To the Editor:-We read with great interest the Editorial View by Roizen that accompanied the article by Kienbaum et al. regarding rapid opiate detoxification under general anesthesia in the May 1998 issue of Anesthesiology. We are concerned, however, that this editorial fosters an inaccurate notion of what this novel treatment achieves for opioid-addicted patients. To our knowledge, there exist no properties of general anesthesia that “break opioid addiction,” and there is no indication “that the mechanism that produces the unconscious state during general anesthesia … may indeed permanently alter brain biochemistry.” Furthermore, nothing of this sort is suggested by the results presented by Kienbaum et al. As far as we understand, the effects of anesthesia on brain biochemistry are transitory, and they dissipate soon after emergence. The objective of administering a general anesthetic for the purpose of treating opioid dependence is merely to enable the patient to tolerate great doses of opioid receptor antagonist drugs and thus undergo complete detoxification in a matter of hours and while unconcious, rather than over several days or weeks while awake and suffering from severe withdrawal symptoms. When awakened from the anesthetic, the opioid receptors are occupied by antagonist drugs and withdrawal symptoms are minimal and they quickly abate. Ongoing treatment with naltrexone to maintain opioid-receptor blockade can then be initiated to prevent drug craving and decrease the likelihood of relapse. As with any form of drug detoxification treatment, rapid opiate detoxification during general anesthesia must be offered in the context of a comprehensive addiction treatment program that also provides supportive psychotherapy or counseling, or both, to address the underlying causes of addiction and to assist the former addict in developing effective relapse prevention strategies.
Robert E. Solomon, M.D., Ph.D.
Stephen F. Markowitz, M.D., Ph.D.
Associate Medical Director; Puget Sound Rapid Opioid Detoxification (PROD); Consultants, Inc., P.S.; Seattle, Washington
(Accepted for publication September 1, 1998.)