5 Reasons Why the California Society of Addiction Medicine Rejects Rapid Opioid Detox

Thinking about ultra rapid detoxification? Maybe you should think again - here are 5 solid reasons why the California Society of Addiction Medicine says ultra rapid opioid detox isn’t worth the risks.

What Is Rapid Opioid Detox?

Sedated withdrawal:

1. You are put under anesthesia or placed under heavy sedation and then given an opioid antagonist, such as naloxone.
2. This opioid antagonist pushes out any opioids in your opioid receptors. This induces immediate full withdrawal, but since you are under sedation, you do not experience the full discomfort.
3. By precipitating withdrawal, you accelerate the process, and by the time you are finished with sedation, much of your discomfort has already passed.

It sounds very appealing (who wouldn’t mind skipping withdrawal) so why don’t major addiction treatment groups like the American Society of Addiction Medicine (ASAM)¹ and the California Society of Addiction Medicine (CSAM) endorse it?² 

Well, unfortunately, it may not work as well as promised – read on for the 5 primary reasons why CSAM won't recommend ultra rapid opioid detoxification for anything beyond research efforts.

Why CSAM Doesn’t Endorse Rapid Opioid Detox

1. Withdrawal Symptoms Can Still Be Severe

Accelerating withdrawal symptom onset (precipitating withdrawal) with opioid antagonists results in intensified symptoms, such as increased hypertension, worsened tachycardia and increase nausea and vomiting.

Although patients may believe that they will sleep through withdrawal and wake up clean and past the worst of it, the reality for many patients is far different; many patients continue to experience severe withdrawal symptoms for days after the procedure.

2. It Does Not Quicken Complex Neuroadaptation

Detox is a period of neuroadaptation during which your brain adapts to a new opioid-free state.

Though ultra rapid detox programs claim to quicken this neuroadaptation, this adaptation does not occur in an instant when an antagonist displaces an opioid from receptors in the brain.

• The adaptation is a complex process involving intercellular pathways and their gene regulation and many different brain circuits and bodily systems.

So though ultra rapid detox protocols can get you opioid free in a hurry – they can’t necessarily help your body adapt to this new state any quicker.

3. There Is Little Standardization

Ultra rapid detox is not a standardized medical procedure, and there are many variables that can affect a person’s safety, such as:

• The period between the procedure and the last dose of opioid used.
• The type of anesthetics used.
• The degree of respiratory support given during the procedure and the level of sedation instilled (asleep or just sedated).
• The type of antagonist used (naloxone, nalmefene or naltrexone) and the mode of antagonist delivery (I.V. or NG tube).
• The duration of sedation.
• The degree of monitoring after the procedure. (Note* On internet forums you hear of situations where patients are taken to hotel rooms shortly after the procedure and forced to endure difficult withdrawal symptoms without monitoring or assistance. If you are evaluating different providers, you should consider the duration of post-procedure on-site monitoring as an important variable in your decision making.)

So lacking any standardization, unless you are a medical professional, it’s quite difficult to know what’s appropriate and what’s safest.

4. The Risks Are Higher

Though conventional opioid detoxification is quite uncomfortable, it is rarely dangerous. Rapid detox under sedation is more dangerous, due to the use of anesthesia and due to the intensification of withdrawal symptoms seen with precipitated withdrawal.

Rapid detox under anesthesia is a much riskier procedure (as is any procedure done under anesthesia) and it isn’t suitable for all people. Complications that have been associated with the procedure, include:

• QT prolongation.
• Extreme epinephrine release and excessive cardiovascular stimulation.
• Rapid and labored breathing.
• Increased muscle activity.
• Death.

 5. Your Odds of Relapse Are High

Unfortunately, rapid opioid detoxification offers no better odds of long-term abstinence than conventional detoxification – statistically, both methods are associated with high relapse rates (in some studies, nearly 90% relapse by 12 months post detox.)

Medication assisted treatment, with methadone or buprenorphine, offers far better odds of long-term recovery.

The CSAM Recommendation

CSAM does not endorse the routine use of anesthesia assisted opioid detoxification; the primary reasons given for this are the lack of standardization and the lack of research demonstrating its safety and effectiveness.

• At the moment, CSAM recommends ultra rapid detox only for research purposes and only with completely informed consent and careful monitoring during and after.