Buprenorphine Treatment for Opiate Addiction-2017

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UROD -Ultra-Rapid Opioid Detox

Anesthesia-assisted chemical detoxification - Rapid Detox


Background: Ultra-rapid-opioid-detox is an expensive procedure commonly carried out in a hospital's ICU. The patient is injected with very high doses of an opiate antagonist (naloxone) under general anesthesia or heavy sedation followed by a slow infusion of naloxone. Proponents of the procedure claim "...complete accelerated detoxification is attained, the patient experiences no withdrawal symptoms, physical dependency is eliminated, and the psychological craving for drugs is greatly reduced..." However, medical experts disagree. Some have called it malpractice and a fraud. In a comprehensive study published in the prestigious Journal of the American Medical Association (JAMA) in 2005 the scientists say, "Rapid opioid detoxification with opioid antagonist induction using general anesthesia has emerged as an expensive, potentially dangerous, unproven approach to treat opioid dependence." and they concluded "Anesthesia-assisted detoxification should have no significant role in the treatment of opioid dependence" - Read the study1,2

The problem with ultra-rapid detox

When we look at the available evidence and consider this method in the context of what we now know about addiction, there should be no expectation of success with this method in the first place.1

We now understand addiction as long-lasting adaptations of the brain some associated with memory. Naloxone infusions, or any other concoction for that matter, is not known, or suspected, to reverse these profound brain changes. Therefore there should be no expectation that the underlying causes of addiction would be altered, let alone corrected, with such methods. Instead, the brain alterations of addiction would still remain despite a decrease in tolerance. So what we should expect to see from this procedure is exactly what we do see, a diminution in tolerance and a return of cravings soon after, which in most cases leads to relapse.1

Beware

There is also a danger associated with this method that the patient may not be aware of. This danger is in addition to the risks associated with general anesthesia. A quick reduction in tolerance increases the risk of fatal overdose. Patients leave treatment with a greater sensitivity to opioids than they had prior to the treatment. A relapse to the dose they were accustomed to could become a fatal overdose post treatment.1

If you look closely at the websites of the peddlers of this method, you'll see no evidence that they possess an understanding of addiction consistent with the current body of evidence. They make no distinction between physical dependence and addiction, treating the two identically often using the term dependence interchangeably. This deception, intentional or not, is essential to make the case in favor of the method. Victims need to be distracted and focused on withdrawal symptoms and not the underlying cause of the cravings (which is the actual addiction). As we know withdrawal is a symptom of physical dependence not addiction and resolved with a slow taper, no need for a $20,000 dangerous procedure.1

Why do some people say it works?

If your focus is solely on withdrawal and not addiction, and assuming you survive the procedure, it may appear to work, as theoretically the painful withdrawal syndrome that accompanies the decrease in tolerance occurs while under anesthesia. You may not experience as much acute withdrawal as you may have otherwise, had you just stopped abruptly on your own. Likewise, the cumulative discomfort of a long taper may also be more uncomfortable, in total, than under anesthesia. But all of this is beside the point and a distraction, because addiction treatment isn't about the withdrawal symptoms it's about the cravings and what cause them. Some addictions such as crack and methamphetamines have little apparent withdrawal syndrome, but are still devastating addictions. There is no quality of life in a continuous detox/relapse cycle, especially if you're down $20K each lap.1

After the procedure, patients are told, "OK the drugs are out of your system it's all up to you now..." But without correcting the source of the cravings, cravings return, and in most cases prompt a relapse. Patients feel guilty and believe they've failed, but what many don't realize is the addiction, the brain adaptations, were there all along, and remain. The procedure did nothing to correct them. The return of cravings was all but inevitable. Some feel they just didn't have enough will power or didn't try hard enough and tragically don't find fault in the method, and pay for another round.1

But suppose someone who was not addicted but only physically dependent was talked into the method, how would they fare? Well, for them it could be an expensive success, again assuming they survived the procedure. Since they never possessed the craving-causing brain adaptations of addiction, the adaptations weren't present post procedure either to cause cravings. Of course since such folks were not addicted they could have simply tapered off of the opioids they were on saving the $20k. You can see here that by not distinguishing between physical dependence and addiction, other factors like the patient's will power, drive or determination can be blamed for the failures and used to explain the illusion of a success.1

Summary: Addicted people who undergo UROD will likely relapse soon after since the underlying problem has not been addressed by the procedure. Physically dependent people who undergo UROD will have accomplished little more than if they initiated their own taper. Convincing victims that physical dependence is the disease (as opposed to addiction) is the tactic of the UROD pusher.1


References:
  1. National Alliance of Advocates for Buprenorphine Treatment- www.NAABT.org
  2. Rapid-detox - UROD- Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction - Eric D. Collins, MD; Herbert D. Kleber, MD; Robert A. Whittington, MD; Nicole E. Heitler, MA - Study

Notes:

  1. Brand names for buprenorphine/naloxone (bup/nx)

    combination products in the US:
    Suboxone Film
    ,
    Zubsolv
    ,
    Bunavail
    , and generic equivalents of the discontinued Suboxone Sublingual Tablets.
  2. Buprenorphine products in the US WITHOUT the added naloxone

    safeguard:
    1. Subutex Tablets
      (
      discontinued in 2009
      ) but the
      generic equivalents remain available
      .
    2. Buprenex®
      is an injectable,
      FDA approved for pain
      NOT addiction -
      illegal to prescribe for opioid addiction
      .
    3. Butrans®
      Patch, also
      FDA approved for pain
      and NOT addiction -
      illegal to prescribe for opioid addiction
      .
    4. Pharmacy-compounded bup or bup/nx
      preparations - NOT FDA approved for addiction -
      illegal to prescribe for opioid addiction
      .
  3. Probuphine®
    is an insertable
    buprenorphine rod
    which goes under the skin and releases bup over the course of 6 months. It
    was FDA approved in May of 2016
    , and is for the treatment of addiction.
  4. Belbuca™
    is a
    buprenorphine film
    which goes on the inside of the cheak. It
    was FDA approved in October of 2015
    , and is for the treatment of pain - NOT FDA approved for addiction -
    illegal to prescribe for opioid addiction
    .
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Disclaimer:

  1. Nothing on this site should be confused for medical advice. The information provided here should only serve to inspire you to find out more from credible sources. We hope to help you understand the disease better so that you know what questions to ask your doctor. Never take any online medical advice over that of a healthcare professional, assume it's all made up. Despite the links to peer reviewed studies all interpretations of said studies may be opinion, unreliable or erroneous. If some patients found something beneficial to them it's not an indication that it will be beneficial to you, on the contrary, it may be dangerous. You, not us, are responsible for what you do with the information you get from this site or any site.

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