Detoxification Procedure for Heroin Addicts

A critical-care procedure for addicted heroin users, called ultrarapid opiate detoxification (UROD), is designed to help users avoid painful withdrawal and recover from their addiction. The procedure should only be performed under the supervision of an anesthesiologist, according to research presented at the annual meeting of the American Society of Anesthesiologists (ASA) in New Orleans (LA, USA).

The UROD procedure, in which the patient is first put to sleep and then allowed to gain consciousness, takes four to six hours, plus 24 hours of hospitalization. Because the procedure causes drastic physical changes in the patient, it should be closely monitored by an anesthesiologist. This is followed by several months of daily medications called antagonists to block the effects of narcotics and reduce the compulsion to again abuse drugs. According to one study, 55% of patients had not resumed drug use six months after the procedure. For some patients, the procedure offers a viable alternative to methadone maintenance.

An analysis of the deaths of seven patients who underwent the procedure was presented at the meeting by Dr. Clifford M. Gevirtz, an anesthesiologist at Mount Sinai School of Medicine (New York, NY, USA). All seven procedures were performed by nurse anesthetists under the supervision of an internist, not an anesthesiologist. Six deaths were caused by pulmonary edema, while the seventh was caused by pneumonia due to aspiration of material from the stomach into the lungs. The analysis also revealed deviations from standard practice, including the absence of a pre-anesthetic evaluation for all seven patients, the administration of anesthetic drugs without regard for body weight or level of muscle relaxation, a lack of appropriate monitoring, and failure to administer medicines to prevent aspiration.

"UROD requires the precise control of anesthesia during the administration of antagonists and strict adherence to the ASA standards of care,” said Dr. Gevirtz. "We believe the seven deaths could have been prevented had proper precautions and techniques been employed by an anesthesiologist.”




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