Friday, March 29, 2013

Rapid Opioid Detoxification

Ah what a beautiful fall day here on the East Coast. The weather is as close to perfect as one could ask for when taking into consideration the sometimes baffling New England weather. The birds are chirping, the sun shining, calm guests of wind pass by creating an almost picture-like atmosphere around me. And here I am enjoying this wonderful day demonstrating the beauty of life....sitting behind my computer screen typing away!

I recently took somewhat of a break from blogging (not intentionally however) and I must say, it feels good to be back at it. For those of you who haven't yet read my "comeback" post, check it out. It's labeled as "I'm Back" and can be found on my blog homepage. Now lets get to business.

For anyone visiting this site for the first time, I welcome you to my blog and hope you will find it both helpful and an enjoyable read. This is now my 14th post and I must say I am becoming more and more pleased with the blog as each post is thought of, written, and published for you guys to read. Over the past several months I have gotten a few comments, a solid number of page views, and even an e-mail from someone looking for a little more advice and someone to "just talk to". I have also noticed that a few people took the most recent poll as well which only adds to my satisfaction. It makes me feel like that I'm getting my blog out there to anyone who's looking for any advice and information about opiate addiction and that I'm not just typing away for nothing. I would like to take a second to thank all of you who have read my blog, commented on it, taken part of the poll, or have passed the word around. THANK YOU!

For this post I would like to talk about a treatment option for opiate addicts that is relatively new. This method of treatment is commonly referred to and known as Rapid Opioid Detoxification and has been met with both praise and criticism. To make things a little easier for myself, I will be referring to the Rapid opioid detoxification as ROD. To give you guys a quick idea of what this is, please let me explain and sum it up in a few quick sentences. ROD is a method of treatment for opiate addicts which often places the patient in a state of unconsciousness while doctors provide the patient with a variety of medications that will help speed up the detoxification process. The patient will be "asleep" for a period of time and will then awaken after the normal period of opiate withdrawal. To put it bluntly, they basically put you asleep, give you some medications to speed up the detox process, and allow the patient to awaken feeling little to no withdrawal symptoms.

When I first heard of this method of treatment, I was very enlightened and curious about the process as it seemed far too good to be true. After doing some research and asking both my addiction doctor and consoler some questions about the matter, I was left with the impression that this method of treatment has a lot of promise but is still in its early stages and needs a lot more work and research put into it. Similar to many of my other posts on this blog, I would like to take this post and divide it into a few sections that will further discuss the matter. I would like to give you guys a brief overview and history of this method of treatment, its effectiveness, the general census of it currently, and my thoughts on it. After that, I'll leave the rest to you guys provide any comments, inputs, or even experiences you have on the matter. On that note, lets begin.

A Basic Overview/History Of  Rapid Opioid Detoxification
The origins and history of ROD are somewhat unclear and shady from what I have been able to research and understand. After doing some of my own research on the matter, I came across a website that gave me a few answers on this question.  This website states that "rapid opiate detox was created in Israel almost 20 years ago by Dr. Andre Waismann, who still practices his craft in Barzilai Medical Center in Ashkelon, Israel," and that this method of treatment came about after a striking number of soldiers from the Israeli army were found to have been suffering from opiate addiction. The army and its doctors (or scientists, not exactly sure who?) came to the conclusion that something must be done to address this growing problem and that the traditional methods of treatment were not good enough for the situation at hand. Over time, research, and much effort, this is where Rapid Opioid Detoxification (ROD) emerged as an option.
There is a brief amount of information from this website that explains the origins and history of this method of treatment and its something that I feel I can't really explain to you guys without basically stating exactly what the website says so rather than to try to put it into my own words and possibly leave out any important information or to say the wrong things, I will put below this paragraph in blue front word for word what the website states (feel free to check out the website yourself if you wish by clicking on the link in the paragraph above).






While this method of treatment has been around for 20 years, it really hasn't been that well known in the U.S. until recently. Some doctors are all for it while others are very much against it, so there isn't really a final census or agreement on the matter as of now. Hopefully there will be more information about this matter as time goes on and that they can fix any of the problems with this procedure. The withdrawals experienced during this procedure are often compared to as how one would feel if they were to go into precipitated withdrawal. If you remember from my previous posts (or worse, know from experience), precipitated withdrawal occurs when you take a drug such as Suboxone, Methadone, or Vivitrol without having waited long enough after any previous use of opiates such as Oxycodone, Heroin, and the like. For those who don't know, precipitated withdrawal is said to be much worse of a feeling than the "normal" opiate withdrawals one would suffer if they were to suddenly stop using opiates after a continued period of time (going cold turkey).

