Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 58, Num. 3, 2004, pp. 132-133

Indian Journal of Medical Science Vol. 58 No. 3, March 2004 , pp. 132-133

Letter to Editor

ULTRA-RAPID OPIOID DETOXIFICATION PROCEDURES IN INDIA: HOW FAR THEY ARE ETHICAL?

Om Prakash Jhirwal, Debasish Basu

Drug De-addiction & Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh - 160012, India E-mail: drjhirwalop@yahoo.co.in

Code Number: ms04021

Sir,

During recent years, opiate detoxification procedures have created renewed interest particularly in field of neuro-biological mechanisms and the new pharmacological approaches to opiate dependence.¹

Ultra-rapid detoxification (URD) emerged in the mid-1990's² and attracted the attention of both media and clinicians. URD, also known as anesthesia-assisted opiate detoxification, is a procedure for detoxifying opioid-dependent patients with opiate antagonists, such as naloxone/naltrexone.³ While under deep sedation, opiate antagonists are administered to the patient as well as symptom-relieving medications in some cases. Patients are examined and prepared for the procedure for 4 to 6 hours. They then undergo URD procedure for 5 to 8 hours. After this procedure, patients are kept in the hospital for next 12 to 24 hours for observation. Claims have been made for its efficacy as a complete cure for opiate addiction.⁴

In India, these detoxification procedures are the object of increasing controversy and are becoming increasingly common among private clinicians and their de-addiction facilities. Most opiate addicts seeking treatment in India are served by the public sector. A wide range of treatment approaches are available, including supportive local social services, public and private detoxification centers, therapeutic communities, and local self-help groups.

URD was introduced in India by private sector de-addiction facilities. These facilities claim in media that URD provides 100 percent success results in opiate addicts without any conscious suffering. This conveys a misconception to the addict that there is a quick, easy, and sure method to come out from dependency. Clearly, this approach contradicts the traditional view of dependency as a bio-psycho-social problem that requires an intensive and comprehensive management for achieving long-term abstinence. It is seen from day to day clinical practice that many URD clients subsequently requested treatment in the public system. Similar doubts were raised by research workers in Western countries who were skeptical of any method claiming "cure" via a simple, short, and uni-dimensional approach. They believe that detoxification and medication alone cannot provide long-term abstinence. Some scientific studies also claim that URD may be much less effective and more expensive than traditional treatment³ which further challenges its feasibility in developing countries.

However, much controversy currently surrounds URD because of its associated risks of mortality and morbidity⁵ which usually hided by private de-addiction facilities. There is need of proper psycho-education among service utilizers and legal authorities must be sensitized regarding these procedures. It is evident from some clinical studies that no specific subgroup of clients benefited more from URD. Nevertheless, limited data is available regarding patient outcome after URD. Finally, one should bear in mind that detoxification is only the initial step of a prolonged therapeutic process with biological, psychological, social and environmental aspects that may influence the final outcome, that is abstinence.

References

1. Nutt DJ. Addiction: brain mechanism and their treatment implications. Lancet 1996;347:31-6.
2. Loimer N, Hofmann P, Chaudhry H. Ultrashort non-invasive opiate detoxification. Am J Psychiatr 1993;150:839.
3. Lawental E. Ultra-rapid opiate detoxification as compared to 30-day in patient detoxification program a retrospective follow-up study. J Subst abuse 2000;11:173-81.
4. Krabbe PF, Laheij RJ, Victor van Cauter RM, de Jong CA. Rapid detoxification from opioid dependence under general anaesthesia versus standard methadone tapering: abstinence rates and withdrawal distress experiences. Addict Biol 2003;8:351-8.
5. Dyer C. Addict died after rapid opiate detoxification. Br Med J 1998;17:170.

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