By Thomas C. Yee, MD
November 17th, 2009
Board-Certified Anesthesiologist (1994) and Board-Certified Pain Management (1997)
Las Vegas Rapid Detox Medical Clinic
How does rapid detox work? Why does rapid detox work? From personally performing hundreds of rapid detox procedures successfully, this writer has continuously modified and improved on not just the practical clinical protocol but also a theoretical understanding of opiate addiction and rapid drug detox. We know it works, but why does it work. From a scientific curiosity, we search for a theoretical basis for our practical clinical success.
Imagine a heroin addict trying to quit cold-turkey style. If he can hang in there for 8 days, by the grace of God and with super-human willpower, overcoming the insufferable physical withdrawal, then he will have successfully quit the initial phase of addiction. He will have overcome the physical addiction. Much psychological work needs to be done by him and hopefully his counselors to beat back the mental craving.
What if we can keep this hypothetical heroin addict asleep for the 8 days? It is reasonable to assume that he would wake up from the sleep feeling free of physical addiction to opiates, feeling no physical withdrawal. What if we can use certain medications and technology to shorten this time period from 8 days to 8 hours? That is rapid detox as being performed in this clinic.
Rapid detox is not black magic. It is accelerated removal of opiates from both the opiate receptors and from the body’s blood circulation. In accomplishing the first part, removal from the receptors, it only takes minutes. In accomplishing the second part, removal of opiates from the body’s circulation, the body’s own kidneys and liver need time; these organs need between 4 to 8 hours to eliminate the opiates from the body. That is why we need to keep the treatment going under anesthesia for at least 8 hours. Otherwise, waking the patient early will result in a patient feeling massive withdrawal.
In the body of an opiate addict, the opiate receptors in the brain, the spinal cord and the gastrointestinal tract are like spoiled children addicted to having a lollipop constantly in their mouths. Imagine a daycare center with 100 such kids. Conventional quitting approach is akin to taking away the lollipop from one child at a time, compelling the child to throw a crying temper tantrum fit for 3 hours. At the end of 3 hours, the crying becomes a whimper and finally stops because the child begins to realize that tantrum will not bring back the lollipop; he begins to adapt to a life without lollipop. One child at a time, we are looking at 300 hours of crying temper tantrum. In rapid detox, as we do it, we would yank out all 100 lollipops at the same time, producing an earth-shaking collective temper tantrum. At the end of 3 hours, however, all 100 children begin to pipe down and reluctantly begin to adapt.
We have observed this in the hundreds of patients we detox. Since our procedure lasts 8 hours, we get to observe the amazing transformation every time. Initially, when the naloxone first enters the blood stream of the patient, he would instantly react under anesthesia, by various involuntary movement of the hands, feet, sneezing, yawning, twitches, etc. Soon, depending on the depth or dosage of the opiate preexisting opiate addiction, the patient would calm down, exhibiting less and less involuntary movement. Invariably, after between 20 minutes to 3 hours, all movements cease except for regular breathing motions. This appears to be a manifestation of the child-like opiate receptors, after throwing temper tantrum, finally giving up and beginning to adapt to a opiate-free brave new world. When the patient wakes up after 8 hours of treatment, he is free of the physical withdrawal and the bulk of physical addiction.
Case after case, patient after patient, we have observed this phenomenon. Opiate receptors do adapt, as long as we take away nearly all opiate in the body. If the residual opiates molecules are in enough quantity to reoccupy certain critical proportion of the overall population of the opiate receptors, then the patient would manifest withdrawal reactions again. We have seen this in those patients who have chronically injected heroin into muscles producing scarred-in pockets of heroin. After rapid detox, when they massage those muscles, they would feel physical withdrawal.
In general patients report little or no physical withdrawal after rapid detox, and can move on with their lives undergoing the very important psychological counseling afterwards without any need for Naltrexone. We have also observed that after patients awaken from anesthesia, if we inject additional naloxone or give patients Naltrexone pill too soon afterwards, they sometimes report feeling of residual physical withdrawal. While if we hold off Naltrexone pill for 10 days after rapid detox,
The patients do not report feeling residual physical withdrawal. So what does this tell us?
This suggests that after rapid detox, if we do nothing to further irritate the receptors, not giving them opiates, nor challenging them again soon with naloxone, patients tend to feel no physical withdrawal or physical craving for opiates. This also suggests that the opiate receptors, when viewed as a population of receptors, exhibit group behaviors different from individual receptors’ behaviors. Hypothetically, if say 60 percent or more of all receptors are binding to opiate molecules, then there is no feeling of withdrawal. If between 10 and 60 % of receptors are binding to opiates, then there is feeling of withdrawal. If less than 10% of receptors are binding to opiates, then also there is no feeling of withdrawal. Within this small minority of receptors, about 10 % or less, if there is active displacement of opiates by naloxone or naltrexone, then the patient would feel moderate physical withdrawal. If this small minority, over the following days, gradually loses the opiate molecules through natural dissociation and metabolism, then there is no feeling of withdrawal.
Perhaps, in conclusion, both the speed of losing opiate molecules from receptors and the overall percentage of opiate-bound receptors contribute to the physical withdrawal and the physical craving in opiate addiction. Also, in conclusion, back to our original example, if a heroin addict could sleep for 8 days straight under adequate anesthesia, then he would be free from physical addiction. By shortening a heroin addict’s cold-turkey quitting torture from 8 days to 8 hours, still keeping him asleep under anesthesia, we have arrived at a practical technique of rapid detox. Our understanding and the proper formulation of the theory behind this success is now beginning to grow.