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June 17, 1998

Rapid Opioid Detoxification—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(23):1871-1872. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-23-jbk0617

In Reply.—In our article, we refer to "overall risks" of perioperative mortality in which anesthesia was thought to be a contributing factor to mortality in "unselected patients" rather than the American Society of Anesthesiologists' physical classification I or II patients as mentioned by Dr Gervitz and colleagues. While we agree that mortality is probably low in these patients, how "rare" remains an open question that available studies of URD are insufficient to answer. Although 2 reports concerning pulmonary edema after naloxone did not describe patients undergoing detoxification, the article that described patients with respiratory compromise who required intubation during URD1raises concerns about the potential risks of URD. There is no evidence that clonidine is protective in this regard. Clinicians considering URD should examine their patients carefully for comorbidities (including cocaine abuse and human immunodeficiency virus infection) that may complicate the procedure. Reports of URD-associated complications including death2suggest that a detailed safety evaluation is needed. Ultrarapid detoxification is designed to make patients undergoing detoxification more comfortable2; however, there are no controlled studies to support this concept. More important, detoxification is only the first step in the long and complex process of substance abuse treatment.3Only 3 studies of URD provided outcome results beyond 1 week and none provided results beyond 1 month.

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