STATS ARTICLES 2004

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Debunking Rapid Detox
December 30, 2004
Maia Szalavitz
Wired hypes unproven and possibly deadly addiction treatment.

Wired joins a long list of major media organizations—from 20/20 to 48 Hours to the Orlando Sentinel—to be drawn in by the unproven promises of “rapid opioid detox.” Even though Wired noted that there are serious concerns about claims that rapid detox enables heroin and other prescription opioid addicts to safely and more effectively withdraw from drug use than other methods, the article failed to tell readers that promoters of rapid detox can’t even prove one of their main selling points for the process – better relief of withdrawal pain.

Instead, Wired called rapid detox “a useful treatment that can seem like a miracle cure,” adding that “for addicts who cannot make it through withdrawal any other way, the $3,000 - $5,000 procedure may be their only hope.” The article also quoted an addiction doctor who “claims [that rapid detox] is one of the most innovative developments in the field since the advent of the 12 step program in the 1930’s.”

Proponents of rapid detox claim that they can put an opioid addict to sleep with anesthesia, pump him full of opioid-blocking drugs, and that upon waking he will suffer no withdrawal symptoms.

But given the inflated claims Wired documented the program making in other areas, the magazine’s loss of skepticism about the treatment is inexplicable. For one, though promoters claim a 65 percent recovery rate after one year (compared to 30-40 percent for other treatments), controlled research doesn’t support this: The largest NIDA-funded study found that after three months, the number of addicts who were clean after rapid detox was no greater than that produced by other methods.

Claims made about the safety of rapid detox are also problematic. While normal detox programs are unpleasant, they are not deadly. About a dozen deaths are known to be associated with complications from rapid detox; seven of those, as Wired noted, occurring under one (still practicing) New Jersey doctor. While these deaths appear to be related to a lack of proper monitoring of patients under anesthesia and immediately following it (the known deaths followed outpatient, not hospital-based, treatment), there’s another risk associated with the procedure that Wired failed to mention.

Rapid detox involves giving large doses of opioid-blocking drugs, including a follow-up prescription for one particular drug called naltrexone, which is to be taken for several months afterwards. This is to prevent any new use of opioids from producing a high and to reduce craving for such drugs.

But Australian researchers have found the rates of overdose death rates increased among heroin addicts who ended naltrexone treatment, compared to those who quit treatment with methadone or buprenorphine. The reason is that naltrexone reduces patients’ tolerances for opioids so that when they stop taking it, they are at far greater risk of death if they relapse and take the doses they once consumed without problem.

In the Australian study of over 1,200 patients, the overdose rate was eight times higher among former naltrexone patients, compared to former methadone or buprenorphine patients. Wired didn’t include this information.

The magazine did note, however, that many rapid detox programs simply provide the detox, a few follow-up phone calls and a naltrexone prescription – exactly the situation in which such overdoses are likely to go unprevented and undetected.

Some rapid detox programs also implant naltrexone under the skin to ensure that addicts won’t skip doses—but some addicts find this so unpleasant that they’ve literally cut the implants out themselves rather than continue the treatment. Naltrexone can also cause extreme anxiety in certain patients.

While studies find naltrexone to be well-tolerated and effective for treating alcohol problems, it seems far less helpful to opioid addicts. A 2002 study, for example, found that only 19 percent of heroin addicts completed a six-month course of naltrexone treatment which had been especially designed to encourage them to take the medicine faithfully. This does not suggest that most opioid addicts find the drug helpful—nor that a procedure involving taking it orally with no support would be particularly effective.

In terms of comfort, rapid detox proponents claim that because opioid-blockers are administered in high doses while the patient is sedated, the withdrawal period is shortened because the receptors are stripped of opioids, then blocked.

But there is little evidence to support the idea that simply stripping and blocking these receptors makes the brain return to normal faster. And there are many rapid detox patients who claim that after waking from anesthesia, they actually suffered more intense and difficult withdrawal periods than they had when they used other detox methods. Without controlled research, it’s impossible to know if comfort or extra pain is more common—and for whom.

Without further research, and as presently conducted, the media should not be using words like “miracle” in association with rapid detox. If it could be proven more comfortable for addicts—even if it had added safety risks and no added advantage in efficacy—that would be a reason to offer it: It could draw people into treatment, who might otherwise die on the street. But if the programs can’t even prove they are more comfortable than other forms of detox, why add the risks and the high cost?

Sadly, I have to close this article with the same cautionary quote I used when I wrote about rapid detox for Newsday in 1996—because research still hasn’t answered the key questions and the media still doesn’t get that claims about extra comfort are as suspect as other claims made for the treatment.

Herbert Kleber, director of the division of substance abuse at Columbia University School of Medicine, is also a former deputy drug czar. It was his work that showed that rapid detox didn’t actually improve long term outcomes. He wrote this back in 1982, and just like in 1996, it’s just as true today:

“The history of the treatment of narcotic withdrawal is a long and dishonorable one. The trail is strewn with cures enthusiastically received and then quietly discarded when they turned out to be relatively ineffective or even worse, productive of greater morbidity and mortality… Any claim for a new method should be put forward modestly and viewed with skepticism until amply documented by careful experimental procedures.”

We’re still waiting for the rapid detox data, and Wired should have known that if a program’s claims of safety and efficacy are exaggerated, the same might be true about its claims of comfort.

 


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