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Sunday, January 10, 2010

First the Body, Then the Mind; How to Quit Opiate Drug Addiction

Opiate drug addictions, such as oxycontin, oxycodone, hydrocodone, heroin, methadone, suboxone, fentanyl have a significant physical component to the addiction, in addition to the psychological component. Counseling and other psychological help to stop the psychological component addiction cannot begin comfortably if the patient was going through physical withdrawal. Rapid Detox for opiate addiction does not pretend to address the psychological aspect of addiction, nor is it a way to alter the patient's mind or personality. It merely stops the physical addiction quickly and with much less withdrawal compared to the traditional "cold-turkey" technique of quitting opiate drugs. Following the 8 hours of rapid detox at our clinic, the patient goes through 36 to 48 hours of one-on-one care to optimize comfort. They also begin their stay at Solutions Recovery Center to start psychological counseling in a residential substance abuse recovery center. We encourage patients to stay for 7, 14 or 21 days to get a good start on the year-long psychological counseling. But keep in mind that the physical component of addiction, the withdrawal and craving, are already substantially eliminated before we hand the patient over to the psychologists and counselors to begin the long-term psychological recovery process.

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Saturday, January 9, 2010

How to Do Rapid Detox for Methadone Addicts


Clinical Experience in Treating Patients Addicted to Methadone Using Rapid Detox technique

 

Methadone has a half life of up to 8 days in the human body. When subjected to the routine rapid detox procedure, the patients' opiate receptors (mu receptors) in the brain, the spinal cord and the gastro-intestinal tract are quickly occupied by naloxone molecules, displacing the methadone molecules. The problem is that after the rapid detox process, the naloxone molecules themselves would leave the opiate receptors and be metabolized. Methadone molecules stored in the fatty tissue of the body are then free to re-occupy the opiate receptors, producing prolonged opiate withdrawal and craving for opiates.

 

There are two strategies to rapid detox methadone. One is to have the patients stop methadone 7 weeks before the detox, and switch to other shorter-lasting narcotics for that period. The other way is to immediately start the patients on Naltrexone oral treatment after intravenous rapid detox. The latter technique can produce worse residual withdrawal symptoms. The former, naturally, would require longer commitment from the patient, making two visits to the detox center, but entails much less hardship after detox.

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You Can Quit Oxycontin, Oxycodone, Heroin and Other Opiates in 8 Hours Without Withdrawal, But Not in 1 Hour, With Legit Rapid Detox Treatment


Longer is Not Easier, but Better, in Rapid Detox under Anesthesia

By Thomas C. Yee, MD                          

Medical Director, Board-Certified Anesthesiologist (1994) and Board-Certified Pain Management (1997)

Las Vegas Rapid Detox Medical Clinic

www.rapid-detox-clinic.org

(800) 276-7021

 

        Who needs rapid detox? Why do we do rapid detox ? Why does it have to last at least six to eight hours under anesthesia while the patient receives the antidote to opiates intravenously? Why not just do it for one hour or two? Why not give the patient Suboxone and declare the rapid detox a success and send the patient home after one hour?

        People who are addicted to opiates, be it heroin, vicodin, oxycontin, Percocet, methadone, suboxone, etc, and cannot quit the addiction on their own and cannot tolerate the physical withdrawal come to us for rapid detox procedure. Not every doctor is qualified to do rapid detox. Only very experienced and board-certified anesthesiologists are also board-certified in pain management should attempt performing rapid detox. Not every pilot is qualified to fly 747 airliners. Not every doctor should be allowed to perform rapid detox.

