How Does Rapid Detox Work? What Are the Risks?

Rapid opioid detoxification (ROD) was created in the 1980s to assist people in detoxing from opioids.

12/27/20225 min read

Rapid Opioid Detox Has Health Consequences

Rapid opioid detoxification (ROD) was created in the 1980s to assist people in detoxing from opioids. It is not widely performed in the United States nowadays due to safety concerns, but it is still available in select contexts. This article reviews what we know about ROD, including its mechanism of action, dangers, and effectiveness in the treatment of opioid withdrawal and opioid use disorder (OUD).

What is Opioid Detoxification and How Does It Work?

Withdrawal symptoms include chills, nausea, vomiting, stomach cramps, fever, sleeplessness, irritability, dysphoria, crawling skin sensation, goosebumps, and desire. Opioid withdrawal, unlike alcohol withdrawal, is not fatal (unless vomiting and dehydration produce volume depletion or electrolyte imbalances), but it is extremely agonizing and unpleasant. It might last up to ten days if left untreated. Detoxification is the first stage of OUD treatment, with the primary goals of reducing suffering and assisting people in committing to long-term treatment. Maintenance, the second stage of treatment, is equally critical. Maintenance frequently entails therapy and/or medication to help the brain repair and avoid relapse into problematic drug usage. In most cases, withdrawal is managed with clonidine and other sedatives, or opioid-containing drugs like methadone or buprenorphine, the latter two of which are tapered over 3-21 days or administered indefinitely for relapse prevention therapy. Suboxone (buprenorphine/naloxone) is a two-component combination drug that can also be used to treat withdrawal symptoms. Buprenorphine (a partial opioid receptor stimulator that reduces overdose risk by blocking high dosages of opioids) and naloxone (a partial opioid receptor stimulator that counteracts withdrawal and craving while also reducing the danger of overdose) (which is a complete opioid receptor blocker, and prevents the medication from being abused). Suboxone is also one of the safest and most widely used maintenance treatment methods for preventing relapse.

What is Rapid Opioid Detoxification, and how does it work?

ROD is a catch-all word for a number of related operations aimed at reducing withdrawal symptoms and getting individuals back to their normal lifestyles as rapidly as possible. Opioid withdrawal is produced pharmacologically with drugs that limit opioids' ability to bind to receptors in the brain, also called as opioid antagonists, rather than allowing withdrawal to occur naturally in ROD. ROD is sometimes done under mild sedation with benzodiazepines, but it's more common to do it under anesthesia [also known as anesthesia-assisted ROD (AAROD)]. When anesthesia is used, the patient is unconscious while their body is going through withdrawal, so they aren't aware of the pain, and the withdrawal period is very short (usually 4-6 hours).

What Is Rapid Detox and How Does It Work?

Regular opioid usage alters the brain's native (endogenous) opioid system, lowering the sensitivity of opioid receptors in the brain. Low receptor sensitivity adds to withdrawal and tolerance, requiring higher doses of the drug to get the same physical and emotional effects. An opioid antagonist, usually naltrexone or naloxone, or in certain circumstances nalmefene, is given throughout all ROD procedures. This returns the brain's endogenous opioid system to its original state faster than it would if withdrawal were allowed to occur naturally.

When anesthesia isn't available, the opioid antagonist is given in a few ascending doses, in combination with a sedative, over many days, because the quick induction of withdrawal with an opioid antagonist can be intense. Because patients are unconscious during withdrawal, they receive a single big dosage of the opioid antagonist if anesthetic is used. At the start of most ROD operations, typical detoxification drugs like clonidine and antidiarrheals are administered to decrease withdrawal symptoms.

Rapid Detox Issues: Rapid Detox Risks

Despite initial optimism that ROD would help persons with OUD, it has become increasingly obvious that ROD is a high-risk drug. As a result of the high rates of serious adverse events (SAEs) associated with AAROD, several large agencies and professional organisations in the United States, the United Kingdom, and Canada have issued statements advising persons with OUD to seek out evidence-based treatment instead. AAROD has a significant serious adverse event risk of 8-9 percent, compared to typical detoxification techniques, which have a low risk of SAEs (1%). Although general anesthesia is linked to complications, ROD during anesthesia increases the chance of complications considerably more. According to a comprehensive review of the literature, while a 2002 study found no SAEs after AAROD, a 2005 study found multiple SAEs in their patient pool. Another case study from 2008 found that a quarter of their patients (none of whom had undergone anesthesia) had delirium. In 2012, it was reported that two patients died and five others had SAEs requiring hospitalization after undergoing AAROD in a New York City clinic, prompting many agencies to advise against the operation. Pulmonary edema, electrolyte imbalances, excessive catecholamine release, altered cardiopulmonary performance, and acute lung injury have all been reported, and may have had a role in some of the negative outcomes.

To make matters worse, ROD is costly and rarely reimbursed by insurance. Furthermore, people lose tolerance after ROD, and if they resume taking opioids at their old level, they are at increased risk of overdosing, increasing the procedure's risk.

Rapid Detox Efficacy: Short- and Long-Term Results?

ROD is not only dangerous, but there is little proof that it works in the short or long term, according to specialists. When compared to patients undergoing conventional detoxification, research revealed that ROD might promote earlier peaking of withdrawal symptoms and lower scores for withdrawal symptoms, as well as higher rates of long-term therapeutic involvement. Recent studies, on the other hand (which are more likely to incorporate buprenorphine as a detoxifying agent in the standard therapy arms) have shown that AAROD does not lessen withdrawal intensity. Furthermore, few empirical investigations (randomized controlled trials) have been conducted, and the available data is regarded as restricted and of poor quality.

Despite the fact that ROD was created for detoxification rather than maintenance, it was always hoped that ROD would help ease the transition to the second phase of treatment and, in the long term, reduce relapse. Unfortunately, research suggest that AAROD has no advantages over normal detoxification techniques in terms of abstinence rates in the short and long term.

Despite the fact that we've covered many of ROD's drawbacks, there are a few things to keep in mind. For one thing, AAROD methods have differed significantly from clinic to clinic, making a thorough investigation difficult. Future well-controlled trials could help to better understand the dangers and benefits of opioid detoxification.

Furthermore, if safe protocols could be created, ROD treatments may be investigated for the treatment of opioid-related pain syndromes or for induction onto long-acting naltrexone for OUD, which is critical for the medication's long-term efficacy. Given the dangers of ROD, recent evidence suggests that medication-assisted treatment (MAT) for opioid use disorder offers favorable treatment outcomes, allowing people to stay off opioids, lower the chance of overdose, and live happy lives.

Opioid Use Disorder Maintenance Treatment

Remember that opioid detoxification is nearly never sufficient as a treatment in and of itself. Most individuals might consider pursuing OUD maintenance treatment after speaking with their doctor to help prevent relapse. Evidence-based maintenance treatment typically combines intense counseling (residential treatment, intensive outpatient group-based therapy, individual outpatient therapy) with opioid drugs like buprenorphine/naloxone (Suboxone), methadone, or opioid antagonists like long-acting naltrexone. Medication for addiction treatment (MAT) for opioid dependence has been extensively examined in multiple large clinical studies and has been shown to reduce mortality, enhance treatment retention, and lower the prevalence of infections linked with IV drug use, such as HIV. Most insurance policies cover it as well.