Normal opiate withdrawals already suck enough as it is, so precipitated withdrawals is something you don't want to mess with. While the patient would normally feel like they were in a state of hell during the course of experiencing precipitated opiate withdrawal, the patient undergoing ROD is supposed to feel little to no discomfort or pain during ROD due to the fact that they are not conscious and are under certain medications. Basically, the procedure has you sleep though the rough part while under medical supervision.

The procedure itself differs slightly from place from place but the basic concepts behind it remain nearly the same. To give you guys a description of the procedure, I have once again provided a detailed description of the procedure from a website I found online (I promise you I'm not getting lazy, I just want everything to be as clear as possible for you guys rather than putting things in my own words) while researching this method of treatment. This information is below this paragraph and is once again in blue front.


Another website provided a brief description of the process for their particular facility and I have listed it below this paragraph as well. This information comes from a facility in New York known as New York Rapid Opioid Detoxification (NYROD).

"The process begins when NYROD is first contacted by a patient or referring source. Patients then undergo a thorough screening of their medical and drug histories, and psychological profiles. Patients will complete an extensive questionnaire which will be reviewed by Dr. Brooks and our addiction specialized therapist. Dr. Brooks and out addiction therapists will speak to each patient in person, or by phone if calling from a great distance. Patient determination to end their opiate addiction is key to acceptance for treatment. With patient consent, previous therapists will be contacted to discuss your addiction and treatment histories. All patients must undergo physical examination and testing appropriate for their age and drug history.

AAROD is an important first step toward becoming opiate addiction free, but is only a first step. Therefore, to optimize outcomes and avoid relapse, NO patient will be allowed into the program unless aftercare has been established. That is, patients must have an inpatient, or outpatient post-procedure treatment plan to help them understand any psychosocial roots of their addictions and trigger avoidance. Our staff will work with you to assure a smooth transition into an aftercare program. In addition, we will maintain contact with each patient with frequent phone calls and return follow-up appointments. Every patient will have 24-hour access numbers to reach us if needed.

Patients are admitted early morning. An intravenous line is started and patients are placed on cardiac and oxygen monitors. Under the care of an ICU trained RN, patients will receive clonidine and intravenous fluids. The clonidine will help stabilize blood pressure and heart rate during detoxification. The fluids will begin the “washout” of the opiates still on the patient’s receptors.
Next, under the direct and constant care of a Board Certified Anesthesiologist, patients are brought into a state of the art procedure room. After the induction of deep intravenous sedation patients are administered the opiate antagonists naloxone and naltrexone until all opiates have been displaced from the opiate receptors and the detoxification is complete. Patients have no awareness or memory of the detoxification process which would otherwise be intolerable. Depending upon the level of addiction and the drugs to which the patient is addicted, the procedure will last from 3 to 4 hours. Before awakening, and only after the patient is completely detoxified, the patient is administered depot naltrexone injection.

Patients are next brought to a comfortable recovery area where they will be continuously monitored through the night by a trained RN. Any residual restlessness or discomfort or expected gastrointestinal distress will be treated as needed. Young patients may have a parent stay with them for all or part of the recovery period.

Before discharge the next morning, every patient will be evaluated by Dr. Brooks, and visited by our therapist to discuss immediate aftercare planning. Unless ready for discharge, patients will be kept. No patient will be allowed to leave without a responsible adult escort.

The aftercare you receive will be individualized and determined by you and your therapist. Some patients will choose to immediately continue in an outpatient setting, working closely with a therapist and joining a support group such as Narcotics Anonymous. Others may feel that they must first enter a more structured program in a protected and anonymous rehabilitation setting, far from their familiar “people, places, and things"

This procedure is supposed to be nearly painless and provides the patient with the chance to achieve sobriety without having to put up with the physical withdrawals from trying to quit opiates. The withdrawals from opiates is often a factor that prevents many (myself included) from going the cold turkey route. This option may also be appealing for those who dislike Opiate Replacement Therapy drugs such as Suboxone, Methadone, or Vivitrol or who feel they would otherwise be unsuccessful with going down this route (or cold turkey). The fact that it is basically a one time procedure (unlike Suboxone/Methadone which is an every day thing) is something that may be very appealing for some addicts.

