I recently took somewhat of a break from blogging (not intentionally however) and I must say, it feels good to be back at it. For those of you who haven't yet read my "comeback" post, check it out. It's labeled as "I'm Back" and can be found on my blog homepage. Now lets get to business.
For anyone visiting this site for the first time, I welcome you to my blog and hope you will find it both helpful and an enjoyable read. This is now my 14th post and I must say I am becoming more and more pleased with the blog as each post is thought of, written, and published for you guys to read. Over the past several months I have gotten a few comments, a solid number of page views, and even an e-mail from someone looking for a little more advice and someone to "just talk to". I have also noticed that a few people took the most recent poll as well which only adds to my satisfaction. It makes me feel like that I'm getting my blog out there to anyone who's looking for any advice and information about opiate addiction and that I'm not just typing away for nothing. I would like to take a second to thank all of you who have read my blog, commented on it, taken part of the poll, or have passed the word around. THANK YOU!
For this post I would like to talk about a treatment option for opiate addicts that is relatively new. This method of treatment is commonly referred to and known as Rapid Opioid Detoxification and has been met with both praise and criticism. To make things a little easier for myself, I will be referring to the Rapid opioid detoxification as ROD. To give you guys a quick idea of what this is, please let me explain and sum it up in a few quick sentences. ROD is a method of treatment for opiate addicts which often places the patient in a state of unconsciousness while doctors provide the patient with a variety of medications that will help speed up the detoxification process. The patient will be "asleep" for a period of time and will then awaken after the normal period of opiate withdrawal. To put it bluntly, they basically put you asleep, give you some medications to speed up the detox process, and allow the patient to awaken feeling little to no withdrawal symptoms.
When I first heard of this method of treatment, I was very enlightened and curious about the process as it seemed far too good to be true. After doing some research and asking both my addiction doctor and consoler some questions about the matter, I was left with the impression that this method of treatment has a lot of promise but is still in its early stages and needs a lot more work and research put into it. Similar to many of my other posts on this blog, I would like to take this post and divide it into a few sections that will further discuss the matter. I would like to give you guys a brief overview and history of this method of treatment, its effectiveness, the general census of it currently, and my thoughts on it. After that, I'll leave the rest to you guys provide any comments, inputs, or even experiences you have on the matter. On that note, lets begin.
Since the original procedure was used on addicted soldiers in Israeli army, it has been gradually perfected by new medications that have since been approved by FDA to help control the effects of the withdrawal. The detoxification drug treatment procedure involves administering intravenous medications that remove opiates from the opioid receptors while the patient is sedated. The detox is done under anesthesia to avoid extreme discomfort and pain from opioid withdrawal symptoms. Additional medications are given to counteract the withdrawal manifestations and to comfort the patient.
Rapid detox under anesthesia can get you through the worst of withdrawal with only limited amount of symptoms that we can help to manage. A small implant containing Naltrexone may be placed under the skin while the patient is still under sedation. The Naltrexone implant slowly releases medication to continually block receptors and help the patient fight the physical symptoms of drug addiction. The Naltrexone implant will entirely dissolve and disappear in approximately two months. Naltrexone implant will take the daily decision making out of your hands. Knowing that narcotics will have no effect on you, if you do slip up, will help the psychological cravings as well.
There sprung up numerous small clinics all over the country duplicating the work that Dr. Waismann began in 1994. Some are well trained and well ran clinics quietly helping patients start new lives, however a few were trying to make a fast buck and ran into trouble and unfortunately those are the ones that get into news and leave a bad taste in the mouths of all.
Internists not doing proper medical screening, not making sure the patients are well enough for the procedure; Anesthesiologists who are not ABA certified, facilities that are ill equipped to deal with emergency situations, etc. Unfortunately the list can go on and on…
The procedure became somewhat controversial, because of the spectacular stories that were heard from time to time, also because no pharmaceutical company was behind it and making a lot of profit (aka Suboxone). However for the professionals who have been involved in it, Addictionologists, Internists, Anesthesiologists – are all believers. They do it because they know it works. Patient after patient, as long as there is a will and a commitment."
While this method of treatment has been around for 20 years, it really hasn't been that well known in the U.S. until recently. Some doctors are all for it while others are very much against it, so there isn't really a final census or agreement on the matter as of now. Hopefully there will be more information about this matter as time goes on and that they can fix any of the problems with this procedure. The withdrawals experienced during this procedure are often compared to as how one would feel if they were to go into precipitated withdrawal. If you remember from my previous posts (or worse, know from experience), precipitated withdrawal occurs when you take a drug such as Suboxone, Methadone, or Vivitrol without having waited long enough after any previous use of opiates such as Oxycodone, Heroin, and the like. For those who don't know, precipitated withdrawal is said to be much worse of a feeling than the "normal" opiate withdrawals one would suffer if they were to suddenly stop using opiates after a continued period of time (going cold turkey).
