TUESDAY, Aug. 23, 2005 (HealthDay News) -- Offered at upscale private clinics, heroin-addiction detoxification using general anesthesia-- where patients are rendered unconscious during initial treatment -- can cost upward of $15,000.
But the most rigorous study of its kind to date finds the therapy provides no added benefit in terms of helping patients kick their habit. And it entails significant risks for serious complications and death, the researchers said.
General anesthesia-assisted "detox" may not even spare most users the worst withdrawal symptoms, said lead researcher Dr. Eric D. Collins of Columbia University in New York City.
"The fantasy is, 'If I'm out of it -- in the way that I don't feel surgery or incision pain when I'm under general anesthesia -- I'm certainly not going to feel withdrawal,' " he said. "And that's true for the [four-to-six-hour] duration of anesthesia. But what our study showed was that in the several days following the anesthesia procedure, everyone has fairly significant withdrawal -- comparable to patients treated by other means, without anesthesia."
The research appears in the Aug. 24/31 issue of the Journal of the American Medical Association.
Federal government statistics released in 2003 found that almost 4 million Americans have said they've tried heroin at least once, while almost 12 million respondents admitted to using a prescription narcotic in a "nonmedicinal" way.
Beginning in the mid-1990s, private clinics across the United States began offering anesthesia-assisted detoxification for patients addicted to opioids such as heroin, or prescription painkillers such as Oxycontin, Vicodin and Percocet.
Heroin detoxification typically begins with the immediate or delayed administration of a powerful opioid-antagonist drug, naltrexone, which quickly shuts down the brain's response to heroin. According to Collins, naltrexone therapy induces painful withdrawal symptoms that can either keep addicts from seeking detoxification in the first place, or encourage relapse once these symptoms appear.
General anesthesia's allure is in helping patients escape those initial symptoms, at least for a few hours. But studies to date have failed to offer convincing evidence that this expensive treatment works any better than conventional detoxification at keeping addicts from long-term relapse.
In the Columbia University study, 106 heroin addicts actively seeking treatment received one of three detox therapies over a 72-hour period: anesthesia-assisted, rapidly administered naltrexone therapy; rapid naltrexone therapy aided by a methadone-like drug, buprenorphine; and delayed naltrexone given with symptom-reducing clonidine, an anti-hypertensive drug.
All participants were also offered 12 weeks of follow-up naltrexone "maintenance" treatment and psychotherapy as part of ongoing care.
According to the researchers, all three groups stuck to therapy about the same amount of time -- an average of about two-and-a-half weeks. As observed in previous studies, most patients also relapsed back into drug use: only 11 percent of the participants were able to provide researchers with opioid-free urine samples 12 weeks after treatment. That rate was similar across the three groups, the researchers noted.
Two of the therapies -- general anesthesia-assisted rapid naltrexone and buprenorphine-assisted rapid naltrexone -- were more than 90 percent effective in getting patients to take the full dose of naltrexone considered essential to any hope of success, the researchers said.
But general anesthesia had one important downside -- safety risks.
"There have been at least 10 deaths in the U.S. linked to this treatment, and many deaths may not be getting reported," Collins said. Many of the deaths are linked to pulmonary edema, a dangerous cardiovascular threat involving fluid build-up in the lungs, he added.
Collins said most patients using general anesthesia are still vulnerable to withdrawal-related discomfort, as well. The therapy does allow patients to get a quick dose of opioid-blocking naltrexone, he said, "and that means that after you leave the anesthesia suite, you couldn't get high on heroin. The problem is that you could the next day, and our data shows that these patients are uncomfortable enough to want to."
The bottom line? "If the goal is to induce naltrexone pretty rapidly, we can do it with at least as much comfort, with greater safety and at much less cost using buprenorphine-assisted detox," compared to general anesthesia, Collins said.
While praising the study's rigor, Dr. Patrick G. O'Connor, chief of general internal medicine at Yale Medical School, said the real hope for the nation's estimated 1 million heroin addicts lies not in detoxification, but in long-term "maintenance" therapies that rely on opioid substitutes such as methadone or buprenorphine. These therapies block withdrawal-associated cravings without providing heroin's high -- allowing users to function normally and leave the world of dealers and needles behind, he said.
"When you look at patients who are chronically relapsing opioid drug users, the likelihood of detox helping is exceedingly low," said O'Connor, the author of an accompanying editorial in the journal. "Maintenance is really the only way to go."
In fact, one recent study found that 75 percent of addicts resumed normal, productive lives with the help of chronic buprenorphine maintenance therapy over the course of one year. By comparison, not one participant who completed a standard six-day detox program was able to do so.
"Detox is probably attractive to people outside the field," said Richard Hawks, deputy director of the National Institute on Drug Abuse's division of pharmacotherapies and dedical consequences of drug abuse, which funded Collin's study.
"Detox implies that you take an addict and clean them up, then they're on their own and they're supposed to stay that way," Hawks said. "But what people don't appreciate is that in most cases, there's chronic relapsing into dependency. That means [addiction] is something you have to deal with on a chronic basis, not something you fix once and the person's fine."
O'Connor agreed, stressing that heroin addiction is simply an illness like many others -- one that will usually require chronic therapy, just as diabetics require daily insulin.
"It fits the chronic disease model that we're all quite comfortable with -- diseases like asthma, diabetes, lung disease," he said. "It's the same thing, and needs to be look upon as such."
More information
To learn more about heroin and heroin addiction, head to the National Institute on Drug Abuse.
