Beware: Rapid Opioid Detox Under Anesthesia

Recently, I've noticed an uptick in the number of U.S. treatment providers offering rapid detoxification from opioids, including fentanyl, methadone, and buprenorphine, under anesthesia. This process has been around at the fringes of addiction medicine for over 20 years, and it is as dangerous as it is disingenuously advertised. Case in point (ANR Clinic) discussed below.

Believe me: I know that getting through withdrawal is the major barrier to most opioid addicts getting clean. There simply aren't words for the dread, sleeplessness, and physical pain.

It's real Hell.

The first time that I had a friend mention that he was considering undergoing opioid withdrawal under anesthesia was circa 2010.

The doctor was a private-pay clinician based out of NYC, and one of the ways that he would entice patients to commit to his service was by offering a few days' worth of morphine to tide them over until they could make it downstate for the detox. Prescription dispensed after full deposit rendered, of course.

I remember looking into this doctor, who later lost his license, expecting to hear some pseudoscientific, biochemical babble justifying his treatment method - complete with infusions of N-acetylcysteine (NAC) and other antioxidants and "healing / regeneration" chemicals / cofactors.

When I discovered that the procedure was actually just introducing an opioid antagonist* into an addicted person's system while they were under anesthesia for 4 to 5 hours, then discharging them with a naltrexone script (or implanted pellet) the next day, I was shocked that any doctor would be reckless enough to perform this procedure and brazen enough to advertise it as a "cure."

*If you're not clear on how the mu opioid receptor system works, consider checking out my article here, which explains full vs. partial agonism, antagonism, binding affinity, withdrawal, and other key concepts.

Inducing opioid withdrawal while under heavy sedation / anesthesia is an increasingly discredited practice that in the U.S. has resulted in over a dozen deaths that were unforced errors. To quote an article summarizing nine studies examining this practice (available here):

"The intensity of withdrawal experienced with anaesthesia‐based approaches is similar to that experienced with approaches using only minimal sedation, but there is a significantly

increased risk of serious adverse events with anaesthesia‐assisted approaches."

This practice is dubious and dangerous, despite which a clinic calling itself Accelerated Neuro Regeneration (ANRclinic.com) is currently listed as a sponsored result in Google searches linked to opioid withdrawal treatment. These scumbags are promising that you will "wake without cravings or withdrawal" and "return to the life [you] led before opioid addiction in as little as 48 hours." These are blatant lies.

The thing is, rapid induction of withdrawal under anesthesia does nothing for you except knock you out for the first 4-5 hours of the severe withdrawal that your doctor is precipitating, which will last a minimum of 48 to 72 hours.

No one can keep you under anesthesia for long enough to get you through several days of acute withdrawal, then several weeks to months of Post-Acute Withdrawal Symptoms (PAWS). PAWS symptoms, by the way, are almost certainly made worse by the fact that you've suddenly induced withdrawal using an antagonist rather than using a slow, steady taper that gives your physiology time to adapt along the way.

If you survive detox under anesthesia, you will wake up in full withdrawal. You will be discharged from care the next day just as sick, or even more sick, than you would be if you had stopped your opioid of choice cold turkey the day before.

Because of this, you will almost certainly relapse. In one study (available here) of an ultrarapid opioid detox protocol, every single participant relapsed within six months of treatment, and 75% did so within one month. This failure rate is abysmal even for opioid addiction treatment.

Only time can heal your neurophysiology. It takes four to six weeks for new receptor creation and other cellular changes to bring your physiology back toward a healthy baseline following cessation of opioid use.

Proper nutrition, exercise, and sleep can speed your recovery, but time takes time. There are no free lunches, and this is perhaps truer of coming off of drugs than most things in life.

An extended, slow taper is the best way to get off of opioids (see my tapering tips here). If you can't hold / ration your own opioids, which is a very common problem, then use a clinician or a trusted friend / family member to dispense them to you daily.

If you cannot deal with the withdrawal symptoms posed by a taper, then you most certainly will not be able to handle full-tilt withdrawal of the sort that you'll experience after waking up from being under anesthesia for this type of procedure. I promise.

If a monthslong taper isn't an option for you, there are intermediate-length buprenorphine and methadone tapers that last 10 to 14 days. It might take some trying to find a provider that is affordable or covered by insurance in your area, but this is a much safer, more effective method.

One more note: These programs almost always discharge you on naltrexone, an antagonist used to manage cravings and block opioids should you take them to get high. Naltrexone is often implanted under the skin in pellet form during these rapid detox protocols, which is foolish; it's a medication with significant side effects, and it should be started gradually, using an oral formulation, so that side effects can be gauged and managed.

