Rapid Detoxification

  1. Table of ContentsPrint
  2. Understanding Rapid and Ultra Rapid Opioid Detoxification
  3. What Are the Proclaimed Benefits?
  4. What Are the Risks?
  5. Is It Recommended for Opioid Detoxification?
  6. Find Help for Addiction

person undergoing rapid opioid detoxification

Although rapid and ultra rapid detox are terms that are often used interchangeably and while both are accelerated methods of detoxification, the protocols for each of these detox methods is different. This page will explore the differences between rapid detox and anesthesia-assisted opioid detox (ultra rapid detox) along with their perceived benefits and respective risks.

For many people, detox is where the attempt to break the cycle of addiction begins and ends. The unpleasant withdrawal symptoms that accompany detoxification often prove to be too much for an individual to take, causing them to relapse back into drug abuse. The cycle of substance abuse, dependence, and withdrawal can be difficult to break, but detox, when done right, can be the starting point for a life free from the perils of addiction. According to the National Institute on Drug Abuse (NIDA), various medications can aid the detox process by alleviating withdrawal symptoms, but these medications won’t speed up the time that the process takes. They simply make the detoxification process safer and more comfortable for the patient.

It should come as no surprise then that when some medical providers began offering a fast alternative to traditional detox that many individuals would be attracted to it. If addicted individuals are able to reduce the amount of time they spend in detox—a process that many are fearful of to begin with—it may seem like a more appealing option. But, patterns of compulsive drug use don’t happen overnight and, therefore, treating a drug dependence issue shouldn’t happen overnight.

Understanding Rapid and Ultra Rapid Opioid Detoxification

Rapid opioid detoxification (ROD) was developed in the 1980s to reduce the length of hospitalization during detox. ROD is a significant departure from traditional detox processes that take days or weeks to complete and include the individual having to endure the full set of withdrawal symptoms, with or without medication. With ROD, a doctor administers an oral opioid antagonist such as naltrexone in order to trigger withdrawal, along with moderate, intravenous oral sedation (also referred to as ‘conscious sedation’), while at the same time administering clonidine and other medications to ease withdrawal symptoms.1,2

person undergoing ultra rapid opioid detoxification

Anesthesia-assisted rapid opioid detox (AAROD) or anesthesia-assisted opiate detoxification (ultra rapid opioid detoxification), on the other hand, is similar to ROD but uses general anesthesia to complete the procedure in several hours. During AAROD, the patient is sedated and given drugs that trigger immediate withdrawal. If the individual was awake during this procedure, they would experience high levels of discomfort, but under the influence of the general anesthetic, they theoretically don’t feel any of the pain of withdrawal. When the patient wakes up, they have no memory of the process and most importantly, their body is clear of any opioid substances.

Using medications to abruptly begin withdrawal has the potential to produce even more severe withdrawal symptoms in the individual, including vomiting, diarrhea, hypertension, and tachycardia (abnormally fast heart rate). Compared to anesthesia-assisted rapid opioid detox, ROD is more gradual and less risky than being placed under general anesthesia, but neither approach is endorsed by leading addiction medicine societies. In fact, there are many calls for further research into the safety and efficacy of these procedures.1,2

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What Are the Proclaimed Benefits?

The chief selling point of any rapid detox program is the promise of shortening the opioid withdrawal process to as little as 2 to 3 days (and with imperceptible withdrawal symptoms in the case of ultra rapid detox). These methods are usually preferred by patients who want a ‘magic bullet’ treatment and do not want to suffer through a long withdrawal process.2

Many addicted individuals fear the detox process altogether and delay treatment as a result. They might believe that if they could forego the painful symptoms of withdrawal completely, they’ll be more likely to venture down the road to recovery. To proponents of rapid or ultra rapid detox, the reward far outweighs the risk. A life of addiction, these professionals argue, is a far greater risk to an individual’s health than the small chance of serious harm.2

However, there are major warranted concerns among those in the medical community about the safety of these detox methods as treatment options. And while the philosophy of rapid detox is that it could minimize the risk of relapse, improving treatment success, this is not well studied nor supported by existing clinical evidence.2,3

What Are the Risks?

Many experts think the medical risks of ultra rapid detox are too high. Putting someone under general anesthesia is a serious procedure and should only be performed when necessary. Also, some argue that experiencing the discomfort of the withdrawal process makes a person less likely to relapse once detox is complete. Because detox is unpleasant and even painful, people don’t generally want to go through the process again so the pain of withdrawal may, in fact, be a motivating factor in staying sober.

Many experts think the medical risks of ultra rapid detox are too high.

Some treatment providers market these detoxification methods to patients in a way that implies that it is easy and there is no real risk. However, although the individual is sedated during the anesthesia-assisted detox process due to the medication and cannot feel what is happening to them, it does not mean that it doesn’t take a significant toll on the body. In the most extreme cases, individuals have died during anesthesia-assisted rapid opiate detoxification procedures, and a number of these centers have been closed over public health concerns.3

According to NIDA, some studies have shown that ultra rapid detox does not actually lessen the severity of withdrawal symptoms.4 In fact, the cited study found that those who underwent the treatment experienced withdrawal symptoms that were as strong as those who underwent buprenorphine-assisted or clonidine-assisted opiate detox.4

In addition, patients may not disclose pre-existing conditions before submitting to rapid or ultra rapid detox, placing them at an increased risk of experiencing an adverse medical event.4

Conditions such as reactive airway disease, obstructive airway disease, heart disease, hepatitis, insulin-dependent diabetes, some psychiatric disorders, and AIDS can complicate general anesthetic procedures. In a study of 106 patients at Columbia University Medical Center,3 individuals experienced pulmonary, psychiatric, and diabetic complications during rapid detox that required hospitalization. The patients did not reveal these preexisting conditions during their admission screening.4

Any detox, regardless of the method, is not a substitute for a full course of treatment for addiction.

Given the adverse events associated with rapid and ultra rapid detox, it is not a good idea to resort to this type of treatment. Forcing your body to go through the entire process of detoxification at an accelerated speed can be physically and emotionally taxing and does not allow you the time and space to implement all the psychosocial interventions that help you work through addiction.

Overcoming substance addiction will remain a lifelong process. A person has to unlearn certain behaviors and make a commitment to avoiding triggers and urges to use. For many people, beginning a sober life requires months or years of treatment. Any detox, rapid or otherwise, is not a substitute for a full course of treatment for addiction.

Find Help for Addiction

doctor talking to patient

If you’re dependent on opioids, you need to make an informed decision about how to safely detox your body and move into getting ongoing care. Before starting your detox program, you will complete an assessment to assist the medical team in making the most appropriate treatment plan for your situation. Most people stay in a detox program for about a week, while attending an inpatient or outpatient facility.

Even though detox is the first step in getting the help you need to get sober, a number of complementary maintenance strategies will help prevent relapse. Depending on your situation this could include individualized therapy, medications, exercise, diet, and other lifestyle changes to promote long-term health and wellness. Once detox is complete, it’s time to move on to getting the therapeutic help you need in an inpatient or outpatient treatment program.

Don’t let another day go by with addiction controlling your life. Take the first step on the journey to health and sobriety today. If you are ready to find help for a substance abuse problem, there are detox treatment programs across the country where you can complete this essential first step in your recovery.


References:

  1. American Society of Addiction Medicine. (2005). Rapid and Ultra Rapid Opioid Detoxification.
  2. California Society of Addiction Medicine. (2011). Anesthesia-Assisted Rapid Opioid Detoxification.
  3. Centers for Disease Control and Prevention. (2013). Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012.
  4. National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox.