Even Dr. Anthony Albanese, co-medical director of Mt. Sinai's addiction medicine program--where more than 95 patients have undergone the technique thus far--concedes that without reliable data from U.S. clinical trials, the case for naltrexone is anecdotal.
"The big question is, what happens in follow-up?" he said. "Does this treatment work better than any other method?"
*
What doctors do know is that the procedure apparently has worked for about 4,000 heroin users in Europe and Mexico since the method was pioneered by Legarda in 1992. CITA America's officials say that 73% of those treated abroad remained opiate-free six months later.
"Recovering from heroin addiction is not high-yield," Albanese said, so any form of treatment that promises to raise the odds of success is worth trying.
"In their permanent memory, addicts have a high that was amazing, and they spend the rest of their life trying to find that high again," Albanese said. "And they never do. That's called chasing the dragon. And that's the compulsion."
So far, the procedure has been effective for Einhorn, who was treated in December. "I went in there loaded, and I was a little skeptical," he said. "I thought this was too good to be true. But I have no desire to use [heroin] today, and [through counseling] I have the tools to [combat that desire] if I do."
The procedure has also worked for San Francisco resident Robin Leland, a 50-year-old printer who was a heroin addict for 15 years. After seeing a television report about naltrexone in November, Leland and his wife flew to Miami.
"I had been trying to put it off because I had tried to kick two or three times, and it was just too painful," Leland said. "Heroin was not a drug I was in love with, just a drug I was hooked on. I even brought a stash to the hospital."
Five months after his stay in Miami, Leland reports that he goes to occasional Narcotics Anonymous meetings and, "I am never tempted. . . . Now life is fun."
Times medical writer Thomas H. Maugh II contributed to this story.
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Reducing Withdrawal Trauma
A new treatment for addicition combines the narcotic antagonist naltrexone with anesthesia to reduce the trauma of detoxification, increasing the likelihood that recovering addicts will stay clean.
How It Works
* Narcotics like heroin and cocaine bind to specific receptors in brain cells to stimulate the pleasureable release of dopamine.
* Naltrexone is a narcotic antagonist. It binds to the narcotic receptors more strongly than either heroin or cocaine, displacing them from the receptors. But it does not produce a high.
