Rapid detox (also known as ultra-rapid detox or rapid opioid detox) is a fairly new set of treatments that use general anesthesia to put someone in a shallow coma during the acute phase of drug detox. Patients will undergo anesthesia and then receive large intravenous doses of opioid antagonists which will purge opioids from the brain and body. After the procedure, patients will be kept in the intensive care unit for 24 hours to recover from anesthesia and then be discharged.
The reasoning behind this approach is to give the body and brain a shock in the form of quickly removing all opioids so that the worst physical symptoms will be finished while the patient is unconscious. This method has been shown to reduce the duration of acute physical withdrawal symptoms, leading to a quicker physical recovery from addiction.
Rapid detox is not for everyone. Firstly, it is extremely expensive and is rarely covered by insurance plans. The benefits of rapid detox are almost exclusively benefits of convenience such as a reduced timeline for detox completion. Additionally, there are several risks associated with rapid detox due to the requirement of general anesthesia for the procedure.
In some cases, the idea of rapid detox may seem preferable to a long outpatient or inpatient detox program. The experience of acute physical detox is nonexistent with rapid detox since the person is unconscious for the entire duration. That being said, there are still post-acute withdrawal symptoms that must be dealt with after this procedure, so it is not a free pass in this regard. Additionally, it is common for patients to have an extreme “hangover” from the anesthesia medications for several days, so this process in effect trades one discomfort for another, albeit a more minor one.
Similar to any medical procedure which requires heavy sedation, a person will go through a screening process before being considered for this treatment. This is done to eliminate the possibility of potentially dangerous health complications or interactions with the medications used in the procedure. Once approved and scheduled, the patient will fast for about 12 hours before the procedure.
On the day of the rapid detox, the patient will be given medications to assist with anesthesia, typically some form of light sedatives such as midazolam or blood pressure medication such as clonidine. Once these have taken effect, anesthetics such as propofol and isoflurane will initiate and maintain the anesthesia, respectively. Skeletal muscle relaxants such as atracurium may be used as well to aid in sedation and relaxation. Once under anesthesia, patients will typically be intubated to help them breathe.
Once under anesthesia and intubated, doctors will administer high doses of opioid antagonists such as naloxone, nalmefene, or naltrexone to purge opioids from opioid receptors in the brain and the body. This is the process that normally makes someone feel so horrible when they experience withdrawal. The medications will bind to opioid receptors much more strongly than the opioid drugs do, thereby forcing the opioid drugs out of the receptors and into the blood to be eliminated through urine.
This process takes many (8+) hours, and after a time the medical team will use what is known as a “naloxone challenge test” to gauge the level of opioid drugs still present in the patient. This test entails a muscular injection of naloxone and looks for emergent withdrawal symptoms. A failed naloxone challenge test means that the opioid antagonist medications have done their job and that the procedure is successful. At this point, anesthesia will be discontinued and the patient will be left to recover in the intensive care unit over the next 24 hours.
Rapid detox, while it is quick, has much higher risks than any other form of detox. The process of anesthesia can be traumatic to the body and brain, and the variety of medications used during the process can complicate things even further. Anesthesia in general has a high risk associated since it produces significant depression of vital functions such as breathing, heart rate, and blood pressure, not to mention the added risks of the detox medications.
While reports vary, there is one particular study that showed an amazing 6% of those who underwent this procedure developed life-threatening conditions. From this study, the life-threatening issues included:
While none of these particular patients died from these complications, the emergence of these issues was completely unexpected and certainly could have been fatal if treatment was not provided immediately.
In New York in 2012 at a clinic that practiced rapid opioid detox, there were 2 deaths out of 75 patients treated, with another 5 patients suffering severe complications that required hospitalization. After a New York State Department of Health review of the clinic’s patient medical records was performed, 1 additional death and 4 more severe reactions were uncovered. In a report on the subject which was published in 2013, the CDC recommends that people avoid undergoing rapid opioid detox by stating that “Safe, evidence-based treatments of opioid dependence (e.g., MAT) exist and are preferred.”
This question is very much debated today, as there are wildly varying reports of the efficacy and success rate of rapid drug detox. Claims which advocate the efficacy of rapid detox are almost exclusively anecdotal in nature, meaning that it is people’s opinions and experiences. Facts or studies do not back up these claims, and the legitimacy of these claims should be taken with caution, as the risks associated with rapid detox are great.
The ease with which detox can be undergone in this rapid fashion may increase the likelihood of relapse later. A major contributor for someone embracing recovery early on is the memory of the pain and discomfort of withdrawal and detox. With this powerful motivator being largely absent through rapid detox, this could lead to a great chance of relapse, and lower rates of long term recovery.
As far as reliable facts are concerned, they seem to point to the ineffectiveness of rapid drug detox as an addiction treatment solution. One prospective study in Iran followed 64 men through the rapid opioid detox process and for several months afterward. It should be noted that the definition of the word “relapse” in the context of this study is defined as “daily use for at least 2 weeks” and not necessarily one instance of drug use. That being said, within 1 month of rapid detox, 48 patients reported relapse with an additional 4 participants reporting one instance of opioid use. At 3 months post-rapid detox, 12 more patients admitted to relapse. Finally, at 6 months post-rapid detox the final 4 had reported relapse which gives this study a 100% relapse rate at 6 months post-rapid detoxification.
Given the extreme cost and the apparent low success rate of rapid drug detox, it should be considered as a last resort. There are effective treatment methods that are much cheaper, sometimes even free, and provide much greater chances of successful recovery.
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