With the rise of the recent opioid epidemic, researchers and medical professionals have been proposing various treatment models for detox and addiction recovery. Historically, successful detoxification and sobriety from opioids has been difficult. Many patients fear the intense discomfort associated with opioid withdrawal symptoms and many drop out of detox programs prematurely to return to opioid abuse.2 Relapsing can be especially dangerous since a period of abstinence reduces a person’s tolerance. This means that if the person uses the same dose they were previously using, they are at an increased risk of overdosing.
In response to these compliance issues, clinicians developed ultra rapid drug detox in the late 1980s.3 Since its inception, it has garnered significant attention within the medical sector. In this procedure, patients are placed under general anesthesia during the acute withdrawal period. Once fully sedated, acute withdrawal is initiated via administration of an opioid antagonist called naltrexone. Naltrexone blocks the effects of opioids, such as heroin and prescription painkillers and, in people with significant physiological dependence, will result in precipitated withdrawal, which is characterized by a rapid and intense onset of opioid withdrawal symptoms. In general, the goal of ultra rapid drug detox is to speed up the withdrawal process and minimize pain and discomfort. Some protocols require electrocardiogram (ECG) monitoring and clonidine pretreatment to control the cardiovascular effects, such as rapid pulse and increased blood pressure, of precipitated withdrawal.3,4
This mode of treatment often attracts patients who want a “quick fix” for treating their opioid addiction, as the overarching premise indicates that you can “go to sleep and wake up clean.”3 That being said, people struggling with opioid addiction should be cautious when considering ultra rapid detox. The best course of action is to meet with your physician to learn more about the benefits vs. the risks.
Research results, while limited, show mixed results regarding ultra rapid drug detox effectiveness. Ultra rapid drug detox is far from a “magic answer” in curing opioid withdrawal symptoms. Even more problematic is that the majority of clinical ultra rapid drug detox trials are nonrandomized and uncontrolled, which means that the results may be inaccurate or lack sufficient evidence on which to base claims of efficacy.2
Although the anesthesia initially induces a period of unconsciousness, research shows that patients may experience distressing symptoms for several days after the procedure. In some instances, the duration of acute withdrawal is difficult to predict since several detox medications are administered throughout detox. As a result, a patient’s withdrawal process is not guaranteed to conclude when they wake up.3
In one study examining 106 patients at Columbia University Medical Center, patients were randomly placed into one of 3 detox method categories: buprenorphine, a partial opioid agonist which reduces withdrawal symptoms and cravings, clonidine and other non-opioids that mitigate certain symptoms, and ultra rapid detox. The patients in the ultra rapid detox group reported symptoms and discomfort comparable to those receiving buprenorphine and clonidine treatment. These symptoms included cramps, nausea, anxiety, and depression. At the end of the study, research showed no advantage in sobriety rates for those who received ultra rapid detox compared to buprenorphine or clonidine-assisted detox. In fact, anesthesia-assisted detox was the only method to result in adverse effects, related to pre-existing conditions, which required hospitalization.4
Other research suggests more positive results. One study consisting of 153 subjects measured the severity of opioid withdrawal symptoms 12 hours after ultra rapid detox was completed. Researchers used the Subjective Opiate Withdrawal Scale (SOWS), which consists of 16 symptoms rated by patients, and determined that the symptoms were well controlled.5
Ultra rapid drug detox presents with considerable controversy in the medical community due to its safety risks and potential medical complications.
To date, case studies have reported the following adverse consequences:2,4,5,6
The Centers of Disease Control and Prevention (CDC) have listed several case reports detailing 7 fatalities from ultrarapid drug detox complications.6 It appears that having preexisting conditions, such as mental health conditions, hepatitis, insulin-dependent diabetes, heart disease, and AIDS, can complicate the process.4 Therefore, if a patient is interested in ultra rapid detox, it is essential that they receive comprehensive medical clearance and a detailed explanation of the potential risks and side effects. It is also up to the medical professionals conducting the assessment to be careful and thorough, as some people may hide their medical histories in order to qualify for ultra rapid detoxification.4
To compound the risks and dangers, ultra rapid opioid detox is not standardized, which means that there are no specific guidelines or requirements that must be followed when performing this procedure. Factors, such as timing of last dose of opioid, the level of sedation, the anesthesia used, the specific opioid antagonist utilized and its dose, the duration of the detox method, and the level of follow-up support, vary dramatically and thus, may influence the safety of ultra rapid detox.3
Traditional detox refers to a set of interventions intended to support and assist those who undergo acute substance withdrawal. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that effective detox consists of evaluation, stabilization, and fostering the patient’s readiness into substance abuse treatment.7
Evaluation refers to adequately testing for the presence of substances in the bloodstream and assessing each patient’s biopsychosocial history. Stabilization refers to assisting patients throughout acute intoxication and withdrawal in order to achieve a drug-free, medically stable state. Finally, as detox alone is rarely sufficient enough of a treatment intervention to ensure sustained recovery, fostering the patient’s entry into longer-term substance abuse treatment entails encouraging and preparing patients to engage in the next step on the treatment continuum of care.7
Detox can take place in several locations including:7
Outpatient detox requires patients to attend clinical and medical services for a designated number of hours or days each week.7 Patients typically live at home and commute to the facility. However, outpatient detox presents numerous risks for people struggling with opioid addiction. For one, outpatient detox has less structure than inpatient, which may increase the risk of noncompliance and drop-out rates.
Fortunately, help is available, and the sooner you contact a detox center, the sooner you can begin your road to recovery. Reach out for support today.
Opioid addiction is a progressive condition, which means that it tends to get worse as time goes on and it is left untreated.