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Anesthesia-Assisted Opioid Detoxification (Rapid Opiate Detox)

Joseph Sitarik, DO

Medically reviewed by

Joseph Sitarik, DO

February 19, 2019

Anesthesia-assisted opioid detoxification (AAROD) is a controversial method used within some treatment centers to facilitate a quicker detox process. This method is debated due to questionable levels of success, a costly price tag, numerous variables, and various purported risks, the most serious of which is death.

As the heroin and opioid epidemic rages across our country, more and more individuals are striving to discern the best path to treatment. In a society where convenience and a sense of immediacy often reign supreme, it is no surprise then, that many individuals seek to bypass the typical duration and symptoms of more traditional detoxification methods, by instead choosing a faster alternative. In this rush towards “wellness,” far too many of these individuals may overlook the reality behind these claims of a “quick fix.”

Why Do Individuals Seek This Form Of Detox?

The California Society of Addiction Medicine (CSAM) offers us a rather succinct explanation of why patients may desire this treatment, asserting “Anesthesia-assisted rapid opiate detoxification appeals to patients who want a ‘magic bullet’ to treat their addiction. Patients do not wish to feel the pain of withdrawal. Rather they want to go to sleep and ‘wake up clean.’” They continue to say that this method of treatment is portrayed by those who offer it to cater to “patient’s unrealistic expectations.” What then can you expect?

What Does A Patient Undergo In AAROD?

As referenced from an explanation of anesthesia-assisted opioid detoxification procedures by a CDC report pertaining to a New York Clinic using these methods (a clinic that did, in fact, have adverse effects detailed below), a patient undergoing AAROD will experience the following procedural steps:

  1. Clinical staff administers various medications, such as clonidine, antiemetics (a drug used to treat nausea and/or vomiting), and antidiarrheal meds, in order to temper the symptoms of withdrawal.
  2. Patient is intubated and general anesthesia begins
  3. “Precipitation of opioid withdrawal by intravenous infusion of high doses of the opioid antagonist naloxone or intramuscular injection of naltrexone”
  4. Staff continues to monitor patient, while keeping them under heavy sedation, until they feel withdrawal has waned.
  5. Patient is extubated and held overnight to recover and ensure there are no complications.

This process typically lasts six to eight hours. When withdrawal is precipitated, or essentially forced to commence, certain symptoms arise, as explained by CASA, including “hypertension, tachycardia, vomiting and diarrhea.” The purpose, then, of AAROD is allowing a patient to avoid these sometimes intense and uncomfortable feelings; despite this, CASA note that many continue to experience “severe symptoms for several days after the procedure.”

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A Process With Numerous Variables

The California Society of Addiction Medicine cautions that this procedure may be dictated or altered by several factors that may have the capacity to impact a patient’s safety and also the overall efficacy of the procedure. They assert that this “is not a standardized procedure,” instead, noting that it has the following variables:

  • When the patient last used the opioid drug
  • To what extent a patient is sedated
  • The measure of respiratory support a patient receives
  • The particular antagonist drug, or specific combination of several, they suggest these may include: narcan, naltrexone, and/or nalmefene.
  • The amount of these drugs that are used
  • The means of administering these drugs (i.e. NG tube versus IV)
  • How long this procedure lasts for
  • How carefully monitored and observed the patient is after this process

As cautioned by CASA and other sources, only patients experiencing good health should be considered for this procedure. The presence of other comorbid medical conditions may further complicate the procedure and create adverse reactions.

What Are The Risks Of AAROD?

In comparison to other forms of detoxification, CASA makes a compelling point—AAROD includes two factors that are not involved in the alternative forms of detox, anesthesia and precipitated withdrawal, both of which they note are associated with risks. Overall, various cardiac concerns have been correlated to this procedure, including pulmonary distress, pulmonary edema, and ventricular bigeminy, as reported by a JAMA Network study that compared AAROD to other forms of detox. CASA notes further concerns in this area, writing that research has documented a significant flux in the production of epinephrine (also called adrenalin) within the body, these heightened levels in turn stimulating the cardiovascular system.

In addition, other documented and reported side effects, risks, and physiological changes include:

  • Sweating
  • Muscle aches
  • Nausea, diarrhea, and/or abdominal cramping
  • QT prolongation (a syndrome that may cause an arrhythmia or irregular heartbeat)
  • Tachypnea (an abnormal state of rapid breathing)
  • An escalated metabolic state and increased muscle activity
  • Thyroid suppression
  • Respiratory distress
  • Acute renal failure
  • Psychosis
  • Delirium
  • Attempted suicide
  • Fatality

We strongly urge you to consider these risks against those of other detox methods, before you make a decision.

Risk Of Fatality Associated With This Form Of Detox

There are numerous reports of fatalities associated with this procedure. The CDC issued a report detailing not only severe adverse health effects, but deaths, linked to the aforementioned New York City clinic. Of 75 total patients that received this treatment, two died and five were hospitalized due to serious side effects of this procedure; all were men. Because of this, the New York State Department of Health, the New York Office of Alcoholism and Substance Abuse Services, and the New York City Department of Health and Mental Hygiene issued a joint-statement urging detox care providers to “avoid use of AAROD in favor of evidence-based options for opioid dependence treatment.”

Is This Method Successful?

