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To the Editor: In his editorial regarding methods of detoxification and treating patients with opioid dependence, Dr O’Connor¹ considers the results of the study by Dr Collins and colleagues² in the same issue of JAMA, as well as an earlier Dutch study.³ He concludes that "anesthesia-assisted opioid detoxification should not have a significant role in the treatment of opioid dependence."

This conclusion about the use of general anesthesia for heroin detoxification and rapid antagonist induction apparently stems from 3 adverse events in the general anesthesia group. One patient, who concealed a history of obstructive sleep apnea, developed negative-airway-pressure pulmonary edema and aspiration pneumonia 14 hours after general anesthesia. Another patient concealed a history of bipolar illness and became manic 5 days after general anesthesia. A patient with diabetes mellitus did not report prior episodes of ketoacidosis, which in this study recurred 2 days after discharge. Neither general anesthesia itself . . . [Full Text of this Article]

Catherine J. de Jong, MD
c.j.dejong@euronet.nl
Department of Anesthesiology
De Lairesse Clinic
Amsterdam, the Netherlands

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