        Our protocol has the patient receive high dose Naloxone (Narcan), the antidote to opiates, intravenously while the patients sleep under anesthesia, for a total of close to eight hours. Some other rapid detox facilities only have the patient sleep for one hour. This difference begs the question: where does the opiate drug go once it has been pushed out of the opiate receptors in the brain by Naloxone? It does not spontaneously disintegrate. Pharmacology teaches us that drugs have certain half-lives, time it takes the body to clear or remove half of the amount of that drug in the body. For the liver and kidneys to remove the heroin or other opiates from the blood circulation, once it has been pushed out of the brain by Naloxone, many hours are needed. This elimination metabolic process cannot be sped up easily. At a rapid detox center that only puts the patient under anesthesia for one hour, they are setting the patient up to wake up in the middle of massive physical withdrawal. Or they give the patient Suboxone, another powerful opiate, to reduce the withdrawal, but further condemning the patient to long term addiction to Suboxone, instead of the original opiate the patient was addicted to.

        Only Naloxone (Narcan, Naltrexone) are antidote to opiates, capable of displacing opiate molecules from the opiate receptors in the brain, in the spinal cord, and in the gastrointestinal tract. Not using enough Naloxone for long enough period to allow the maximum of opiate molecules to be removed not just from the brain but from the whole body altogether, through the liver and kidneys, is not adequate detox. Instead of waking up practically free of physical withdrawal and physical craving for opiates, the patients would wake up feeling severe withdrawal. It is technically more challenging to keep the patients asleep for longer periods, but that is precisely why in our clinic the experienced board-certified anesthesiologist stays with that one single patient continuously for eight hours, to ensure safety and comfort of the patient.

        The lay person often asks: "Isn't eight hours of anesthesia dangerous?" That is similar to asking: "Isn't it dangerous to fly in a Boeing 747 across the ocean for twelve hours?" The danger is reduced to an acceptable when you have highly trained professionals willing to attend to the patient or passenger, physically attending to their safety and wellbeing, without distraction, for the entire duration. Without an experienced pilot at the helm, even one hour flying in a Boeing 747 would be risky. With an experienced pilot, flying cross-ocean on trips lasting 12 to 14 hours becomes safe.

        One hour under anesthesia for rapid detox is not enough, leaving patient waking up in massive withdrawal. Perhaps that is why there are horror stories on internet about "rapid detox." When it comes to rapid detox under anesthesia, longer duration is not easier on the doctor and staff performing the procedure, but it is better for the patient.

 

By Thomas C. Yee, MD        

Medical Director

Board-certified in both Anesthesiology and Pain Medicine

 

www.rapid-detox-clinic.org

 

Las Vegas Rapid Detox Medical Clinic

 (800) 276-7021

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1:27 pm pst          Comments

You Can Quit Oxycontin, Heroin, Methadone, Suboxone and Other Opiates Without Withdrawal; Rapid Detox is Not Black Magic
By Thomas C. Yee, MD                          

Medical Director, Board-Certified Anesthesiologist (1994) and Board-Certified Pain Management (1997)

Las Vegas Rapid Detox Medical Clinic

www.rapid-detox-clinic.org

(800) 276-7021

 

        How does rapid detox work? Why does rapid detox work? From personally performing hundreds of rapid detox procedures successfully, this writer has continuously modified and improved on not just the practical clinical protocol but also a theoretical understanding of opiate addiction and rapid detox. We know it works, but why does it work. From a scientific curiosity, we search for a theoretical basis for our practical clinical success.

        Imagine a heroin addict trying to quit cold-turkey style. If he can hang in there for 8 days, by the grace of God and with super-human willpower, overcoming the insufferable physical withdrawal, then he will have successfully quit the initial phase of addiction. He will have overcome the physical addiction. Much psychological work needs to be done by him and hopefully his counselors to beat back the mental craving.

        What if we can keep this hypothetical heroin addict asleep for the 8 days? It is reasonable to assume that he would wake up from the sleep feeling free of physical addiction to opiates, feeling no physical withdrawal. What if we can use certain medications and technology to shorten this time period from 8 days to 8 hours? That is rapid detox as being performed in this clinic.