Based on what I have read, patients will often stay in the facility or hospital for a few days and will be closely monitored. After the procedure, patients will be sometimes be prescribed Naltrexone to help them remain sober. It is important to remember that Naltrexone is not addicting and is the same drug that is found in the Vivitrol shot that I talked about here. It is also recommended that after the procedure that the patient continues to see their doctor, live a drug and alcohol free life, and seek support and/or AA/NA meetings.

Effectiveness/Opinion Of Rapid Opioid Detoxification
As I said previously in this post, there is still much debate as to exactly how effective the ROD can be and where it ranks among the many other treatment options out there. Many feel the procedure has much promise but is still in its early stages of development and that the procedure itself carries its own risks. There are others who feel the procedure offers little to no advantage over more traditional methods of treatments besides allowing the patient to avoid the physical withdrawals that so often accompany the challenging process of quitting opiates. In other words, while the patient may be able to avoid withdrawal, he or she will still have to face the mental aspect of addiction (cravings, depression, etc.), which can be just as difficult or harder than the physical part of quitting opiates.
A major drawback of ROD is that it is usually expensive, in fact quite expensive, as typical procedures usually range anywhere from as low as $5,000 to as high as $30,000 as well as additional costs of having to stay in a hospital for monitoring after the procedure and any medications you may be given. Based on my own research, it appears the average price is usually between $15,000-$20,000. That's a lot of money for most of us and to make matters worse, from what I have read getting insurance to cover the procedure can be quite difficult. Again everyone and their cases are different so some might pay more or less than others or may get better (or worse) insurance coverage. However, staying at an inpatient rehabilitation center is also pretty expensive ranging from a couple hundred dollars a day to thousands of dollars a day depending upon the place and situation. Suboxone, Vivitrol, and Methadone can also burn a hole in your pockets as well but is usually cheaper than ROD or an inpatient stay at a rehabilitation center. In other words, unless you plan on going cold turkey, getting clean can often be quite expensive.
To give you guys a clearer picture of what I'm saying, take my situation for example. I am currently on 1 mg of Suboxone a day and usually end up paying about $300-350 a month for my prescription, appointments with my addiction doctor, and meetings with my drug addiction consular which are all mandatory to remain in the outpatient Suboxone program I am part of. And those numbers are with insurance coverage (I'm told I have pretty good insurance too). If you're looking at getting on an opiate replacement therapy program, staying in an inpatient program, or giving the ROD procedure a try, insurance is a near must unless you have the money to spend. I have never been to an inpatient rehabilitation program but to give you an idea of what a stay at a average/normal (not some shithole or some 5 star resort-like rehab), I have included a list of prices without insurance coverage for a typical inpatient stay at a rehabilitation center (Waismann Method Medical Group and Domus Retreat) below:
  • 5 day program is $18,800

  • 1 week program is $20,800

  • 10 day program is $23,800

  • 2 week program is $27,800

  • 3 week program is $33,800

  • 4 week program is $39,800

    Another disadvantage are the risks involved with this procedure. For this procedure, the patient will sometimes be put under anesthesia to basically have them "sleep" through the entire procedure. As most of you already probably know, anesthesia does carry its own risks despite the fact that it is commonly used and well known. These risks can be intensified for those with medical issues or disease so be sure to think this over and talk both regularly and honestly with your doctor if you feel ROD is the route you wish to go. The patient will also be given a variety of drugs (I'm not sure what) so it is important you know what you're being given in case you have any allergies or bad reactions to these drugs. A final risk involved in the procedure is the same risk you take when you decide to go cold turkey. Detoxing off opiates is very rarely life-threatening but it still does take its toll on your body when/if you decide to go cold turkey off opiates. These same risks will be present if you undergo the ROD procedure. I don't want to scare anyone or to seem as though I'm trying to lead you guys in a direction but I feel it is my duty to at least mention that there has been cases of people actually dying during the procedure or a few days after it. This is something that really concerned me but we must also take into consideration that people can die or suffer from complications during any procedure that involves anesthesia as well as the fact that some addicts can be in a relatively poor state of health in the first place. Like anything in life, this procedure has its risks. The following excerpt is taken from an article which explains some of the risks involved with this procedure:


    Rapid Opioid Detoxification does not guarantee life-long sobriety and a person who undergoes this treatment has no greater chance of remaining sober than someone who attempts to go cold turkey or use opiate replacement therapy. Someone can be cold turkey off of opiates for a month and suddenly relapse. Someone may be on Suboxone or Methadone for 2 years and relapse. Hell, there are people who have decades of sobriety who end up suddenly relapsing. The same unfortunately goes for patients who have undergone a ROD procedure. I'm not trying to sound like a jerk when I say that (there certainly are people who have undergone cold turkey, opiate replacement therapy, and  I'm sure ROD who have gotten and remained sober) but I want to be as honest as I can be with you guys. ROD will help you avoid the physical withdrawals but you'll most likely still end up having to fight off urges, struggle with the mind games of addiction, and live through the mental anguish for quite some time after you quit opiates. I bring this up because $20,000 is a lot to pay to get sober to end up relapsing later on. Like I've said before, some people get it their first time while others, their 100th try. Everyone is different so don't feel as if I'm speaking for you and every opiate addict out there. Getting sober is easier for others just as it can be harder for others.