Normal opiate withdrawals already suck enough as it is, so precipitated withdrawals is something you don't want to mess with. While the patient would normally feel like they were in a state of hell during the course of experiencing precipitated opiate withdrawal, the patient undergoing ROD is supposed to feel little to no discomfort or pain during ROD due to the fact that they are not conscious and are under certain medications. Basically, the procedure has you sleep though the rough part while under medical supervision.
The procedure itself differs slightly from place from place but the basic concepts behind it remain nearly the same. To give you guys a description of the procedure, I have once again provided a detailed description of the procedure from a website I found online (I promise you I'm not getting lazy, I just want everything to be as clear as possible for you guys rather than putting things in my own words) while researching this method of treatment. This information is below this paragraph and is once again in blue front.
"Naltrexone is sometimes used for rapid detoxification ("rapid detox") regimens for opioid dependence. The principle of rapid detoxification is to induce opioid-receptor blockage while the patient is in a state of impaired consciousness, so as to attenuate the withdrawal symptoms experienced by the patient. Rapid detoxification under general anesthesia (sometimes called "ultra-rapid detox") involves an unconscious patient and requires intubation and external ventilation. Rapid detoxification is also possible under lighter sedation. The rapid detoxification procedure is followed by oral naltrexone daily for up to 12 months for opioid dependence management. There are a number of practitioners who will use a naltrexone implant, usually placed in the lower abdomen, to replace the oral naltrexone."
Another website provided a brief description of the process for their particular facility and I have listed it below this paragraph as well. This information comes from a facility in New York known as New York Rapid Opioid Detoxification (NYROD).
"The process begins when NYROD is first contacted by a patient or referring source. Patients then undergo a thorough screening of their medical and drug histories, and psychological profiles. Patients will complete an extensive questionnaire which will be reviewed by Dr. Brooks and our addiction specialized therapist. Dr. Brooks and out addiction therapists will speak to each patient in person, or by phone if calling from a great distance. Patient determination to end their opiate addiction is key to acceptance for treatment. With patient consent, previous therapists will be contacted to discuss your addiction and treatment histories. All patients must undergo physical examination and testing appropriate for their age and drug history.
AAROD is an important first step toward becoming opiate addiction free, but is only a first step. Therefore, to optimize outcomes and avoid relapse, NO patient will be allowed into the program unless aftercare has been established. That is, patients must have an inpatient, or outpatient post-procedure treatment plan to help them understand any psychosocial roots of their addictions and trigger avoidance. Our staff will work with you to assure a smooth transition into an aftercare program. In addition, we will maintain contact with each patient with frequent phone calls and return follow-up appointments. Every patient will have 24-hour access numbers to reach us if needed.
Patients are admitted early morning. An intravenous line is started and patients are placed on cardiac and oxygen monitors. Under the care of an ICU trained RN, patients will receive clonidine and intravenous fluids. The clonidine will help stabilize blood pressure and heart rate during detoxification. The fluids will begin the “washout” of the opiates still on the patient’s receptors.
Next, under the direct and constant care of a Board Certified Anesthesiologist, patients are brought into a state of the art procedure room. After the induction of deep intravenous sedation patients are administered the opiate antagonists naloxone and naltrexone until all opiates have been displaced from the opiate receptors and the detoxification is complete. Patients have no awareness or memory of the detoxification process which would otherwise be intolerable. Depending upon the level of addiction and the drugs to which the patient is addicted, the procedure will last from 3 to 4 hours. Before awakening, and only after the patient is completely detoxified, the patient is administered depot naltrexone injection.
Patients are next brought to a comfortable recovery area where they will be continuously monitored through the night by a trained RN. Any residual restlessness or discomfort or expected gastrointestinal distress will be treated as needed. Young patients may have a parent stay with them for all or part of the recovery period.
Before discharge the next morning, every patient will be evaluated by Dr. Brooks, and visited by our therapist to discuss immediate aftercare planning. Unless ready for discharge, patients will be kept. No patient will be allowed to leave without a responsible adult escort.
The aftercare you receive will be individualized and determined by you and your therapist. Some patients will choose to immediately continue in an outpatient setting, working closely with a therapist and joining a support group such as Narcotics Anonymous. Others may feel that they must first enter a more structured program in a protected and anonymous rehabilitation setting, far from their familiar “people, places, and things"
This procedure is supposed to be nearly painless and provides the patient with the chance to achieve sobriety without having to put up with the physical withdrawals from trying to quit opiates. The withdrawals from opiates is often a factor that prevents many (myself included) from going the cold turkey route. This option may also be appealing for those who dislike Opiate Replacement Therapy drugs such as Suboxone, Methadone, or Vivitrol or who feel they would otherwise be unsuccessful with going down this route (or cold turkey). The fact that it is basically a one time procedure (unlike Suboxone/Methadone which is an every day thing) is something that may be very appealing for some addicts.
