By Thomas C. Yee, MD
October 3rd, 2009
Board-Certified Anesthesiologist (1994) and Board-Certified Pain Management (1997)
Las Vegas Rapid Detox Medical Clinic
Whenever we get a patient in our rapid detox clinic that has injected heroin into the muscles in the thighs, legs, buttocks and arms for long duration, we know we are facing a different and more ferocious beast. If you palpate, touch these areas, you would feel numerous hard knobs of deep scar tissues, result of thousands of un-sterile injections of dirty heroin. They have resorted to injecting straight into the muscles because they had run out of veins to inject; these are long-term hard-core heroin users.
Realizing these hard, knobby, scarred muscles constitute a large reservoir of yet un-absorbed heroin is the key to helping these patients start on the road of recovery from multi-year heroin addiction. Even if such patients stop using heroin today, they might have enough heroin trapped in the scar tissues of the leg and buttock muscles that would leak out into the blood stream, erratically, and unpredictably over the following weeks or even months. How do you do rapid detox on someone whose heroin is not within reach of the detox medications? When Naloxone, the antidote to all opioids, can only remove heroin when it is attached to the opioid receptors in the brain, the spinal cord and the gastro-intestinal tract, how can you eliminate the heroin that is not attached to the receptors, but rather is hiding in the hard-to-reach muscle scar pockets?
Perhaps the answer is that you should take your time. For these patients, rapid detox truly is only the first step. They need to stay in a residential rehab center for 30 to 60 days, following the type of 8 hour-long rapid detox under anesthesia. They will definitely still feel both physical and psychological withdrawal after the rapid detox, as opposed to the other opioid-addicted patients who feel very little physical withdrawal after rapid detox. After rapid detox, for these patients, we simply have to immediately start higher intensity oral medication treatment for the next 30 to 45 days. Rapid detox serves only as the initiator of the overall treatment. As the heroin slowly leaks out from the scar tissue in the muscles, they will feel more withdrawal. When that happens, the treatment is intense oral medications and supportive psycho-therapy in a residential rehab setting.
These patients are the hardest to detox and rehab, right up there with Methadone and Suboxone addicts, due to the fact that all three: intramuscular heroin reservoir, Methadone and Suboxone hide in the body tissues extensively. Because they hide, therefore they are difficult to be detoxed rapidly. But paradoxically, without rapid detox as an initiator or the long term addiction recovery treatment, these addicts won’t even try to quit, because they know how difficult it is to quit.
It’s much harder to quit intramuscular heroin than to quit intravenous heroin addiction. It’s much harder to quit Suboxone than to quit heroin. It is much harder to quit Methadone than to quit heroin. Ironic, but true.
Intramuscular injection of heroin, over long-term, makes the addict a different beast to detox and rehab. The patients need to know that up-front. Regardless of the hardship, at least rapid-detox is a quick way to get started, removing the first 8 days of withdrawal hardship. It is just that when an intravenous heroin user might have faced 10 days of withdrawal had he decided to quit cold-turkey style on his own, an intramuscular heroin user would face 40 days, a Methadone user would face 60 days, and a Suboxone addict would face 25 days. Rapid Detox, as we perform it in helping patients quit, is not black magic; but it does take away the first 8 days of withdrawal hardship in just 8 hours under anesthesia.