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Introduction This handbook has been written in order to answer as many of your questions as possible. Should you have questions not answered here please ask any of our staff members for assistance. Our goal is to make your treatment as safe and as comfortable as possible.
What is Rapid Opiate Detoxification Under Anaesthesia (RODA)? Rapid Opiate Detoxification under Anaesthesia (RODA) is a means of withdrawing from opiates (heroin, opium, codeine, methadone, etc.). It is a more comfortable and quicker means of doing so than both the typical “cold turkey” and “valium and clonidine” home withdrawal methods. It is only a small part of a more comprehensive addiction treatment program, however, and should not be seen as a means of treating the underlying addiction itself. It is a service best provided to those for whom an inability or unwillingness to tolerate withdrawal symptoms is the only impediment to abstinence-based recovery. As such those seeking access to RODA must be actively engaged in a program of recovery prior to the procedure itself.
What happens before my procedure? Prior to Rapid Opiate Detoxification under Anaesthesia clients will see one of the clinic physicians with training and expertise in addiction medicine. He/she will conduct an in-depth assessment to determine if, indeed, you are a candidate for RODA. The assessment will typically consist of an interview, laboratory investigations, and a physical examination. If, following the assessment, you are not considered an appropriate candidate for RODA, your attending physician will help you engage in the type of recovery program which needs to be in place prior to RODA. Compliance with the terms of that recovery program will greatly increase the likelihood of your acceptance for RODA. Once you and your physician agree that Rapid Opiate Detoxification under Anaesthesia is indicated he/she will book a date for your procedure. It is your responsibility to ensure that you are on time; otherwise you may lose your deposit. Your caregiver, who will have been provided with a handout outlining his/her responsibilities, must accompany you.
What happens on the day of my procedure? The day of your procedure begins at midnight the night before. You must not eat or drink anything after this time as it puts you at risk for aspiration (vomiting and choking) during the procedure. It is extremely important that your stomach be completely empty before your anesthetic. If you eat anything, the procedure will be cancelled and, once again, you may lose your deposit. If you are using medication that you must take in the morning please consult your doctor, and if indicated you will be allowed to take it with a SIP of water at least two hours before your anesthetic. You will arrive at the clinic at the pre-arranged time and our staff will meet you. You will be taken to a changing area where you will change into a standard hospital gown. While we take care to safeguard your belongings, we strongly recommend that you not bring any valuables with you to ensure they do not get lost. We cannot be responsible for any lost or stolen articles. We ask that you arrive wearing loose-fitting and comfortable clothing, and low-heeled shoes. No platform heels please! Once you are ready you will be taken to our anesthetic suite. An intravenous will be placed in your arm or foot and you will be connected to a number of machines that monitor your heart rate, ECG, oxygen saturation, carbon dioxide levels, and blood pressure. The anesthesiologist will then administer a series of medications, which will put you to sleep for the duration of the procedure. When you wake up, you will be drowsy but this will clear quite quickly. You will still be in withdrawal and you will experience some residual symptoms, which may be alleviated by medications. A critical care nurse will monitor your progress and, under the supervision of your physician, will administer medications as needed. Approximately 1 - 1˝ hours after you wake up you will be asked to take a shower. We strongly recommend that you avail yourself of this amenity as it often makes patients feel much better. However, the choice is left up to you. At this time our staff will have you walking about. When we feel you are stable you will be allowed to leave the clinic with your caregiver. We have found that most patients are able to leave the clinic about 2-3 hours after waking up from the anesthetic.
What is the role of the “caregiver?” Please select your caregiver carefully! Your caregiver is the person who will be directly responsible for your care once you leave the clinic. All patients MUST have a caregiver. This is not an option. The caregiver may be a relative, partner, or a friend. Your caregiver will be interviewed prior to your procedure, and will be provided with a handout, which explains his/her responsibilities. Your caregiver will be given instructions for your post-procedure care before you leave the clinic. He/she will be taught how to administer sandostatin injections, which will be provided for you. These injections are important for the control of diarrhea after the procedure. Our clinic nurse will pre-fill syringes for you and show your caregiver how to administer these. You will need one injection every 12 hours (or more frequently if indicated and approved by your physician) and our nurse will tell your caregiver what times you will need the injections.