        Rapid detox is not black magic. It is accelerated removal of opiates from both the opiate receptors and from the body's blood circulation. In accomplishing the first part, removal from the receptors, it only takes minutes. In accomplishing the second part, removal of opiates from the body's circulation, the body's own kidneys and liver need time; these organs need between 4 to 8 hours to eliminate the opiates from the body. That is why we need to keep the treatment going under anesthesia for at least 8 hours. Otherwise, waking the patient early will result in a patient feeling massive withdrawal.

        In the body of an opiate addict, the opiate receptors in the brain, the spinal cord and the gastrointestinal tract are like spoiled children addicted to having a lollipop constantly in their mouths. Imagine a daycare center with 100 such kids. Conventional quitting approach is akin to taking away the lollipop from one child at a time, compelling the child to throw a crying temper tantrum fit for 3 hours. At the end of 3 hours, the crying becomes a whimper and finally stops because the child begins to realize that tantrum will not bring back the lollipop; he begins to adapt to a life without lollipop. One child at a time, we are looking at 300 hours of crying temper tantrum. In rapid detox, as we do it, we would yank out all 100 lollipops at the same time, producing an earth-shaking collective temper tantrum. At the end of 3 hours, however, all 100 children begin to pipe down and reluctantly begin to adapt.

        We have observed this in the hundreds of patients we detox. Since our procedure lasts 8 hours, we get to observe the amazing transformation every time. Initially, when the naloxone first enters the blood stream of the patient, he would instantly react under anesthesia, by various involuntary movement of the hands, feet, sneezing, yawning, twitches, etc. Soon, depending on the depth or dosage of the opiate preexisting opiate addiction, the patient would calm down, exhibiting less and less involuntary movement. Invariably, after between 20 minutes to 3 hours, all movements cease except for regular breathing motions. This appears to be a manifestation of the child-like opiate receptors, after throwing temper tantrum, finally giving up and beginning to adapt to a opiate-free brave new world. When the patient wakes up after 8 hours of treatment, he is free of the physical withdrawal and the bulk of physical addiction.

        Case after case, patient after patient, we have observed this phenomenon. Opiate receptors do adapt, as long as we take away nearly all opiate in the body. If the residual opiates molecules are in enough quantity to reoccupy certain critical proportion of the overall population of the opiate receptors, then the patient would manifest withdrawal reactions again. We have seen this in those patients who have chronically injected heroin into muscles producing scarred-in pockets of heroin. After rapid detox, when they massage those muscles, they would feel physical withdrawal.

In general patients report little or no physical withdrawal after rapid detox, and can move on with their lives undergoing the very important psychological counseling afterwards without any need for Naltrexone. We have also observed that after patients awaken from anesthesia, if we inject additional naloxone or give patients Naltrexone pill too soon afterwards, they sometimes report feeling of residual physical withdrawal. While if we hold off Naltrexone pill for 10 days after rapid detox,

The patients do not report feeling residual physical withdrawal. So what does this tell us?    

This suggests that after rapid detox, if we do nothing to further irritate the receptors, not giving them opiates, nor challenging them again soon with naloxone, patients tend to feel no physical withdrawal or physical craving for opiates. This also suggests that the opiate receptors, when viewed as a population of receptors, exhibit group behaviors different from individual receptors' behaviors. Hypothetically, if say 60 percent or more of all receptors are binding to opiate molecules, then there is no feeling of withdrawal. If between 10 and 60 % of receptors are binding to opiates, then there is feeling of withdrawal. If less than 10% of receptors are binding to opiates, then also there is no feeling of withdrawal. Within this small minority of receptors, about 10 % or less, if there is active displacement of opiates by naloxone or naltrexone, then the patient would feel moderate physical withdrawal. If this small minority, over the following days, gradually loses the opiate molecules through natural dissociation and metabolism, then there is no feeling of withdrawal.

Perhaps, in conclusion, both the speed of losing opiate molecules from receptors and the overall percentage of opiate-bound receptors contribute to the physical withdrawal and the physical craving in opiate addiction. Also, in conclusion, back to our original example, if a heroin addict could sleep for 8 days straight under adequate anesthesia, then he would be free from physical addiction. By shortening a heroin addict's cold-turkey quitting torture from 8 days to 8 hours, still keeping him asleep under anesthesia, we have arrived at a practical technique of rapid detox. Our understanding and the proper formulation of the theory behind this success is now beginning to grow.

