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In Reply: The study by Dr Favrat and colleagues¹ comparing anesthesia-assisted rapid opioid detoxification with a clonidine-based inpatient alternative had results similar to ours. As Drs Favrat and Besson noted, 3 randomized clinical trials have now failed to find evidence to support long-term efficacy for the anesthesia-assisted procedure, and none has demonstrated evidence supporting its use. In our study, the positive control procedure, buprenorphine-assisted rapid opioid detoxification, was comparable with the anesthesia procedure on all important positive outcome measures (withdrawal scores, rates of naltrexone induction, and treatment retention) while being much safer and far less expensive.

We agree with Dr Miller that the results of our study, as well as those of McGregor et al² and Favrat et al,¹ should be very carefully considered by clinics and hospitals that might offer the anesthesia procedure, as well as by patients considering it. Miller highlights the high relapse rates in all 3 . . . [Full Text of this Article]

Eric D. Collins, MD
edc3@columbia.edu

Herbert D. Kleber, MD
Division on Substance Abuse

Robert A. Whittington, MD
Department of Anesthesiology
College of Physicians & Surgeons of Columbia University
New York, NY