Anesthesia doesn’t ease heroin detox

Heroin detoxification under general anesthesia has been touted as a fast and pain-free way for addicts to get clean, but new research indicates that this method offers no benefit over other protocols that are safer and much less expensive.

“Anyone who might be interested in anesthesia for detox should know that it’s costly, dangerous, and not better than alternative approaches,” Dr. Eric D. Collins told Reuters Health.

Anesthesia-assisted opioid withdrawal, which was introduced roughly 15 years ago, involves administering a drug to counteract the effects of narcotics while the person being detoxed is unconscious under general anesthesia.

Proponents contend that by decreasing physical discomfort, this method takes the fear out of detoxification, thereby increasing patient compliance. A few studies have compared this treatment, which carries a price tag of up to $15,000, with other forms of detox, but the results haven’t led to firm conclusions.

In the present study, Collins, from the College of Physicians and Surgeons of Columbia University, New York, and colleagues assessed the outcomes of 106 heroin-dependent patients who were randomly assigned to one of three detox strategies: treatment with the anti-opiate drug naltrexone along with either anesthesia, or the drug buprenorphine, or with clonidine.

Each protocol was applied over 72 hours, and then the patients received 12 weeks of naltrexone maintenance therapy and relapse-prevention psychotherapy. The researchers’ findings appear in the Journal of the American Medical Association.

Withdrawal severity was comparable with the three detoxification methods, the report indicates, and rates of completion of the in-hospital phase of detoxification were similar with each.

Over 12 weeks, only 20 percent, 24 percent, and 9 percent of patients in the anesthesia, buprenorphine, and clonidine groups, respectively, stayed with the program. Those differences were not significant from a statistical standpoint.

Three potentially life-threatening complications—severe fluid buildup in the lungs, suicidal thoughts in a patient who had concealed a history of bipolar disorder, and diabetic crisis—were seen in the anesthesia group.

“Still, the last thing that I would want is for people to be discouraged by our results,” Collins said. “This study does not mean that patients can’t be treated for their opioid dependence; it just means that the treatments out there that are cheaper and safer (than anesthesia) are also at least as effective.”

SOURCE: Journal of the American Medical Association, August 24/31, 2005.

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