Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Although Drs O'Connor
and Kosten1have done the medical public
a service by bringing the techniques of rapid detoxification into the open,
their perspective on rapid opiate detoxification is askew and does somewhat
of a disservice to the published literature.
The authors confuse different aspects of the treatment of opiate addiction.
The first is a desire on the part of the addicted patient to change. Second
is a decision to detoxify or to continue dependence using maintenance of opiates
such as methadone or leuomethadyl acetate hydrochloride. The third aspect
is maintenance of abstinence from opiates in those who are detoxified. While
the first aspect certainly may have a bearing on the efficacy of the latter
2, it is illogical to assume that the method of detoxification bears any relationship
to the capacity to maintain abstinence. These are 2 separate issues. Herein
lies the major problem of the article by O'Connor and Kosten.
Gooberman LL. Rapid Opioid Detoxification. JAMA. 1998;279(23):1871-1872. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-23-jbk0617