Aetna considers ultra rapid detoxification (UROD) experimental and investigational as a clinical detoxification treatment and for all other indications.

Detoxification, although important, is only the first step in long-term relapse prevention treatment of opiate addiction. Proven detoxification procedures presently involve a gradual withdrawal followed by medication and long-term psychosocial support in producing long-term abstinence from illicit opioid use.

In the UROD procedure, opiate detoxification is induced by the use of a bolus injection of very high doses of an opiate antagonist (naloxone) under general anesthesia or heavy sedation followed by a slow infusion of low dose naloxone. The four-hour procedure is carried out in an ICU and the patient requires one to two days of hospitalization for a full treatment protocol. Proponents of the procedure claim that complete accelerated detoxification is attained, the patient experiences no withdrawal symptoms, physical dependency is eliminated, and the psychological craving for drugs is greatly reduced. However, experts prominent in the field opiate addiction in 1996 reported their concerns about UROD stating that detoxification is not a cure for opiate addiction and that medication without psychosocial support has little impact on opiate addiction.

There is no scientifically-based evidence in the medical literature to substantiate that UROD is safe and effective as a clinical detoxification treatment. There is a reported risk of serious adverse events, including death with the use of anesthetics, making the risk:benefit ratio of this detoxification procedure unacceptable. Besides direct causality associated with inadvertent anesthetic overdose, there is also the risk of indirect causality related to possible aspiration and choking from emesis that may occur when an anesthetized or heavily sedated individual is detoxified while asleep.

To date, only one double blind study and few research reports have systematically documented the nature of the UROD procedure and its safety and efficacy for both immediate detoxification and longer term relapse prevention. No double blind studies indicate that ultra-short detoxification procedures are more successful in decreasing relapse to opiates than longer duration treatments.

The California Technology Assessment Forum (CTAF, 2002) has determined that rapid and ultra rapid opiate detoxification does not meet CTAF's assessment criteria. The CTAF assessment concluded: "Existing published studies of rapid detoxification and ultra rapid detoxification have raised the prospect of new approaches to opioid detoxification. However, methodological limitations limit the generalizability of the studies, and thus these techniques, to widespread clinical application. Lack of randomization and blinding, sample size variations, different clinical profiles of studied patients, and diverse pharmacologic treatment used and clinical settings, preclude comparisons between studies and the drawing of any firm conclusions regarding the efficacy and safety of these procedures. The post-detoxification relapse rate for these techniques appears to be quite variable. The most suitable patients for these procedures must still be defined. Both rapid and ultra rapid opioid detoxification must undergo further scientific evaluation in randomized, controlled trials to determine whether their clinical effectiveness and safety outweigh their risks. Further research is also warranted to evaluate longer-term outcomes and compare these methods with other treatments for opioid addiction such as methadone maintenance supervised methadone taper, naltrexone maintenance, counseling-supported abstinence, and toxicological surveillance."

A structured evidence review by Gowing, et al. (2004) reached the following conclusions about UROD: "Considerably more research evidence will be needed before any conclusions can be drawn regarding the effectiveness of managing withdrawal by administration of opioid antagonists under heavy sedation or anaesthesia. The risk of vomiting during sedation, respiratory depression and cardiac irregularities point to the approach being limited to facilities equipped for intubation, assisted ventilation and a high level of monitoring, and with the capacity to respond to adverse events that might occur. The approach must be regarded as experimental with both risks and benefits remaining uncertain."