Please don't get so desperate that you go nuclear. You'll end up worse off than you are now.

More Information About Anrclinic.com

Despite the fact that it has been featured on Fox News and USA Today - indeed, perhaps because of that fact, given the grievous state of mass media and medical advertising in the United States in the present day - this outfit advertises itself with some incredibly sketchy claims, and there are other red flags associated with it, as well.

The website quite correctly notes the dangers and drawbacks of rapid opioid detox under anesthesia (link here):

"Some of the cons of rapid opioid detox include: 

• Undergoing more stress due to the speed of the detoxification process 

• Being at an increased rate of relapse, which can ultimately lead to you having to undergo the drug detox process several times. 

• Rapid detox only assists the patient in eliminating opioids; it does not address the root cause of dependency."

The website notes the damage caused by "standard" rapid opioid detox under anesthesia, including the possibility of death while under, the high rate of relapse compared to other methods, and the fact that the procedure does nothing to address the underlying neurophysiological and cognitive / emotional changes that drive addiction - without changing which the rate of relapse is essentially 100 percent.

However, the website contains absolutely no concrete information about what makes ANR Clinic's approach different from standard, anesthesia-assisted rapid opioid detoxification using naltrexone as the precipitating agent (and with naltrexone treatment ongoing afterward to combat cravings and to block opioids in the event of relapse).

Again, there is not one single shred of evidence that the ANR Clinic employs any protocol other than a standard rapid opioid detox that is induced using the opioid antagonist naltrexone, the first 4-5 hours of which occurs under anesthesia. As with all such protocols, ANR Clinic prescribes its patients naltrexone for the following year to help with cravings and to block the high from opioids should relapse occur. Note that the clinic is promising that your neurophysiology will be immediately corrected and that you will not suffer from cravings! It uses pseudoscientific babble like "Post-procedure endorphin system optimization in the hospital" and "Rebalancing of endogenous opioids and receptors," which means absolutely nothing in this context - only time can achieve these returns to neurophysiological baseline (and, ironically, endorphins are blocked by naltrexone just as exogenous opioid drugs are, so this protocol can actually work against restoring normal endorphin function). These lies would be laughable if they weren't so dangerous and evil. Put bluntly, this entire chart is a lie. To quote one of The Office's most memetic moments, "It's the same picture." ANR Clinic's protocol is rapid detox.

As evidenced by the above chart, the clinic's materials state that standard rapid opioid detox protocols aren't administered by anesthesiologists or intensivists, as opposed to ANR's protocol, which is; likewise, the chart states that rapid opioid detox procedures are not performed in the hospital (ICU) setting using advanced critical care monitoring equipment.

Both of these allegations are patently false. There are two notable cases of physicians who did not have expertise in anesthesiology / critical care or addiction medicine / psych, who had action taken against their licenses due to performing anesthesia-assisted opioid detoxes in a non-hospital outpatient facility (article here). However, this occurred in the very early days of the implementation of these protocols in the U.S. (around 1990-2000), and almost all rapid opioid detox protocols are now performed in hospital settings and overseen by anesthesiologists.

Now, the clinic's website does provide information on some of its staff, including its founder and director, Dr. Andre Waismann, a Brazilian-born-and-educated surgeon and intensive care specialist who practiced in Israel for much of his medical career.

First of all, Dr. Waismann does not possess training in Addiction Medicine or Psychiatry. Although his background in intensive care would, in fact, give him some degree of expertise in how receptor systems function, it would not equip him with expertise about the long-term physiologic and cognitive / emotional changes that characterize addiction.

Moreover, a background in anesthesiology would be much more suitable for performing the type of procedure that the ANR Clinic specializes in (which is probably why the two staff anesthesiologists are the ones who actually administer / oversee the procedure).

Frankly speaking, Dr. Waismann's list of talks and achievements is anemic relative to what I would expect for a physician who was truly at the forefront of his area of medicine. The website's e-resume simply lists a series of talks, only three or four of which were given in the United States, as well as a series of articles in non-specialized, popular news media - all advertising ANR Clinic.

There are none of the journal articles, textbook chapters, and other indicators of a robust medical career that a trained eye would look for to gauge a physician's expertise and professional achievement.

