Opiate detoxification under anaesthesia

Enthusiasm must be tempered with caution and scientific scrutiny

At least 10 000 opiate misusers have recently undergone a new detoxification treatment in which acute provocation of withdrawal by opiate antagonists is administered under the cover of a general anaesthetic.1 2 3This technique has been variously hailed as a revolutionary breakthrough or condemned as exploitation of the addicts and their families. While neither the antagonist provocation nor the use of a general anaesthetic is new the combination has apparently captured the imagination of some clinicians, misusers and their families, and commercial interests—the treatment is available only in the private sector and is expensive.

Much of the controversy has been generated by competing claims of effectiveness and competence from rival providers. Anyone trying to make an objective assessment has been hampered by the lack of information about techniques and of any independent evaluation.3 Indeed, the starting position should be that this technique needs to be shown to produce clear cut benefits sufficient to offset its inherent dangers.4 These include both the hazards of prolonged general anaesthesia and those …