Drug detoxification (often shortened to "detox") is a collective of interventions directed at controlling acute drug intoxication and drug withdrawal. It refers to a purging from the body of the substances to which a patient is addicted and acutely under the influence. The process of detoxification aims at lessening the physical effects caused by the addictive substances.
Detoxification programs do not necessarily treat the other aspects of drug addiction: namely, psychological aspects of addiction, social factors, and the often complex behavioral issues that are intermingled with addiction.
There are typically three steps to drug detoxification:[1]
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Rapid opiate detox was created in Israel almost 20 years ago by Dr. Andre Waismann, who still practices his craft in Brazilai Medical Center in Ashdod, Israel.[2]
Since the original procedure was used on addicted soldiers in Israeli army, it has been gradually perfected by new medications that have since been approved by FDA to help control the effects of the withdrawal. The detoxification drug treatment procedure involves administering intravenous medications that remove opiates from the opioid receptors while the patient is sedated. The detox is done under anesthesia to avoid extreme discomfort and pain from opioid withdrawal symptoms. Additional medications are given to counteract the withdrawal manifestations and to comfort the patient.
The often painful symptoms of drug withdrawal may last for several days and can stand as a barrier to the treatment of a drug abuse problem. Some practitioners use "rapid" or "ultra rapid" detoxification methods to condense the withdrawal process into a considerably shorter period of time, about two hours, while the addict is asleep.[3] Rapid detox patients placed under anesthesia while given treatment drugs, such as naltrexone, can avoid the extreme pain associated with such treatments, say proponents, and bypass the major effects of withdrawal.[3] Critics argue that the treatments can be very expensive and that safety has not been sufficiently demonstrated.[3] A 2005 clinical study on "ultra rapid detox" for heroin addicts, comparing buprenorphine-assisted or clonidine-assisted opioid detoxification to anesthesia-assisted detoxification, reported that anesthesia patients commonly underwent withdrawal when they awoke from, had a similar study dropout rate (approximately 80%), and some anesthesia patients experienced severe medical complications.[4][5] Another 2005 study compared clonidine-assisted detoxification to (rapid) clonidine-naloxone precipitated withdrawal under anesthesia, reporting no significant differences in degree or duration of pain, withdrawal severity, or drug craving, with similar withdrawal sequelae, oral naltrexone compliance levels, and abstinence from heroin four weeks following detoxification.[6]
According to a 2001 analysis of 13 Australian drug treatment trials, conducted by Australia's National Drug and Alcohol Research Centre, rapid opioid detoxification was determined to be the most effective method of getting people off drugs in the short term, however long-term rates of continued treatment were less successful; in contrast, methadone maintenance treatments were determined to be more cost-effective with patients more likely to remain in treatment.[7]
The concept of "detoxification" comes from the discredited autotoxin theory of Dr. George E. Pettey and others. David F. Musto says that "according to Pettey, opiates stimulated the production of toxins in the intestines, which had the physiological effect associated with withdrawal phenomena... Therefore treatment would consist of purging the body of toxins and any lurking morphine that might remain to stimulate toxin production in the future."[8]
Rapid opiate detoxification therapy, which critics claim lacks long-term efficacy and can actually be detrimental to a patient's long-term recovery has led to controversy. Additionally, there have been many questions raised about the ethics as well as safety of rapid detox following a number of deaths resulting from the procedure.[9][10][11][12]