    Full-size image (5 K)
    This chart shows the percentage of patients who remained sober after a Rapid Opioid Detox procedure. This chart was obtained in the book Drug and Alcohol Dependence (Vol. 52, Issue 53-Pages 177-270). The link to this information can be found by clicking Here.

    The following excerpt is from a study that was conducted in 1999 by American Society of Anesthesiologists. It discusses the success rate of the procedure in 20 individuals as well any side effects experienced by these people. The link to this study can be found by clicking here. Here it is below in blue front:

    "Background: Opioid addiction therapy includes successful detoxification, rehabilitation, and sometimes methadone maintenance. However, the patient may have physical, mental, and emotional pain while trying to achieve abstinence. A new detoxification technique that incorporates general anesthesia uses a high‐dose opioid antagonist to compress detoxification to within 6 h while avoiding the withdrawal.
    Methods: After Institutional Review Board approval and detailed informed consent, 20 patients, American Society of Anesthesiologists status I–II, addicted to various opioids underwent anesthesia‐assisted rapid opioid detoxification. After baseline hemodynamics and withdrawal scores were obtained, anesthesia was induced. After testing with 0.4 mg intravenous naloxone, 4 mg nalmefene, was infused over 2 to 3 h. After emergence, severity of withdrawal was scored before and after administration of 0.4 mg intravenous naloxone. After 24 h, patients began outpatient follow‐up treatment while taking oral naltrexone.
    Results: All 20 patients were successfully detoxified with no adverse anesthetic events. After the first post‐treatment test dose of 0.4 mg naloxone, 13 of 20 patients had no signs of withdrawal and hemodynamic changes were minimal. Withdrawal scores were always very low and similar before and after detoxification. Three of 17 patients (18%) available for follow‐up have remained abstinent from opioids since treatment (≤ 18 months). Four other patients are clean after brief relapses.
    Conclusions: Anesthesia‐assisted opioid detoxification is an alternative to conventional detoxification."

    Getting and staying clean is not an easy thing but is something we (us opiate addicts) must seek, or eventually seek. Most who continue a life of abusing opiates usually end up in jail, institutions, being homeless, or even dead. For those who don't get to any of those places, they will probably end up hurting their families/friends (in addition to themselves), ruining relationships, losing their jobs, and basically destroying their lives. Think about it,  how many happy, successful opiate addicts do you know or have you heard of? If you're like me, none. Addiction may not seem so bad at first but trust me, it will eventually bite you in the ass if you put up with it long enough. Again, I hate to appear gloomy and like a jerk on a high horse, but this is usually the case and is something I know from experience. My rock bottom wasn't jail, homelessness, or death but I did hurt some of the people I cared most about, did some things I would have never thought I would have done, and changed (negatively) as a person. I hated what I was doing and who I was becoming, eventually getting help and can honestly say I am happy the way my life is going right now. It hasn't been easy but like I've said numerous times before, it is possible. I'm still learning this myself as I continue my journey towards sobriety.

    What I just mentioned in the previous paragraph is there for a reason. I want to stress to you guys that just like Suboxone, Vivitrol, or Methadone, Rapid Opioid Detoxification is not some miracle drug or procedure. After patient goes through this procedure, he/she will have to continue battling their addiction. It doesn't just go away after this procedure. This is where AA/NA meetings, counseling/therapy, and changing your surroundings and people around you are critical. Just like some Suboxone/Methadone/Vivitrol and rehabilitation centers, some clinics that offer ROD may try to lure you to give ROD a shot with statements of high success rates and an answer to your problems. These places, after all, are businesses and have a product/service they are trying to sell. Remember that. I'm not trying to knock any of these things as they can certainly help someone but you must remember that they are only a tool in your battle against addiction. Think of them a weapon on the battle field. You are battling addiction and have at your hands a variety of weapons. These weapons can include AA/NA meetings, sober networks, coping skills/mechanisms, and opiate replacement therapy drugs such as Suboxone or Methadone. However at the end of the day, it is not the weapons that are on the battlefield that wins (or loses) the war, it is people who are fighting on it that do.