What medications will I need afterwards? We have found that all patients react differently to this procedure. The symptoms after Rapid Opiate Detoxification under Anaesthesia vary from individual to individual and may include anxiety, nausea, vomiting, diarrhea, chills, muscle aches, and insomnia. Your doctor will prescribe medications that may help with these symptoms. These medications can be purchased at any pharmacy. Remember that you have undergone detoxification from opiates, and the symptoms that appear with standard detoxification can manifest after Rapid Opiate Detoxification under Anaesthesia, however they are milder and shorter lived. The medications that your doctor selects will be chosen with your past medical history in mind, and he/she will attempt to use those medications which have worked for you previously. You will need to resume taking any prescription medications that you take on a regular basis as soon as possible after your procedure. If you are unsure of when to do so make sure you discuss this with your attending physician.
What is naltrexone and how will I take it? Naltrexone is a drug that blocks the opiate receptors in your brain. It has been available in Canada and the United States for many years. Naltrexone may eliminate cravings for opiates. As well, it will markedly impair your ability to “get high” using opiates and it will provide you with a degree of protection against overdose if you relapse following the detoxification procedure. You will have had naltrexone administered to you during your procedure, and this will remain in your system for about 24-36 hours.
What is Naltrexone Maintenance? Naltrexone maintenance involves the insertion of a naltrexone pellet under your skin while you are asleep. This pellet will release Naltrexone continuously into your bloodstream for 30-60 days. This implant is not commercially available in Canada or the United States. Its use is not approved by the Health Protection Branch of Health and Welfare Canada, or by the FDA in the United States. We have received SPECIAL PERMISSION from the Health Protection Branch of Health Canada to utilize this implant with our patients. The implant lasts up to 60 days and can be followed up by oral naltrexone or by another implant. Physicians in the United States, Canada, and Great Britain have used this implant and have found it to be a useful adjunct to Rapid Opiate Detoxification under Anaesthesia. Your doctor will make a small incision in your arm or abdomen and insert the pellet while you are under anesthesia. The stitches may be under your skin and will dissolve on their own, or they may have to be removed in one week’s time. For the first three days you must keep the wound clean and dry.
What can I eat after the procedure? For the first 24-48 hours we recommend a clear fluid diet, as this will decrease the incidence of nausea and vomiting. Clear fluids include juices, soft drinks, water and clear broth. Neither strong citrus juices nor milk products are recommended. You must make every effort to drink at least one ounce of clear fluid hourly in order to prevent dehydration. From the second or third day onward, however, you may eat whatever you can tolerate.
What can I do after the procedure? For the first 24 hours you will probably not feel like doing more than resting in bed and, hopefully, sleeping. A bath, shower or whirlpool bath is ideal for easing some of the post procedure symptoms. On the second day we recommend you begin some light activity such as walking outside around your home. You don’t have to do a lot but you must start to regain your strength. Activity and exercise is the best way to achieve this. By the third or fourth day you may feel well enough to resume some of your normal activities.
When do I come back to the clinic? We ask you to you come to our clinic for a follow-up check-up three days after your procedure. At that time you may have further questions for our staff. During this visit your doctor will review your progress with you and adjust your medications as needed. Further follow up is expected of you and will, in fact, be one of the preconditions of acceptance for Rapid Opiate Detoxification under Anaesthesia.
Do I need more treatment once the RODA is complete? Absolutely! Rapid Opiate Detoxification under Anaesthesia is only an alternative detoxification process. Although it is less painful, less noxious, and less intense than standard detox it is NOT A CURE for addiction. Addiction is a complex brain disorder, which requires life long vigilance to keep in check. Relapse is common. In order to maintain ongoing abstinence and to experience the benefits of abstinence-based recovery you must participate in a program of self-help such as Narcotics Anonymous, attend counseling, and keep regular appointments with a physician experienced in treating patients with substance abuse disorders. Residential treatment may be critical to ongoing recovery and your attending physician may insist that you enter such a program as a condition of RODA. Our staff will help you contact the appropriate people or agencies that provide this form of care.
What happens if my caregiver or I have questions after we leave the clinic? A doctor is on call 24 hours a day and is available by pager. If there is an emergent situation, or you have a question related to your care, you or your caregiver can page one of the doctors. Your caregiver will be provided with a handout with specific instructions in that regard.
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