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October 22, 1997

Opiate Detoxification Under Anesthesia

JAMA. 1997;278(16):1318. doi:10.1001/jama.1997.03550160038029

To the Editor.  —The Medical News & Perspectives article by Dr Stephenson1 did not mention some important concerns regarding the Center for the Investigation and Treatment of Addiction (CITA) organization. First, Loimer et al2 were the first to publish the basic technique of using an opiate antagonist plus general anesthesia for treatment of opiate withdrawal in 1988. One of us (C.B.) described some minor modifications (clonidine premedication, propofol anesthesia, and naltrexone administered via nasogastric tube) in 1989.3 These are some of the "trade secrets" claimed by CITA.Second, Stephenson rightly questions CITA's unpublished (and unvalidated) "success rates." Studies with urine-validated abstinence rates of more than 70% at 4 and 12 months have been published,4,5 but reflect patient selection and post-withdrawal treatment factors, including a supervised naltrexone regimen, rather than the detoxification method.4 Detoxification certainly is not synonymous with rehabilitation, but many patients are already rehabilitated