Currently, the American Society of Addiction Medicine
and the American Society of Anesthesiologists do NOT
offer specific guidelines to consumers or providers of the one day detox method.
Therefore, I will offer these guidelines to consumers in an attempt to help you in asking
important questions from providers and choosing an appropriate one day detox facility.
Other physicians have offered their own suggested guidelines. Click here to view these comments.
Guidelines for One Day Detox programs.
- An anesthesiologist or nurse anesthetist should be by
the patient's bedside during the entire detoxification period. Some providers
will try to call the procedure "sedation" instead of "anesthesia."
This is only a play with words in an attempt to save total costs. In all cases of one day
detox, the patient is unconscious, does not respond to verbal commands, and is at risk for
aspiration unless an endotracheal tube is placed (the patient is pre-disposed to vomiting
and may have stomach contents enter the lungs if appropriate precautions are not taken).
Anesthesiologist and nurse anesthetists are the only professionals specifically
trained to manage patients in this state of consciousness. I refer you to general
guidelines adopted by the American
Society of Anesthesiologists. Specifically noted are 1) "Qualified anesthesia
personnel shall be present in the room throughout the conduct of all general anesthetics,
regional anesthetics and monitored anesthesia care". 2) During all anesthetics, the
patient's oxygenation, ventilation, circulation and temperature shall be continually
evaluated" (note the word "continually" - this is a basic standard of
care).
- One day detoxification programs should have linkage to
post-detox rehabilitation services. It is clear that detoxification without
rehabilitation results in poor long-term abstinent rates. Scientific studies will need to
be done to evaluate whether or not simple referral to a rehabilitation program is
efficient. I recommend that specific rehabilitation is linked directly to the detox
program.
- A medical professional specifically trained in the
management of addictions (preferably a member of the American
Society of Addiction Medicine) should have oversight of the entire detoxification and
rehabilitation program. This statement is self-explanatory and underscores
concerns regarding providers who offer one day detox without having education and
experience in treating opiate dependency.
- Providers should make an attempt to select patients who
show evidence of maintaining long term abstinence from opiates. The one day
detox procedure should not be a revolving door detoxification.
- No patient should be forced to participate in one day
detoxification. The procedure is potentially beneficial only for those
patients who want to quit using opiates.