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Ask the Experts

Question:

Does Columbia offer a one-day detoxification from heroin or prescription pain killers?

Answered by: Eric Collins

No. Researchers at Columbia tested the approach to opioid detoxification commonly referred to as "ultra rapid" (link to JAMA article) and found it more dangerous and costly as well as no more effective than alternative ways to detoxify opioid-dependent individuals.

The so-called "ultra-rapid detoxification" techniques (offered in the U.S. and many other countries) were touted as a quick, painless way to get off heroin and prescription opioids (pain medications like oxycodone/OxyContin, Vicodin, morphine, Dilaudid, and others).

Most of these procedures combined opioid-blocking medications (naltrexone, nalmefene), which would produce immediate and extreme withdrawal discomfort, with general anesthesia, so that individuals would not feel the discomfort. The appeal of the promised pain-free technique was difficult to resist, because withdrawal from heroin and most other opioids can be extraordinarily uncomfortable for 4 to 6 days.

In most cases, these procedures were very expensive (with prices ranging from several thousand dollars to over $15,000). And there were reports of complications, in some cases even deaths, associated with the treatment, usually within the first 48 hours after anesthesia. And, despite many early reports of wonderful treatment results from the groups performing the procedures, several controlled trials have failed to demonstrate any lasting benefit of the treatment, with most patients relapsing to heroin or opioid use within 3 to 12 months, regardless of how they were detoxified. In fact, the procedure was associated with several serious adverse events, including one life-threatening (but ultimately successfully treated) case of pulmonary edema (fluid in the lungs), which had previously caused several deaths among patients undergoing the treatment elsewhere. Despite claims by proponents that the procedures were pain-free, patients detoxified under anesthesia have withdrawal discomfort comparable to those detoxified by other means for days afterwards.