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June 17, 1998

Rapid Opioid Detoxification

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

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.