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Heroin Rapid Detox

For many people, the first step to quitting heroin is enrolling in a detox program. Detox programs vary, and some may use methods such as rapid detox and ultra rapid detox. These are procedures where the person is given a medication to bring on withdrawal and then given other drugs to treat the symptoms. In the case of ultra rapid detox, they are heavily sedated or placed into a state similar to being put under via general anesthesia prior to surgery.

These procedures are not covered by insurance companies, so the cost is quite high. They can also be unsafe from a medical and psychological standpoint.

People considering rapid detox procedures should be aware of the risks in pursuing them, as well as the other options available for detox. They should also be aware that detox does not actually treat an addiction, so people who undergo detox should consider further treatment.

Why Do You Need Detox?

Although heroin withdrawal is not life-threatening, people going through it are likely to experience some uncomfortable symptoms. Detox programs provide support, monitoring, and specific medications to help people remain as safe and comfortable as possible while they withdraw from heroin.

Heroin user about to use
Some of the symptoms a person may experience during heroin withdrawal include:1

  • Dysphoric mood, i.e., feeling unhappy and dissatisfied.
  • Insomnia.
  • Yawning.
  • Muscle aches and pains.
  • Nausea or vomiting.
  • Diarrhea
  • Fever
  • Sweating
  • Teary eyes.
  • Runny nose.
  • Dilated pupils.
  • Goosebumps.

Most people begin to experience these symptoms within 6–12 hours of their last heroin use. The symptoms tend to peak within 1–3 days and then subside over the following 5–7 days. However, some symptoms, such as anxiety and insomnia, may persist for months.1

What Is Rapid Detoxification?

Rapid detox was developed in the 1980s. Its goals were to shorten the length of hospitalization of people undergoing withdrawal and to start them on a course of naltrexone, a medication that  blocks the effects of other opioids.2

During rapid detox, the person receives gradually increasing doses of naltrexone, which initiates withdrawal. They may also receive other detox medications, such as clonidine, to help treat withdrawal symptoms. They may be moderately sedated; however, the person is awake and able to communicate with the doctor throughout the process.2,5

Although rapid detox has been studied in clinical research, it is not widely accepted by addiction treatment professionals or their patients. The reasons for this are unclear, but may have to do with the rapid onset and intensity of symptoms.2

Understanding Ultra Rapid Detoxification

Ultra rapid opioid detoxification (UROD), sometimes referred to as anesthesia-assisted rapid opioid detoxification (AAROD), is similar to rapid detox but involves anesthesia. The person receives an opioid antagonist to induce withdrawal, as well as a sedative/anesthetic, which keeps them unconscious throughout the process. They also may be given medications such as clonidine or antiemetics to manage symptoms.2,3

In theory, because the person is under anesthesia, they are not conscious of the withdrawal symptoms. People who do not want to experience the pain of withdrawal may find this appealing.2

However, UROD is not a standardized procedure. Many factors can affect the safety of the procedure, such as when the person last used heroin, the anesthetics used, the level of sedation and respiratory support, the doses of and clinical response to the opioid antagonist, and other factors that can vary from person to person. In addition, the full duration of withdrawal with UROD remains difficult to gauge because people are given various medications for weeks afterward that can mask symptoms.2

Concerns With Rapid Heroin Detox

For anyone who has been through the uncomfortable experience of heroin withdrawal—or is considering the prospect of it for the first time—the idea of bypassing all of it and waking up without symptoms is extremely seductive. Being sick from withdrawal often keeps the user trapped in the cycle of addiction. Rapid detox is designed to get the person past this stage of misery and avoid withdrawal completely.

However, despite these apparent advantages, there are several concerns with the rapid detox approach.

  • The New York City Department of Health and Mental Hygiene (DOHMH) was notified in 2012 that 3 people experienced complications and required hospitalization after undergoing UROD at a specific clinic, and 1 of these people died. After this event, DOHMH performed a further investigation and found that 2 people had died and 5 had experienced complications after undergoing UROD at this clinic.3
  • A 2006 National Institute on Drug Abuse (NIDA) trial found that people who woke up after UROD experienced symptoms similar to people who had undergone traditional detox involving buprenorphine and clonidine. Of the patients in the UROD group, 3 experienced complications, including pulmonary and psychiatric complications and a metabolic complication of diabetes. These complications were related to pre-existing conditions the patients didn’t reveal before the study. The study authors found no advantage to UROD and reported that risks of UROD can include “fluid accumulation in the lungs, metabolic complications of diabetes, and a worsening of underlying bipolar illness, as well as other potentially serious adverse events.”4
  • The California Society of Addition Medicine (CSAM) reports that people who undergo UROD continue to experience withdrawal symptoms for days after the acute phase has ended, stating, “there is no reason to believe that a patient’s withdrawal is complete when they wake up from anesthesia.” CSAM also found that UROD is no better at preventing relapse than traditional detox methods.2
  • In a policy statement, the American Society of Addiction Medicine (ASAM) concluded that UROD has uncertain risks and benefits, and its use in clinical settings is not supported. It is their opinion that more research is needed to fully evaluate both methods.5

In addition, it is possible that because those who go through ultra rapid detox theoretically do not suffer any withdrawal symptoms, they may have less incentive to stay clean and avoid future detox than someone who completed a regular detox and felt the full effects of it—which could make them less willing to go back to using again.

Depressed patient with doctor

For all of these reasons, seeking medical detox treatment at a rehab center or a standalone facility is generally considered the safest approach. These more standard detox options are often more affordable and more likely to be covered by insurance. Based on specific needs, a person may receive opioid medications such as methadone or buprenorphine that can help to reduce both withdrawal symptoms and cravings. Keep in mind, however, that these medications do not make the process any faster.

Once a person completes detox, it is advisable to engage in counseling or an addiction treatment program to learn relapse prevention skills and uncover any underlying psychological or mental health problems that can trigger heroin use in the future. Recovery requires effort and patience, and it continues far beyond the withdrawal phase.

Heroin addiction doesn’t have to control your life. If you or someone you care about is struggling with a heroin addiction, please reach out for help today.

Sources

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Karan, L. & Martin, J. Anesthesia-Assisted Rapid Opioid Detoxification. California Society of Addiction Medicine.
  3. Centers for Disease Control and Prevention. (2013). Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012.
  4. National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox.
  5. American Society of Addiction Medicine. (2005). Rapid and Ultra Rapid Opioid Detoxification

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