Heroin: the ultrafast withdrawal under general anesthesia should be abandoned

General anesthesia has no place in the heroin withdrawal, U.S. researchers concluded that compared three methods of treatment of addiction to the drug in a study published in the "Journal of the American Medical Association."
The heroin withdrawal under medical supervision is accompanied by a high failure rate, including patients fear the physical effects and therefore avoid preferring to submit to or leaving early. Even patients who complete treatment have a high relapse rate, in part due to the lack of continuity in the monitoring.

These problems have resulted, there are fifteen years to develop a program of weaning ultrafast under general anesthesia with administration of an opioid antagonist to neutralize the effects of heroin when the patient is unconscious in the effect of general anesthesia.

This treatment is expensive, however, it is not covered by health insurance in the United States and especially suffers from a lack of evidence of its effectiveness. Some experts also fear its effects on health.

Eric D. Collins and his colleagues at Columbia University in New York conducted a study between 2000 and 2003 to evaluate the safety, tolerability and efficacy of this approach by comparing it to two other methods of weaning hospital.

One hundred (106) patients addicted to heroin were involved in this work. They were divided into three groups: in the first, the patients underwent the withdrawal method by induction of general anesthesia with a preventive-based naltrexone treatment in the second, it was a technique of rapid withdrawal be a substitute for opioids (buprenorphine), followed by the induction of a preventive basis of naltrexone treatment in the past, doctors have applied clonidine treatment (antihypertensive reducing withdrawal symptoms), followed by the delayed induction of preventive treatment with naltrexone.

The severity of withdrawal symptoms was similar for all three methods of weaning, the authors report. Compared to the technology-based antihypertensive treatment, the other two methods of weaning were followed by a higher rate of adherence to basic preventive naltrexone outpatient treatment (94% for anesthesia, 97% buprenorphine and 21 % for clonidine). However, weaning hospital was followed with the same seriousness, whatever the method.

By the third week, half of the patients in each group had discontinued treatment. At the end of follow-up, they were no more than 20% in the anesthesia group, 24% in the buprenorphine group and 9% in the clonidine group to continue.

Only the withdrawal under anesthesia was associated with three potentially dangerous side effects: severe pulmonary edema and aspiration pneumonia, diabetic ketoacidosis, and a mixed bipolar disorder requiring hospitalization.

"Our findings suggest that general anesthesia is not its role in the treatment of opioid dependence," the authors conclude.