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Collins ED, Kleber HD, Whittington RA, Heitler NE. Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin
Detoxification and Naltrexone Induction: A Randomized Trial. JAMA. 2005;294(8):903–913. doi:10.1001/jama.294.8.903
Author Affiliations: Division on Substance
Abuse, New York State Psychiatric Institute and Department of Psychiatry,
College of Physicians and Surgeons of Columbia University (Drs Collins and
Kleber and Ms Heitler); Department of Anesthesiology, College of Physicians
and Surgeons of Columbia University (Dr Whittington).
Context Rapid opioid detoxification with opioid antagonist induction using general
anesthesia has emerged as an expensive, potentially dangerous, unproven approach
to treat opioid dependence.
Objective To determine how anesthesia-assisted detoxification with rapid antagonist
induction for heroin dependence compared with 2 alternative detoxification
and antagonist induction methods.
Design, Setting, and Patients A total of 106 treatment-seeking heroin-dependent patients, aged 21
through 50 years, were randomly assigned to 1 of 3 inpatient withdrawal treatments
over 72 hours followed by 12 weeks of outpatient naltrexone maintenance with
relapse prevention psychotherapy. This randomized trial was conducted between
2000 and 2003 at Columbia University Medical Center’s Clinical Research
Center. Outpatient treatment occurred at the Columbia University research
service for substance use disorders. Patients were included if they had an
American Society of Anesthesiologists physical status of I or II, were without
major comorbid psychiatric illness, and were not dependent on other drugs
Interventions Anesthesia-assisted rapid opioid detoxification with naltrexone induction,
buprenorphine-assisted rapid opioid detoxification with naltrexone induction,
and clonidine-assisted opioid detoxification with delayed naltrexone induction.
Main Outcome Measures Withdrawal severity scores on objective and subjective scales; proportions
of patients receiving naltrexone, completing inpatient detoxification, and
retained in treatment; proportion of opioid-positive urine specimens.
Results Mean withdrawal severities were comparable across the 3 treatments.
Compared with clonidine-assisted detoxification, the anesthesia- and buprenorphine-assisted
detoxification interventions had significantly greater rates of naltrexone
induction (94% anesthesia, 97% buprenorphine, and 21% clonidine), but the
groups did not differ in rates of completion of inpatient detoxification.
Treatment retention over 12 weeks was not significantly different among groups
with 7 of 35 (20%) retained in the anesthesia-assisted group, 9 of 37 (24%)
in the buprenorphine-assisted group, and 3 of 34 (9%) in the clonidine-assisted
group. Induction with 50 mg of naltrexone significantly reduced the risk of
dropping out (odds ratio, 0.28; 95% confidence interval, 0.15-0.51). There
were no significant group differences in proportions of opioid-positive urine
specimens. The anesthesia procedure was associated with 3 potentially life-threatening
Conclusion These data do not support the use of general anesthesia for heroin detoxification
and rapid opioid antagonist induction.
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