    There are a lot of different answers and numbers out there in regards to the effectiveness and success rate of Rapid Opioid Detoxification. Some will claim close to a 100% success while others will be as low as 20-30%. Unfortunately for addicts, most (but not all!) will fail their first (or few) times of trying to get clean. My addiction consular always told me that relapse is part of recovery but that just because it's part of it doesn't mean it has to be. Meatballs can be a part of a spaghetti diner but you don't have to eat them, you can simply eat around them or not put them on your plate and you'll still have your spaghetti. While this metaphor may sound silly at first, if you take a moment to think about it, it is a great comparison for the tools we can use to achieve sobriety.

    I don't really have an answer for you guys about how effective or successful this procedure is other than what I just have stated previously. There are articles out there about this topic however, and I would like to provide you guys with them. After reading through a couple of them, you'll probably get what I'm saying about how there isn't really a clear-cut answer about how effective or successful ROD is or can be. Here are some of these articles below:

    My Final Thoughts On Rapid Opioid Detoxification
    When I first heard of the Rapid Opioid Detoxification, I was really interested and curious about the procedure. When I heard that you could simply "sleep" through the withdrawals and wake up feeling almost "normal", I simply couldn't believe what I was hearing. It seemed to good to be true. After doing my own research, I began to learn exactly what the procedure was, what it was about, how it worked, and much more information. Yet here I am today, still somewhat puzzled about it.
    I haven't met or talked to anyone who has undergone the procedure or who knows someone who has. I have never undergone it myself and probably never will as it seems far to expensive for my case and I am a little bit concerned about the potential risks that come along with the procedure. If you asked me if I would ever consider getting this procedure, I would answer truthfully with a no. Between the costs, risks, and uncertainty of the procedure, I feel I wouldn't be comfortable enough going through with it.
    However, I really do believe there is a lot of promise for a procedure such as this and I think it shows how far the addiction community has come in treating those who suffer from this disease.


    1. Accelerated opiate detoxification has a long history dating back more than 40 years having been researched and advanced by many doctors worldwide. In the mid 1970’s, the use of opiate receptor antagonists was first described. (Blackley 1975, Resnick 1977) Opiate receptor antagonists such as naloxone and naltrexone competitively bind with opiate receptors in the brain, blocking the ability of opiates to have any effect, and inhibiting opiate craving. In the 1990’s investigators combined naltrexone, a long-acting opiate receptor antagonist, with clonidine, an alpha 2-agonist, which suppresses the noradrenergic hyperactivity associated with opiate withdrawal, and with other medications to shorten the duration of the symptoms of withdrawal. (O’Connor 1992) However, even with pharmacologic agents used to manage withdrawal symptoms, there is a significant dropout rate from inpatient detox due to discomfort, as high as 30% (Scherbaum et al, 1998).

      Various protocols of “Rapid” or “Ultra Rapid” opiate detoxification (ROD or UROD) have been developed since 1988 when Loimer reported his “Ultra Rapid” technique of detoxification under anesthesia to rapidly induce detoxification while blocking the severe symptoms of opiate withdrawal. 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, withdrawal is minimal, and craving is limited. Oral naltrexone maintenance can be initiated immediately and continued to reduce the risk of relapse. In 1992, Dr. Juan Jose Legarda from Spain developed a form of ultra rapid opiate detoxification (UROD) using general anesthesia to transition patients to naltrexone (a long-acting antagonist).

      Several different methods of rapid detox under anesthesia have been described and reported. (Cook 1998, De Giacomo 1999, Greenberg 2000, Loimer 1990, Legarda 1994, Pfab 1996, Scherbaum 1998, Cucchia 1998, Gold 1999, Bell 1999, Umbricht 1999, Kienbaum 2000, Hensel 2000, Elman 2001, Chutuape 2001, Collins 2005) There is to date no uniformly accepted and practiced method, and several reports of complications occurring in centers in which appropriate monitoring was not provided, or where patients with underlying risk factors were included, have led to a great deal of controversy surrounding the practice of the procedure at all.

    2. You should fix the information above. Rapid Detox has decades of existence and it has nothing to do with the Israeli doctor Dr. Waismann. He got trained by his partner Dr.Legarda that was already practicing rapid detox.

    3. Your kidney plays an important role in detoxification. Find out a couple of tips on what you can do for a detox diet that aids in good kidney health.