In what read like a paid advertisement, Britain’s Independent newspaper has become the latest media outlet to fall for the claims of the promoters of a procedure called “rapid” or “ultra rapid” opioid detox.
The Independent is in good company: Barbara Walters, 48 Hours, even Wired have promoted this treatment, which has actually led to about a dozen deaths around the world.
The Independent claims that in the world of addiction treatment everyone believes addiction is a psychological problem, but only rapid detox treats it as a medical one.
This is what happens when journalists who don’t follow a beat write about a topic without bothering to check the medical literature, let alone Google. Almost everyone in the field of addiction has been singing from the “addiction is a disease” song sheet for decades.
While I am the first to criticize the field for saying “disease,” and then turning around and treating addiction with untrained counselors or faith-based moralistic attacks, it is simply wrong to claim that most addiction treatment ignores biology. If anything, the idea of addiction as a disease affecting the brain is over-emphasized.
The main rationale for methadone maintenance is, in fact, that addiction is a medical problem and that providing an opioid makes up for a deficiency in the brain. It is the most-used treatment for opioid addiction in the UK, and, not coincidentally, the best-supported by evidence.
The key problem with the Independent’s story is that it failed to mention the most important study on rapid detox, Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction, which was conducted at Columbia University Medical Center, and published in the Journal of the American Medical Association in 2005. The study, a randomized controlled trial, compared rapid detox to two other treatment methods and found that it provided
“no benefit… over a safer, cheaper, and potentially outpatient alternative using buprenorphine as a bridge to naltrexone treatment. Taken together with the results of earlier studies, our findings suggest that general anesthesia for rapid antagonist induction does not currently have a meaningful role to play in the treatment of opioid dependence.”
Contrary to the media’s advertorials stories, and the Independent’s claim that patients wake up from the anesthesia used in rapid detox without withdrawal symptoms, the study found that withdrawal was no less severe than other less risky methods (rapid detox includes the use of anesthesia, when a patient is likely to be vomiting.)
Three patients in the rapid detox group also had “potentially life-threatening adverse events.” But as with the fact that there have been deaths associated with the procedure, this potentially life-saving information never made it into the Independent’s story.