Alexander DeLuca, M.D.
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Heroin Detoxification
Dr. Michael Miller's Letter to the Editors of JAMA in Response to: 'Anesthesia-assisted vs Buprenorphine- or Clonidine-assisted Heroin Detoxification and Naltrexone Induction: A Randomized Trial' - Collins et al., JAMA, 294:903-913, 2005

 
Michael Miller, M.D., JAMA, 295(8): 885-886, 2006. Posted: 2006-02-22.
[Identifier: http://www.doctordeluca.com/Library/DetoxEngage/UrodVsRod-Miller06.htm]

Related resources:  Detoxification and Patient Engagement archives
 
See also:
Anesthesia-assisted vs Buprenorphine- or Clonidine-assisted Heroin Detoxification and Naltrexone Induction: A Randomized Trial
Eric Collins et al., JAMA, 294(8): 903-913, 2005
What is Ultra-Rapid Opiate detox (UROD) and how is it different from Rapid Opiate detox (ROD)? - DeLuca, Addiction-related FAQ #18, 2000
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[This Letter in Adobe PDF format]

To the Editor:
The study by Dr Collins and colleagues [1] will surely be of interest to hospitals and other clinical facilities that are considering the introduction of either ultrarapid opiate detoxification (using general anesthesia along with an opioid antagonist, such as intravenous naloxone) or rapid opiate detoxification (using other means of sedation along with an opioid antagonist, such as oral naltrexone). The results were mixed, as expected in a study addressing management of patients with heroin addiction, one of the most intractable problems in addiction medicine.

However, given the small sample size, we still do not have adequate data to advise patients about the extent to which rapid treatment that does not use anesthesia is safer than ultrarapid treatment that uses general anesthesia; nor do we know whether the incorporation of opioid antagonists (naloxone or naltrexone) is responsible for differences in clinical outcome. Moreover, examining detoxification approaches alone does not establish the best approach to use for the treatment of the chronic disease of opioid addiction. Detoxification is only management of the transient condition of acute withdrawal and is a prelude to the necessary long-term task of managing a patient's opioid addiction. [2]

With the increase in unauthorized use of prescription opioids, [3-4] clinicians in the past decade have confronted a bimodal cohort of patients with a dependency on opioids: those addicted to heroin and those addicted to pharmaceuticals. [5] Although the study by Collins et al addressed only those with heroin addiction, much remains to be elucidated by well-designed studies addressing the needs of both of these cohorts of opioid addicts.

Michael M. Miller, MD
mmmille4@facstaff.wisc.edu
NewStart Alcohol/Drug Treatment Program
Meriter Hospital Madison, Wis

Financial Disclosures:
None reported.

References:
1. Collins ED, Kleber HD, Whittington RA, Heitler NE. Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial. JAMA. 2005;294:903-913.

2. American Society of Addiction Medicine (ASAM). Public Policy Statement on Rapid and Ultra Rapid Opioid Detoxification. Chevy Chase, Md: American Society of Addiction Medicine; 2005.

3. Ling W, Wesson DR, Smith DE. Abuse of prescription opioids. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB, eds. Principles of Addiction Medicine. 3rd ed. Chevy Chase, Md: American Society of Addiction Medicine; 2003.

4. Grzybowski S. The black market in prescription drugs. Lancet. 2004;364(suppl 1):s28-s29.

5. Community Epidemiology Work Group. Advance Report: Prescription Drug Abuse. Bethesda, Md: National Institute on Drug Abuse. Epidemiologic Trends in Drug Abuse. NIH publication 04-5363A. June 2004.

[This Letter in Adobe PDF format]

[END]