Heroin Detox Using Anesthesia Limited and Risky, Study Says

Using general anesthesia to help detoxify heroin addicts is no more effective than other treatments and potentially much more dangerous, says a study to be published today by Columbia University researchers.

The method -- going by names such as “rapid detox” and “detox in a day” -- has been promoted as a quick and easy way to relieve the stress and pain of withdrawal from heroin as well as from more easily accessible opiates, such as Vicodin and OxyContin.

Dr. Eric D. Collins, an assistant professor of psychiatry at Columbia, studied 106 addicts, who were divided into three groups.

One group was put under general anesthesia for about five hours and given a high dose of naltrexone, a drug used to neutralize heroin’s effects. Another was given a heroin substitute called buprenorphine and eased onto naltrexone. A third group was given the antihypertensive clonidine, which lessens withdrawal symptoms.

All patients were then offered 12 weeks of additional naltrexone therapy and psychotherapy designed to prevent a relapse into heroin use.

None of the methods was very successful.

The results showed high relapse rates, with 11% of the patients finishing treatment and providing no more than two heroin-positive urine samples.

Three patients who underwent general anesthesia nearly died.

One suffered a severe buildup of fluid in the lungs and pneumonia, and another developed dangerously high blood sugar levels. A third patient entered a bipolar mental state that required hospitalization. All of the incidents were related to the use of general anesthesia.

The benefits of the method “were limited to the few hours when patients were under general anesthesia, and they came with risks that should be intolerable,” said Collins, lead author of the study, to be published in the Journal of the American Medical Assn.

Jake Epperly, clinical director of the Midwest Rapid Opiate Detox Center, which has clinics nationwide, disputed the study’s findings, saying the Columbia physicians were inexperienced with using general anesthesia as a detoxification method.

“Our anesthesiologists have done 400 or 500 procedures on average,” he said. “Experience is everything.”

In an editorial accompanying the study, Dr. Patrick G. O’Connor, a professor at the Yale School of Medicine, said the low success rate with the three methods showed that the best therapy still was weaning patients through long-term use of a heroin substitute, such as methadone.

Such treatment is prohibited in many California counties, including Fresno, Kern and Sacramento, where maintenance is seen as another kind of drug dependency.