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To the Editor.— In an otherwise excellent review of rapid and ultrarapid opioid detoxification techniques by Drs O'Connor and Kosten,¹ we would like to point out 3 major errors and make 1 point of clarification.

First, the anesthesia mortality rate of 1 in 1185 to 1 in 6789 is out-of-date, and was cited from a textbook published in 1992. Current anesthesia mortality among the American Society of Anesthesiologists' physical classification I and II patients, into which the vast majority of young people addicted to opiates almost undoubtedly fit, is rare.^2-3

Second, the cases of pulmonary edema that occurred after naloxone administration were not in patients undergoing detoxification but rather were during anesthetic administration for surgery; most important, these patients did not receive clonidine as part of the anesthetic. In performing ultrarapid detoxification (URD), a fundamental point is the high-dose administration of an ₂ agonist prior to detoxification. There are no reports . . . [Full Text of this Article]