Drug Abuse (NIDA). These costs come from lost workplace production, as well as health care costs, crime, and legal expenses. Opioid drugs are some of the most abused substances in America and even in the world, as an estimated 26.4 million to 36 million people abuse opioids globally, according to the World Drug Report of 2012.
Opioid drugs include illicit street drugs such as heroin as well as prescription narcotics like OxyContin and Vicodin. Opioid painkillers specifically were involved in 71.3 percent of pharmaceutical overdose deaths in 2013, as reported by the Centers for Disease Control and Prevention (CDC). The CDC lists drug overdose as the leading cause of injury death in America in 2012, surpassing even car crashes.
Opioid addiction is a complex and chronic brain disease, requiring specialized treatment. It should come as no surprise then that people are often searching for a “cure” or quick fix for this rising epidemic. Several years ago, medical professionals created a procedure called ultra-rapid opiate detoxification (UROD), also called anesthesia-assisted ultra rapid detox. Though it promises a quick fix to the detox process, it comes with risks.
Chronic opioid abuse makes chemical changes in the brain, including interference with the brain’s natural reward pathways. Opioids dull pain sensations and give users a euphoric rush or “high.” Chronic abuse may lead to physical and emotional dependence on opioids, and when these drugs are then removed, or even between doses, withdrawal can begin.
The opioid withdrawal syndrome is not typically life-threatening, although it can be very uncomfortable. Most common are flu-like symptoms as well as psychological side effects, including agitation, anxiety, insomnia, and drug cravings. Many may choose to avoid treatment or detox because they do not wish to experience withdrawal. UROD may seem like the answer for those wishing to avoid a lengthy detox treatment and even possibly “sleep” through many of the difficult side effects of withdrawal.
Detox is the process of removing any harmful toxins from your body, and it is often the first step in substance abuse treatment. Often, detox protocols utilize medications to help manage cravings and uncomfortable withdrawal symptoms that may occur as substances leave the body. This should be performed in a detox facility with 24-hour medical supervision.
In the case of anesthesia-assisted ultra rapid detox, general anesthesia or heavy sedation is used to accelerate the detox process and then opioid antagonists, or blockers, such as naltrexone, are usually used intravenously to induce withdrawal. Opioid drugs bind to opioid receptor sites in the brain and opioid antagonists effectively block these sites from receiving more opioids. Medications such as clonidine may be given as a pretreatment for UROD, and opioid antagonists as well as antiemetics may be continued after the initial procedure, which lasts between six and eight hours and must be done in an inpatient clinical or hospital setting under close medical supervision and vigilant monitoring.
The concept is for the individual to be asleep during the worst of the withdrawal symptoms; however, since the opioid withdrawal process is not fully realized, it is likely that symptoms will continue even after the UROD procedure is completed. The California Society of Addiction Medicine (CSAM) publishes that since the opioid withdrawal syndrome affects so many aspects of the brain and body, there is no way to predict its duration or severity, or that patients attempting UROD will wake up after the procedure and not suffer from any withdrawal side effects.
Addiction is a chronic disease as well, and detox is not a “cure” but only a part of treatment. The American Society of Addiction Medicine (ASAM) does not support the use of UROD as a treatment for opioid addiction, especially if it is not combined with a comprehensive care plan, including therapies and other services.
Anesthesia-assisted ultra rapid detox is relatively new and not offered at very many places due to high risk factors and questions about its safety and effectiveness. The Journal of the American Medical Association (JAMA) reports that studies do not support using general anesthesia for heroin detox, stating that there is no evidence that it is effective long-term.
Opioid and substance abuse withdrawal and recovery are complex and different for everyone. UROD is highly variable, and each person may have a different result, depending on factors such as the last dose of opioid, the type and method of sedation [i.e., intravenous (IV) or a nasogastric tube (NG), which is inserted through the nose and down into the stomach], and the type of opioid antagonist or follow-up medications used.
During UROD, patients may be hooked up to an ECG machine in order to monitor heart rate for cardiac complications. Sedated patients also need to be monitored closely for signs of delirium, vomiting, or diarrhea that can occur after inducing rapid opioid withdrawal through opioid antagonists.
Anesthesia-assisted ultra rapid detox is considered a risky and expensive procedure with the following potential side effects:
- Fluid accumulation in the lungs
- Elevation of liver enzymes
- Elevated blood sugar
- Renal failure
- Cardiac arrhythmia
- Gastric ulcer
- Peripheral numbness
- Speech difficulties
- Elevated blood pressure
- Pulmonary edema
- Thyroid hormone suppression
- Psychosis or complications of a psychiatric nature
Those undergoing UROD need to be extensively prescreened for any and all underlying medical conditions as well. The National Institute on Drug Abuse (NIDA) reports that three of the 35 patients studied who underwent UROD suffered from severe adverse reactions due to underlying and preexisting medical conditions that were not divulged or discovered prior to the procedure. Furthermore, an investigation was done on a New York City clinic that performed 75 anesthesia-assisted ultra rapid detox procedures between January and September of 2012, and the Centers for Disease Control and Prevention (CDC) published that of these procedures, there were five adverse reactions requiring immediate hospitalization and two deaths, making the serious adverse event rate 9.3 percent.
Another risk factor to UROD is the rate and potential danger of relapse after detox without proper follow-up care. Relapse after detox can be especially hazardous as users who return to previous levels of drug abuse may not have the same tolerance levels as before, which can result in a life-threatening overdose.
Anesthesia-assisted ultra rapid detox is rarely recommended and often not supported by insurance. A successful recovery program often includes a detox protocol, but general other methods are considered safer and more effective long-term. Partial opioid agonists, such as methadone or buprenorphine, may be used to help wean off opioids in a more gradual way that can help smooth withdrawal symptoms and combat drug cravings. Partial opioid agonists act on the same receptors in the brain as full agonists do, although to a lesser effect. They also usually have longer half-lives, meaning they stay in the system longer and are dispensed under the supervision of a medical professional who can monitor progress and ensure the continued success of the treatment program.
The use of medications in treatment should be considered adjunct to behavioral therapies. Addiction has emotional components that need to be cared for during treatment. Psychotherapies, such as cognitive behavioral therapy, can help to identify potential stressors or triggers in one’s environment, social circle, or personal psychology that may create drug-seeking and compulsive behaviors. Behavioral therapies provide tools for coping with these situations and helps to turn negative thought and behavior patterns into positive ones.
A positive self-image and healthy self-esteem are additional important aspects of recovery. Support groups and counseling sessions help to form positive connections and social networks that can enable success and a substance-free future.
There is no “magic bullet” when it comes to substance abuse treatment, but with commitment and the right specialized care provided by compassionate and professional staff members, you can find a healthy and safe balance in life. Call us to learn more.
The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.