By Thomas C. Yee, MD
November 3rd, 2009
Board-Certified Anesthesiologist (1994) and Board-Certified Pain Management (1997)
Las Vegas Rapid Detox Medical Clinic
Who needs rapid detox? Why do we do rapid detox? Why does it have to last at least six to eight hours under anesthesia while the patient receives the antidote to opiates intravenously? Why not just do it for one hour or two? Why not give the patient Suboxone and declare the rapid detox a success and send the patient home after one hour?
People who are addicted to opiates, be it heroin, vicodin, oxycontin, Percocet, methadone, suboxone, etc, and cannot quit the addiction on their own and cannot tolerate the physical withdrawal come to us for rapid detox procedure. Not every doctor is qualified to do rapid detox. Only very experienced and board-certified anesthesiologists are also board-certified in pain management should attempt performing rapid detox. Not every pilot is qualified to fly 747 airliners. Not every doctor should be allowed to perform rapid detox.
Our protocol has the patient receive high dose Naloxone (Narcan), the antidote to opiates, intravenously while the patients sleep under anesthesia, for a total of close to eight hours. Some other rapid detox facilities only have the patient sleep for one hour. This difference begs the question: where does the opiate drug go once it has been pushed out of the opiate receptors in the brain by Naloxone? It does not spontaneously disintegrate. Pharmacology teaches us that drugs have certain half-lives, time it takes the body to clear or remove half of the amount of that drug in the body. For the liver and kidneys to remove the heroin or other opiates from the blood circulation, once it has been pushed out of the brain by Naloxone, many hours are needed. This elimination metabolic process cannot be sped up easily. At a rapid detox center that only puts the patient under anesthesia for one hour, they are setting the patient up to wake up in the middle of massive physical withdrawal. Or they give the patient Suboxone, another powerful opiate, to reduce the withdrawal, but further condemning the patient to long term addiction to Suboxone, instead of the original opiate the patient was addicted to.
Only Naloxone (Narcan, Naltrexone) are antidote to opiates, capable of displacing opiate molecules from the opiate receptors in the brain, in the spinal cord, and in the gastrointestinal tract. Not using enough Naloxone for long enough period to allow the maximum of opiate molecules to be removed not just from the brain but from the whole body altogether, through the liver and kidneys, is not adequate detox. Instead of waking up practically free of physical withdrawal and physical craving for opiates, the patients would wake up feeling severe withdrawal. It is technically more challenging to keep the patients asleep for longer periods, but that is precisely why in our clinic the experienced board-certified anesthesiologist stays with that one single patient continuously for eight hours, to ensure safety and comfort of the patient.
The lay person often asks: “Isn’t eight hours of anesthesia dangerous?” That is similar to asking: “Isn’t it dangerous to fly in a Boeing 747 across the ocean for twelve hours?” The danger is reduced to an acceptable when you have highly trained professionals willing to attend to the patient or passenger, physically attending to their safety and wellbeing, without distraction, for the entire duration. Without an experienced pilot at the helm, even one hour flying in a Boeing 747 would be risky. With an experienced pilot, flying cross-ocean on trips lasting 12 to 14 hours becomes safe.
One hour under anesthesia for rapid detox is not enough, leaving patient waking up in massive withdrawal. Perhaps that is why there are horror stories on internet about “rapid detox.” When it comes to rapid detox under anesthesia, longer duration is not easier on the doctor and staff performing the procedure, but it is better for the patient.