In terms of dealing with serious medical issues, I wouldn't be comfortable entrusting a physician with Dr. Waismann's credentials with my own care or the care of a family member who I actually like. He is a Foreign Medical Grad (FMG) with very little expertise relevant to the field that he claims to have developed a pioneering treatment in.

As far as the anesthesiologists, Nurse Practitioners, and the rest of the team go, I don't see any blatant red flags, but - based on the undergrad universities, med schools, residency programs, and publications / other career achievements listed - I see no indication that this is anything other than a mediocre team at best.

Even more sketchily, the website's repeated assertion that Dr. Waismann's method has helped 24,000 patients worldwide since its inception is not backed up by any concrete data about how many have achieved long-term recovery.

I am incredibly suspicious of this program due to the vagueness of the information provided on its website as well as the other red flags presented therein.

As mentioned above, the website claims that patients will "wake without cravings or withdrawal" and "return to the life [they] led before opioid addiction in as little as 48 hours."

For the reasons discussed above, this is simply not possible even in the best of outcomes.

It is disgusting, deeply unethical, and quite possibly illegal to advertise these benefits while at the same time noting that "standard" rapid opioid detox under anesthesia is ineffective because healing from the neurophysiological changes that characterize addiction is a longer-term process that detox itself is only the first phase of.

In the interest of thoroughness, I put in a phone call to ANR Clinic, posing as a patient interested in their services (actually, I have been considering short-term, medically-assisted detoxes for the remainder of my methadone withdrawal).

The representative I spoke with was kind, generous with her time, and somewhat more reasonable in expectation-setting than the organization's promotional materials. However, she repeated the vague language found throughout the website, did not have concrete success / failure data, and could not provide one substantive example of how ANR Clinic's protocol differed from standard, rapid opioid detox under anesthesia.

She simply asserted the high level of expertise of their providers and claimed without evidence that their treatment approach was "more individualized."

The out-of-pocket cost for the program is just over $20K USD, which - believe it or not - is quite affordable for this type of service, which lasts 4 to 6 days, including pre-procedure consultation on the day before the procedure; the day of the procedure, during which the patient spends 4-5 hours under anesthesia in an ICU-like environment, followed by a night in the hospital; and several days spent in a hotel afterward, where their care team visits you to check on your progress.

The clinic's representative was very quick to provide me with links to financial institutions that can help with financing for people who can't pay outright: People are taking out loans to get this done.

Again, during two in-depth phone calls, I asked probing questions about ANR Clinic's treatment approach, and fam, on my life - there is absolutely no difference between this program and standard rapid opioid detox under anesthesia, which the ANR Clinic roundly and correctly criticizes.

Literally the only differences from the classic, anesthesia-assisted rapid opioid detox protocols that the representative was able to list were being encouraged to go to the beach and eat fresh foods to regenerate your endorphins! (I'm not kidding. She said that).

ANR Clinic is essentially a marketing gimmick that attempts to convince you that it's better than the dozens of other treatment providers that use the same protocol with very little success.

Yes, they encourage you to pursue psychological treatment after you return home, but you are required to find and initiate such treatment yourself.

The clinic's doctors simply give you a one-year prescription for naltrexone and periodically check in on how you're doing in the most cursory mode imaginable.

Note ANR Clinic's claim in this sponsored Google search listing: "ANR Allows Patients to Return to the Life Before Opioid Addiction in as Little as 48 Hours." Elsewhere on the website, the clinic promises to "eliminate cravings and relapse" via the anesthesia-assisted detox, which is flat out impossible even with continuing naltrexone treatment after detox; naltrexone might ameliorate cravings for some addicts, but it is by no means foolproof, and it doesn't work particularly well for many opioid addicts.

It's surreal and obscene how deceptive ANR Clinic's information is.

I am angry that this cruel farce is allowed to exist in our country, and I am considering getting in touch with the appropriate regulatory authorities.

However, I am 100% sure that this program exists in Florida because it is one of the most medically deregulated states in the Union; for example, it is one of only a few states that do not require doctors to carry malpractice insurance. (It is no coincidence that elaborate, extended insurance fraud for addiction treatment via the "Florida Shuffle" bears the name that it does; I wrote about body brokering and the Florida Shuffle here, if you're interested).

To my fellow addicts and those who love us more than we typically deserve: Please be careful. There are so many predators out there who will promise you the world and take money that you don't have in exchange for "treatment" that in some cases can even make addiction worse.

Bottom line: Anyone promising a "pain-free" return to "normal physiology" after opioid addiction by offering to detox you under anesthesia is using your desperation to sell you a lie. Please don't fall for these scammers.