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To the Editor: The study by Dr Collins and colleagues¹ will surely be of interest to hospitals and other clinical facilities that are considering the introduction of either ultrarapid opiate detoxification (using general anesthesia along with an opioid antagonist, such as intravenous naloxone) or rapid opiate detoxification (using other means of sedation along with an opioid antagonist, such as oral naltrexone). The results were mixed, as expected in a study addressing management of patients with heroin addiction, one of the most intractable problems in addiction medicine.

However, given the small sample size, we still do not have adequate data to advise patients about the extent to which rapid treatment that does not use anesthesia is safer than ultrarapid treatment that uses general anesthesia; nor do we know whether the incorporation of opioid antagonists (naloxone or naltrexone) is responsible for differences in clinical outcome. Moreover, examining detoxification approaches alone does not . . . [Full Text of this Article]

Michael M. Miller, MD
mmmille4@facstaff.wisc.edu
NewStart Alcohol/Drug Treatment Program
Meriter Hospital
Madison, Wis

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