While results are mixed, typically, research illustrates that in the long term, this method does not offer more substantial results for abstinence or treatment retention; many times these numbers are similar, begging us to ask if it is worth the risk. While one study notes that at the onset, in comparison to methadone-tapering, this method looks good, the favorable results decrease over time. Specifically, at one to two months, this procedure offered increased abstinence rates and decreased symptoms of withdrawal; however, at the three-month mark, the difference was “not significant.” The same study also cites comparisons on findings on abstinence between this method and 30-day inpatient detoxification at the 12 and 18-month interval marks, writing that the former method yielded only a 22 percent rate of abstinence, whereas, the latter was almost double, at 42 percent.

A second study, “Rapid Opioid Detoxification during General Anesthesia: A Review of 20 Patients,” published by journal Anesthesiology, details findings on the study participant’s intensity of withdrawal symptoms, as determined by The Clinical Institute Narcotic Assessment (CINA) Scale, which measures 11 criteria of withdrawal symptoms. What they found is this: one patient had moderate to severe withdrawal, with a CINA score of 12 out of 20; 13 had mild symptoms with CINA scores of one to four, and six individuals exhibited no criteria for withdrawal. Patients experiencing discomfort required additional medications to reduce withdrawal symptoms.

This study asserts that long-term abstinence rates are considerably close to those of other detox treatments. At the time of the study’s publication, only three participants had maintained abstinence since treatment, four had relapsed, then returned to sobriety; four had relapsed back to current drug use, and one experienced an overdose-related fatality. It is worth noting too, that one individual actually died on the second day after the procedure, which researchers equate to a possible risk; however, this was not conclusive as an autopsy was not allowed.

Research Asserts “No Compelling Reason” To Use This Method

The National Institute on Drug Abuse (NIDA) reports on a NIDA-funded clinical trial, that we spoke of before, published by The JAMA Network, which asserts that “Heroin-addicted patients who undergo so-called ultrarapid, anesthesia-assisted detoxification suffer withdrawal symptoms as severe as those endured by patients in detoxification by traditional methods.” Further, researchers “concluded that there is no compelling reason to use general anesthesia in the treatment of opiate dependence, especially as it presents particular safety concerns.” The study examined 106 individuals who desired to detox from heroin, ranging in age from 21 to 50, with a history of daily heroin abuse. Participants were randomly grouped into one of three forms of detox, for a duration of a three day inpatient stay.

According to NIDA, the first group, who received the ultra rapid detox, underwent a four to six hour anesthesia while receiving naltrexone. The second group was awake and received one dose of buprenorphine. The third group was also awake and was administered a combination of clonidine and nonopioid medications as needed. Once the anesthesia wore off, researchers found that “patients in the ultra rapid detox group demonstrated and reported symptoms of discomfort comparable to those experienced by participants receiving the buprenorphine- and clonidine-assisted methods.”

After they left the inpatient phase, 90 percent of the former two study groups completed naltrexone induction, whereas only 21 percent of those who had received clonidine did so. Lastly, though related to preexisting health conditions, three individuals within the anesthesia-assisted group experienced “serious adverse events,” while no individuals had these issues in the other two groups.

The National Institute on Drug Abuse quotes the study’s author, Dr. Collins, who felt this method carried serious risks. He cautions that “Patients should consider the many risks associated with this approach, including fluid accumulation in the lungs, metabolic complications of diabetes, and a worsening of underlying bipolar illness, as well as other potentially serious adverse events.” To add to this, and adding further insight to the study’s findings of adverse effects, NIDA writes that “Those with preexisting medical conditions—including some psychiatric disorders, elevated blood sugar, insulin-dependent diabetes, prior pneumonias, hepatitis, heart disease, and AIDS—are particularly at risk for anesthesia-related adverse events.”

On board with these findings, CASA writes that it “does not support the routine use of Anesthesia Assisted Opioid Detoxification,” instead, detailing that they feel it should only be used in situations surrounding research applications. They also note that any supposed benefits of this detox method do not outweigh the risks.

Detox Is Only The First Step

Some individuals may seek this form of detox in order to expedite the treatment process, by obtaining a sober state more quickly. What many may fail to realize, is that only becoming abstinent from a drug does not beget a recovered state. In fact, true treatment begins after detox ceases. This false perception may lead some to wrongly think that they are not in need of treatment. The Substance Abuse and Mental Health Services Administration’s “Treatment Improvement Protocols” offers an interesting perspective on this, writing that “the desire for rapid opioid detoxification is a remnant of the belief system of a century ago, when detoxification often was erroneously equated with cure.” While detox is important, it is only the first step towards wellness and true sobriety.

Addiction medicine has been transported since this time; over the past century, and even the past decades, numerous impactful treatment modalities have been further honed and developed. Because of this, we strongly urge you to fully consider all of your options, including both detox and treatment. These two components should work together, to ensure the highest spectrum of evidence-based care, and as we’ve detailed today, many research-driven entities do not feel that anesthesia-assisted opioid detoxification safely and effectively fulfills this role.

We Can Help You Find A Successful Way To Detox

There are so many facts to consider when you’re affronted with an addiction. Though the growing body of research on addiction medicine provides better access and understanding to your treatment options, it can also make it confusing. Fortunately, help exists—our highly-trained and insightful staff is up to date on all the best, and most effective, detox and treatment options.

Let help you choose a detox program to begin your transition to a sober life and a treatment program to give you the best chance of a successful recovery. Contact us now.

Centers for Disease Control and Prevention - Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012

National Institute on Drug Abuse - Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox

The JAMA Network - Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction

Anesthesiology - Rapid Opioid Detoxification during General Anesthesia: A Review of 20 Patients

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