Based on what I have read, patients will often stay in the facility or hospital for a few days and will be closely monitored. After the procedure, patients will be sometimes be prescribed Naltrexone to help them remain sober. It is important to remember that Naltrexone is not addicting and is the same drug that is found in the Vivitrol shot that I talked about here. It is also recommended that after the procedure that the patient continues to see their doctor, live a drug and alcohol free life, and seek support and/or AA/NA meetings.
There have been a number of deaths related to the procedure, where patients have died within days of a rapid detox, and one prominent clinic was closed down over concerns over health and safety.
Advocates argue that although there are risks, the risks of a lifetime of abuse and addiction are greater, and for society as a whole rapid opiate detox betters health. This may or may not be true, but it is not likely very encouraging on an individual basis and when deciding on personal options."
Rapid Opioid Detoxification does not guarantee life-long sobriety and a person who undergoes this treatment has no greater chance of remaining sober than someone who attempts to go cold turkey or use opiate replacement therapy. Someone can be cold turkey off of opiates for a month and suddenly relapse. Someone may be on Suboxone or Methadone for 2 years and relapse. Hell, there are people who have decades of sobriety who end up suddenly relapsing. The same unfortunately goes for patients who have undergone a ROD procedure. I'm not trying to sound like a jerk when I say that (there certainly are people who have undergone cold turkey, opiate replacement therapy, and I'm sure ROD who have gotten and remained sober) but I want to be as honest as I can be with you guys. ROD will help you avoid the physical withdrawals but you'll most likely still end up having to fight off urges, struggle with the mind games of addiction, and live through the mental anguish for quite some time after you quit opiates. I bring this up because $20,000 is a lot to pay to get sober to end up relapsing later on. Like I've said before, some people get it their first time while others, their 100th try. Everyone is different so don't feel as if I'm speaking for you and every opiate addict out there. Getting sober is easier for others just as it can be harder for others.
The following excerpt is from a study that was conducted in 1999 by American Society of Anesthesiologists. It discusses the success rate of the procedure in 20 individuals as well any side effects experienced by these people. The link to this study can be found by clicking here. Here it is below in blue front:
Getting and staying clean is not an easy thing but is something we (us opiate addicts) must seek, or eventually seek. Most who continue a life of abusing opiates usually end up in jail, institutions, being homeless, or even dead. For those who don't get to any of those places, they will probably end up hurting their families/friends (in addition to themselves), ruining relationships, losing their jobs, and basically destroying their lives. Think about it, how many happy, successful opiate addicts do you know or have you heard of? If you're like me, none. Addiction may not seem so bad at first but trust me, it will eventually bite you in the ass if you put up with it long enough. Again, I hate to appear gloomy and like a jerk on a high horse, but this is usually the case and is something I know from experience. My rock bottom wasn't jail, homelessness, or death but I did hurt some of the people I cared most about, did some things I would have never thought I would have done, and changed (negatively) as a person. I hated what I was doing and who I was becoming, eventually getting help and can honestly say I am happy the way my life is going right now. It hasn't been easy but like I've said numerous times before, it is possible. I'm still learning this myself as I continue my journey towards sobriety.
What I just mentioned in the previous paragraph is there for a reason. I want to stress to you guys that just like Suboxone, Vivitrol, or Methadone, Rapid Opioid Detoxification is not some miracle drug or procedure. After patient goes through this procedure, he/she will have to continue battling their addiction. It doesn't just go away after this procedure. This is where AA/NA meetings, counseling/therapy, and changing your surroundings and people around you are critical. Just like some Suboxone/Methadone/Vivitrol and rehabilitation centers, some clinics that offer ROD may try to lure you to give ROD a shot with statements of high success rates and an answer to your problems. These places, after all, are businesses and have a product/service they are trying to sell. Remember that. I'm not trying to knock any of these things as they can certainly help someone but you must remember that they are only a tool in your battle against addiction. Think of them a weapon on the battle field. You are battling addiction and have at your hands a variety of weapons. These weapons can include AA/NA meetings, sober networks, coping skills/mechanisms, and opiate replacement therapy drugs such as Suboxone or Methadone. However at the end of the day, it is not the weapons that are on the battlefield that wins (or loses) the war, it is people who are fighting on it that do.
There are a lot of different answers and numbers out there in regards to the effectiveness and success rate of Rapid Opioid Detoxification. Some will claim close to a 100% success while others will be as low as 20-30%. Unfortunately for addicts, most (but not all!) will fail their first (or few) times of trying to get clean. My addiction consular always told me that relapse is part of recovery but that just because it's part of it doesn't mean it has to be. Meatballs can be a part of a spaghetti diner but you don't have to eat them, you can simply eat around them or not put them on your plate and you'll still have your spaghetti. While this metaphor may sound silly at first, if you take a moment to think about it, it is a great comparison for the tools we can use to achieve sobriety.
I don't really have an answer for you guys about how effective or successful this procedure is other than what I just have stated previously. There are articles out there about this topic however, and I would like to provide you guys with them. After reading through a couple of them, you'll probably get what I'm saying about how there isn't really a clear-cut answer about how effective or successful ROD is or can be. Here are some of these articles below: