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A relatively new method for cleansing heroin and other opiates from the system has some immediate benefits, but poses risks for those who are unfamiliar with the procedure or new to heroin use.

Rapid detox, involving the use of an opiate antagonist and anasthesia, was developed by an Austrian physician during the late 1980s. Known also as ultra-rapid detox, neuro-regulation, intensive detox, and the Waismann Method, it is an alternative to traditional five-to seven-day detoxification programs. The procedure, depending on the protocol used, can take anywhere from four to 24 hours, with subsequent aftercare taking place in a recovery room or ICU.

The treatment team usually consists of a doctor or nurse and an anasthesiologist. Using an intravenous line, the anasthesiologist first administers fentanil or phenobarbital to the patient to induce sleep. Blood pressure, pulse, oxygen saturation, and temperature are constantly monitored to alert the team to the presence of withdrawal symptoms. Naltrexone, a medication usually taken orally, is crushed into a powder and fed to the patient through a nasogastric tube. This drug is given in titrated amounts throughout the procedure, and is designed to reduce cravings among those addicted to heroin. Drugs are also used to help lower blood pressure, which may become elevated during withdrawal, and to counteract nausea--another withdrawal symptom.

When the procedure is finished, the supervising physician may administer Naltrexone as an implant under the skin. Tranquilizers such as benzodiazepines (Xanax, Ativan, etc.) as well as additional doses of blood pressure medication also may be used after the patient awakens. Once patients are able to walk, they are discharged.

Advocates for the procedure say it is a safe alternative to other types of detox. (Opiate detox usually means a stay in a hospital of up to seven days or longer, or an even longer outpatient treatment with methadone or other opiate derivatives.) They offer it as a way for patients to get help who may not ordinarily identify themselves as addicts and are reluctant to be associated with any type of traditional treatment or self-help program. The benefits are immediate, allowing patients to go back to work, home, or school with a minimum of disruption to their daily lives. In addition, since patients are unconscious during the procedure, they don't suffer from uncomfortable withdrawal symptoms. Over 10,000 patients have benefited from this procedure.

But there are a number of documented problems as well, and some of the benefits are questionable. Opiate withdrawal, although it is extremely uncomfortable, is rarely life-threatening, unless seizures are involved. Rapid detox, on the other hand, has been responsible for at least 10 deaths from complications arising during the procedure. There can also be heart and respiratory problems.

Although Naltrexone has been approved for oral use by the FDA, no studies have been conducted to evaluate its use as an implant. And finally, while the procedure may eliminate the physical dependency from heroin and other opiates, the patient still has to do the hard work of recovery from the addictive process. This usually means going to 12-step groups such as Narcotics Anonymous, avoiding places and people associated with drugs, and involving a patient's family and friends.

Rapid detox can be a useful way for someone who has used heroin to end physical dependence and get on with his or her life quickly. In many cases it's a comfortable and fast way to address the immediate medical problems connected with heroin use. However, the procedure is not risk-free, and nothing can guarantee against relapse except long-term recovery work.