       

By Thomas C. Yee, MD       

Medical Director

Board-certified in both Anesthesiology and Pain Medicine

 

www.rapid-detox-clinic.org

 

Las Vegas Rapid Detox Medical Clinic

 (800) 276-7021

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1:23 pm pst          Comments

Rapid Detox Works but Only as First Step in Recovery from Oxycontin, Heroin, other Opiate Drug Addiction, Not a Replacement for Drug Addiction Recovery
Rapid Detox, a First Step in Recovery, Not a Replacement for Recovery

Rapid detox, or ultra rapid detox, should only be the initial part of the recovery process, to always be followed by extensive psycho-social counseling, therapies and life habit-changing arrangement. Addiction to Heroin, Oxycontin, Vicodin, Lortab, Oxycodone, Hydrocodone, Suboxone, Methadone are all opiate drug addictions.

Without these follow-up steps, there is chance for relapse. Rapid detox only stops the physical addiction, without putting the patients through the torture of feeling the withdrawal process, but it does not address the psychological and social underpinning of the addiction. The patient must get psycho-social counseling and realignment therapies following rapid detox. With Rapid Detox, patients can enter the long recovery process without the bulk of the suffering from physical withdrawal. In this context, it is an advantageous first step, because it quickly achieves significant reduction in addiction and physical withdrawal if performed correctly. It does not require super-human will power or tolerance for the physical withdrawal process that may last 5 to 10 days. Without Rapid Detox, patients may be dissuaded from even trying, or they may not even be able to sit through counseling sessions due to the evolving physical withdrawal.

As a board-certified anesthesiologist with 19 years of clinical experience, especially with constant exposures to both pain management and cardiac anesthesia, I have come to appreciate some finer points of the techniques of rapid detox. We perform what I believe to be a more advanced rapid detox technique at our center, www.rapid-detox-clinic.org. For example, we keep patients under anesthesia and receiving intravenous naloxone for at least 8 hours, longer than any other treatment center (they do between 2 to 4 hours). This works better because the displaced opiate molecules, away from the opiate receptors, still needs time to be eliminated by the liver and kidneys, a process that cannot be accelerated, requiring at least 8 hours. This and many other variations in technique and expertise among rapid detox treatment centers make it difficult for scholars to compare the efficacy and safety between rapid detox and other methods.

Since the central nervous system is the site where most of the competitive inhibition takes place between the naloxone molecules and the opiate molecules, it makes sense to monitor the brain. That is why in our treatment, we monitor the brain's electro-encephalogram (EEG) and cerebral oximetry (rSO2) continuously to ensure adequate and appropriate anesthetic depth and optimal brain oxygenation and perfusion. These are techniques adopted from my parallel practice as a cardiac anesthesiologist providing service to open-heart surgeries. It is essential to monitor the patients as if they are undergoing major surgeries. Being over-prepared and being over-cautious are  very important in creating a safe rapid detox process.

Our detox center, www.rapid-detox-clinic.org, actually performs the rapid detox procedure at Desert Springs Hospital, www.desertspringshospital.com, in Las Vegas. during a patients' 48 hour stay in the hospital, we never have fewer than 1 person dedicated to staying with the patient, by the bed-side, at all time. Not only is it always at least one-on-one, but often two-on-one. This is important not just to take care of the patient's comfort needs, but also to provide constant and compassionate care with immediate human responsiveness. This and the above features separate us from all other rapid detox clinics.              

Thomas Yee, MD  

Medical Director,

Board-certified by American Board of Anesthesiology (1994) and American Board of Pain Medicine (1997)

Las Vegas Rapid Detox Medical Clinic

www.rapiddetoxlasvegas.com                  800-276-7021

1:18 pm pst          Comments


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