Medical treatment strategies for opiate addiction have evolved since the 1950s, when methadone was first used to aid withdrawal. Methadone maintenance programs, in which patients are given methadone, another opiate, as a substitute for the drug of dependence, have been a mainstay of opiate addiction treatment for decades. Now other drugs, like buprenorphine, are given in a similar way to be a substitute for the drug of addiction. For the majority of patients this is not an acceptable alternative, because the physical dependence continues, and is often a lifelong commitment. For most patients, the goal of treatment is complete abstinence.
The necessary first step toward abstinence is completely clearing the drug from the body, called detoxification. The use of opiate receptor antagonists in detoxification was first described in the 1970’s.25 These medications, such as naloxone and naltrexone, competitively bind with opiate receptors in the brain. They block the ability of opiates to have any effect on the brain, and block the opiate craving as well. In the 1990s physicians combined naltrexone, a long-acting opiate receptor antagonist, with clonidine and other medications to shorten the duration of the symptoms of withdrawal.22,23
Various protocols of "rapid" or "ultrarapid" opiate detoxification (ROD) have been developed since 1988 when Loimer reported his "ultrarapid" technique of detoxification under anesthesia to rapidly induce detoxification while blocking the severe symptoms of opiate withdrawal. (Cook 1998, De Giacomo 1999, Greenberg 2000, Loimer 1990, Legarda 1994, Pfab 1996, Scherbaum 1998, Cuccia 1998, Gold 1999, Bell 1999, Umbricht 1999, Kienbaum 2000, Hensel 2000, Elman 2001, Chuatape 2001, Collins 2005). These accelerated methods use high doses of naltrexone to shorten the duration of acute withdrawal to a period of hours, in contrast to several days, and while under anesthesia the patient is not subject to discomfort. When the patient awakens from anesthesia, detoxification is complete. The brain and body are completely cleared of opiates, yet there is no awareness of experiencing the severe withdrawal syndrome, and craving is blocked. Oral naltrexone maintenance can be initiated immediately and continued to reduce the risk of relapse.
In This Article:
Clinical Evidence of Rapid Opiate Detoxification Programs
There have been many recent clinical studies demonstrating the safety and efficacy of rapid, anesthesia-assisted techniques in helping individuals to successfully reverse their opiate dependence and return to healthy, productive lives.
Several studies report the safety and efficacy of the procedure:
- Gold et al12 reported a group of 20 patients who underwent rapid opiate detox (ROD), with no adverse events
- Krabbe et al16 compared rapid opiate detoxification to standard methadone tapering in 30 opiate dependent patients and found no statistically significant difference in abstinence rates at three months
- Hensel and Knox13 reported on their detoxification of 72 opiate addicted patients using rapid opiate detoxification and reported no significant complications. At 12 months post rapid opiate detoxification, 68% of individuals were abstinent from opiates.
- A review of rapid opiate detoxification by Kaye15 in 2003 concluded that "Ultrarapid detoxification, performed under the proper circumstances, is associated with few adverse events and is relatively comfortable for patients who seek treatment for their addiction." Further, they recommend that "the future may include making the procedure available to a larger patient population."
Accelerated Opiate Neuro-Regulation (AON)
One method of rapid opiate detoxification is Accelerated Opiate Neuro-Regulation (AON). This rapid detox program reverses opiate dependence while patients are under sedation or anesthesia. Accelerated opiate neuro-regulation is not a cure for drug dependency or pain killer addiction. It chemically reverses the physical dependence upon the drug so that individuals can get a fresh start on life again.
Patients are admitted to a hospital where they can be carefully monitored in a private and safe setting. The patient is sedated or anesthetized by a trained anesthesiologist so that he or she can sleep comfortably through the detoxification and the withdrawal syndrome that occurs. A high dose of naltrexone is given while the patient is sleeping to enable complete and total reversal of opiates in just an hour or two, without having to suffer through the discomfort of withdrawal. Other medications are given as necessary to minimize withdrawal symptoms. The patient wakes up completely free of opiates. The day after the procedure patients often feel "under the weather." They have some lack of energy, diarrhea, and possibly some nausea and vomiting. They do not, however, experience physical cravings. Patients typically feel noticeably better every few hours, and after a brief recuperation period (usually a few days) the patient can return to normal life.
Continuing to take the medication naltrexone after going home helps to reduce any cravings for the opiate. Ongoing counseling or participation in support groups is recommended to help ensure abstinence.