General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomized controlled trial

Aim Opioid detoxification by administering opioid-antagonists under general anaesthesia has caused considerable controversy. This study is conducted to determine whether rapid detoxification under general anaesthesia results in higher levels of opioid abstinence than rapid detoxification without anaesthesia. Design Randomized controlled open clinical trial from September 1999 to August 2001. Setting Four addiction centres in collaboration with three general hospitals in the Netherlands. Participants A total of 272 opioid-dependcnt patients whose previous attempts to abstain were unsuccessful. Intervention Patients received rapid detoxification with general anaesthesia (RD-GA) or without general anaesthesia (RD). Measurements Urine screens and an interview (EuropASI) to assess opioid abstinence; two questionnaires (SOOS, OOWS) to measure withdrawal symptoms and one to measure craving (VAS). Findings One month after the intervention 62.8% of the patients in the RDGA group and 60.09% in the RD group were abstinent for opioids (P = 0.71). No adverse events or complications occurred during RD: however, in the RD-GA group, five adverse events necessitated admission to a general hospital. The average 1-month cost for RD was EURO2517 versus EURO4439 for RD-GA. Conclusions Rapid detoxification under general anaesthesia did not result in higher levels of opioid abstinence than rapid detoxification without anaesthesia. The cost of the former intervention was much higher.