Medical procedures that are not covered by insurance have a feel of what medicine must have been like in the old days before the AMA and the Drug War. That, at least, was what my experience was like with rapid detox. From the beginning the whole process seemed a little less than professional. Before I get into the whole story, however, I should provide some background information.
What is Rapid Detox
"Rapid Detox" is better termed "Rapid Antagonist Detox" (it even has a good acronym: RAD). The basic idea is that the body is flushed with an opioid antagonist such as narcan. This throws the body into immediate complete withdrawal. What normally happens over a three day period, happens in a couple of hours. (Increasingly, antagonists are being used with other--traditional--procedures.
Living Through It
Since the time period is compressed, so too is the pain. Roughly speaking, all of the pain that would be experienced over three days is crammed into the couple of hours of the rapid detox. To make the pain bearable, the patient is put to sleep.
When the patient wakes up, he is no longer addicted to heroin (or whatever opioid he has been doing). At least that is the theory. As with most things, there is a big difference between theory and practice as I will discuss later. Upon regaining consciousness, he patient is, however, quite weak. It is standard procedure to have a nurse watch him for the next day or so--until he is able to care for himself.
Rapid detox sounded like a great way to get clean. The truth was, it was the only option I had that would allow me to keep my job. Where I lived, there were no out-patient detoxes. You couldn't, for example, get a 21 day methadone detox without checking into a clinic. I could have gone on methadone maintenance, but that idea terrified me.
When I decided to undergo a rapid detox, I shopped around. I could not take much time off work. Regardless of the clinic I chose, however, the costs were very high. The ones in the city in which I lived were $7000 or more. The cheapest one I found was $2700, but it was 3000 miles away. I did eventually go with that clinic, but it turned out to still be very expensive. It cost $1200 to fly there; my "nursing" cost over $1000; hotel, $500; support meds, $300 (for what would have cost me less than $100 had I been able to buy them myself).
I scheduled the detox to minimize the disruption to my work. I booked a flight for Thursday night. I arrived at my hotel very late that night. The next morning I took a cab to the clinic. I was about five minutes early, so of course the clinic was closed. It seemed completely dead--like it was abandoned. The thought then entered my mind that I had made a huge mistake; perhaps I was going to be stuck in New Jersey to detox with nothing, alone.
No One's Home
The crew showed up right at the time they told me to arrive. It bothered me that no one had arrived early, but the place so quickly began buzzing with activity that I put the feeling behind me. The first thing they did upon my entry was to get my credit card and charge $2700 on it. I know that medicine is a business, but this struck me as a crass operation.
Meet the Doctors
After they got my money, they took me to a room where I talked to the detox doctor. He just went over the drugs I was going to take after the procedure. This was just naltrexone, to keep me from using afterwards and about a week's worth of tamazapam to help me sleep.
Without much fanfare, I was taken to an operatory where I met the man who it turned out ran the operation--at least, from a medical standpoint. He was an anesthesiologist. He went on and on about how good my hands looked. In retrospect, I see that he was just happy that I was making his life easy. He had to attach an IV, and that was probably a big problem with most of his patients. Had he met me only a year later, we would have had a very different experience.
As it was, he found a vein on my left hand with one try and I was unconscious within a minute. My last memory of the clinic watching him fiddling with the tube that was feeding me my drug cocktail. My next memory was sitting in a wheelchair that was being pushed into my hotel. I looked up and saw that I was being pushed by the anesthesiologist. Once I was deposited into my room, he disappeared.
The next three days were pretty much all the same. I was vomiting up everything I drank. I was experiencing uncontrollable diarrhea--soiling my sheets each time. The nurse dutifully cleaned up after me, but it was quite embarrassing. I think for the first time in my life, I understood the humiliation of growing old and decrepit. Right after this experience I wondered why they didn't give me a diaper which would have made the nurse's job easier and experience less unpleasant.
Since that time, I have learned a lot of withdrawal. This has caused me to wonder about a much more important issue. Why didn't they give me medications to relieve my discomfort? In addition to the two problems I have already mentioned--both of which can be successfully treated with minimal difficulty--I was not sleeping. I had drugs for this, but they were not given to me at that time.
A big issue for patients who have just undergone this treatment is getting enough fluids. Because of my vomiting and simple lack of desire, I was not getting much fluid into my body. After two days of this, my nurse had the anesthesiologist come over with two saline solution bags. He broke one, and put the other into an IV for me. At the time, I thought it was really great that he came over to do that. I felt differently when I was billed $500 for the visit. It made me wonder what I was paying the nurse for if she couldn't prepare an IV for me.
After three days, I was still a mess. I was freezing unless the room temperature was over 100. On the plane home, the guy sitting by me was moved because of my shivering and vomiting. I was in no condition to go back to work as scheduled. I took another two days off work. When I did go back, I was still in very bad shape--it was obvious to everyone.
I felt like I had been ripped off; the treatment did not go as promised. It doesn't seem to matter who is running the program, any criticism seems to be answered with a bunch of excuses. When asked about the diarrhea they would say, for example, "You hadn't defecated for a week before. What do you expect?"
What I expect is to be warned ahead of time what is going to (or may) happen. In addition, whoever is running the program should be knowledgeable in traditional opioid withdrawal. Any symptoms that occur after the procedure should be treated. Make sure what whoever you hire to detox you is able and willing to provide this kind of aftercare. With this assurance, a rapid detox will work well for people who have minor habits. Those with large habits should simply stay away from this kind of detox.