Anesthesia is a risk factor for drug and alcohol craving and relapse in ex-abusers

Relapse to cocaine, heroin, and alcohol is a common occurrence in ex-abuser s of these substances. Although there are many potential causes for relapse , we postulate that one cause in some people may be reexposure in an anesth esia setting to a drug similar to the formerly abused drug. We hypothesize, for example, that opioids given during and after surgery may reinstate cra ving for, and initiate subsequent seeking of, heroin in former abusers. The re are a substantial number of animal studies and some human studies docume nting a reinstatement phenomenon in which an experimenter-administered psyc hoactive drug can precipitate drug-seeking behavior in 'abstinent' animals and humans. There is concern amongst health professionals and patients alik e on this issue, and we discuss possible avenues of research, both preclini cal and clinical, to explore the validity of our hypothesis. (C) 1999 Harco urt Publishers Ltd.