Letters Page #883

Subject: RE: #868, Publish or Perish!
From: ajbyrne@ozemail.com.au
Date: Mar. 13, 1999

Dear Colleagues,

From his report to MIE, Dr Daiter uses his own experience with rapid detoxification to justify its implementation and, apparently, to influence others to do the same. On my understanding, there is still little medical evidence on the safety and effectiveness of rapid detoxication from opiates in heroin addiction.

Dr Daiter uses emotive expressions concerning methadone, describing it as "liquid handcuffs". Others may call it a "liberating treatment" which frees them from the "tyranny of heroin". But such loaded terms are unhelpful in an important scientific debate.

And a scientific debate is what we need since young people are dying in droves. It is not useful to state that these treatments were given 'with good success' and that 'UROD' was 'preferable'. It would be helpful if Dr Jeff Daiter MD could publish his favorable results so that others can learn from his experience using this modality.

Recent authors^[1] have been critical of the general implementation of this treatment prior to controlled trials. In specific cases there may well be justification for using an unusual and costly treatment. However, in the general patient population the use of rapid detoxification under anesthetic is still not known to be beneficial long-term.

^[1]References:

Brewer C. Unethical promotion of rapid opiate detoxification under anaesthesia (RODA) The Lancet (1988) 351:218

Dyer C. Addict died after rapid opiate detoxification. BMJ (1998) 316 (17 January)

Gossop M, Strang J. Rapid anaesthetic-antagonist detoxification of heroin addicts: what origins, evidence base and clinical justification? B J Intensive Care 1997;7:66-9.

Herman BH, Czechowicz D. NIDA Scientific Report of Ultra Rapid Detoxification with Anesthesia (UROD): Opinion of the Consultants and Criteria Relating to Evaluating the Safety and Efficacy of UROD, February 23, 1996.

O'Connor PG, Kosten TR. Rapid and Ultrarapid Opioid Detoxification Techniques. 1998 JAMA 279;3:229-234

comment by Dr Andrew Byrne ..

Dr Andrew Byrne,
General Practitioner, Drug and Alcohol,
75 Redfern Street,
Redfern,
New South Wales, 2016,
Australia
Tel (61 - 2) 9319 5524 Fax 9318 0631
Email ajbyrne@ozemail.com.au

Author of: "Methadone in the Treatment of Narcotic Addiction" and "Addict in the Family".