Magazine article Clinical Psychiatry News

Buprenorphine Opiate Detox Beats Anesthesia: Safety Concerns

Magazine article Clinical Psychiatry News

Buprenorphine Opiate Detox Beats Anesthesia: Safety Concerns

Article excerpt

SAN FRANCISCO -- Opiate detoxification by the rapid buprenorphine method offers clear advantages over the trendy--but far riskier--anesthesia rapid opiate detox method, Dr. Herbert D. Kleber reported at the annual meeting of the American Psychiatric Association.

"You get much more potential for serious adverse events with the anesthesia detox. There are a couple dozen deaths reported worldwide. We find that even with very careful patient selection, it's still quite risky--and it's no different in terms of long-term outcome than the buprenorphine. So my preference in terms of detoxification is if you need to do it rapidly, do the rapid buprenorphine detox," said Dr. Kleber, professor of psychiatry and director of the division on substance abuse at Columbia University and the New York State Psychiatric Institute, New York.

He and his colleagues are just wrapping up a randomized clinical trial comparing anesthesia rapid opiate detox (AROD) with buprenorphine rapid detox and with detoxification using clonidine.

The data analyses aren't completed yet, but Dr. Kleber was able to form a strong early clinical impression of the results because the study was unblinded. He was particularly impressed by the fact that, despite meticulous oversight, there was one case of pulmonary edema and one case of diabetic ketoacidosis in the AROD group. And yet there was no payoff in terms of better efficacy.

"We found AROD produces comparable or worse withdrawal symptoms over the [first] 48 hours after patients awake than buprenorphine or clonidine," he said.

The AROD technique involves endotracheal intubation followed by about 6 hours under general anesthesia, then a few more hours in the recovery room. The hope has been that this approach would result in less discomfort and therefore higher completion rates than other detox methods, but that has not been borne out. …

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