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Clean and sober in 48 hours?

'Rapid detox' promises opiate addicts an easier out, but some doctors call for more studies to prove its value.

October 28, 2002|Daniel Costello | Special to The Times

Lisa Hill, a 27-year-old prescription drug addict, lies in a hospital bed in Tustin, about to undergo her third detox attempt. A few minutes later, doctors give her anesthesia, stick a breathing tube down her throat and then administer a liquid dose of Naltrexone. During the next few hours, the drug cleans Hill's body and brain of any remnants of the painkiller Vicodin that she has been hooked on since a car accident in 2000.

If Hill were awake, she'd be suffering hours of severe headaches, vomiting, shakes, sweats and relentless abdominal pain. The doctors, though, don't wake her for several hours, and later give her sleeping pills to make it through the night. In the morning, she wakes up, takes a shower and goes home. A few hours later, she no longer craves.

The treatment takes two days, from start to finish.

This new and controversial drug detoxification therapy is known as "rapid detox." Advocates say it's the next generation in drug treatment, far easier and more effective than traditional methods, such as 28-day programs or methadone clinics. It's primarily used for people addicted to opiates, such as heroin, morphine or Oxycontin -- a highly addictive prescription pain medication -- because those habits are considered the most difficult to kick. Other detox programs that promise speedy treatment for people addicted to cocaine and alcohol are beginning to be offered across the country, although such programs are not yet common.

"This is more successful than traditional treatments. And it's more humane," says Clare Waismann, director of the Waismann Institute in Beverly Hills, who brought the treatment to the U.S. five years ago from Israel, a major center of research into rapid detox programs. The number of patients undergoing treatment at the institute's clinic in Tustin has tripled in the last two years, Waismann says.

Popularity and criticism

The concept of rapid detox is appealing for a number of reasons. As the name suggests, the treatment is faster and more convenient than alternatives. Patients could enter treatment on a Thursday and be back to work by Monday, without disrupting their lives for weeks or attracting the attention of bosses, co-workers and friends. Although medical insurance doesn't cover the treatment, which costs about $10,000, the programs are less costly than some of the longer and fancier drug treatment programs.

Moreover, by most accounts, traditional treatment methods don't work for many patients. By some estimates, as few as 15% to 30% of opiate addicts complete traditional treatments. Rapid detox clinics claim success rates of up to 60%, although those claims have not been validated by rigorous scientific studies.

Despite its growing popularity, many physicians and some prominent addiction specialists are critical of rapid detox therapy. A key concern is the lack of clinical studies demonstrating the benefits and risks of the treatment. Several smaller studies, here and abroad, have been inconclusive. Researchers at Columbia University are doing a larger study comparing one-year success rates of rapid detox and traditional therapy, but their work won't be completed for another year.

Because there is a small risk to any patient undergoing anesthesia, many doctors say they won't recommend rapid detox until more is known. "Our view is that there just isn't adequate scientific evidence about [rapid detox] and that currently it involves an unacceptable level of health risk," says Dr. Lawrence Brown, president of the American Society of Addiction Medicine, which serves as the American Medical Assn.'s expert on addiction medicine.

Nevertheless, supporters of rapid detox say demand for their programs is growing. There are no federal statistics on the number of patients who have undergone the treatment, but officials at several major clinics estimate that 5,000 people in the U.S. have had rapid detox therapy this year. Several dozen clinics, from Miami to Seattle, now offer rapid detox treatment, and one company, Los Angeles-based CITA Biomedical, says it is expanding its program nationwide next year.

Treatment's key element

At the heart of the treatment is Naltrexone, a nonaddictive, non-mood altering drug that helps break down the physical effects opiates have on the body over time. Opiates attach to receptors, or proteins, in the brain and produce a sensation of feeling "high." Naltrexone, known as a narcotic antagonist, helps to block those receptors and to quickly clean the patient's system of any opiates.

After treatment, patients take Naltrexone once a day for up to nine months. Alternatively, they can have a Naltrexone pellet inserted in their abdomens that releases the drug over six weeks. If an addict takes an opiate while on Naltrexone, doctors say, they will not experience a sensation of feeling high.

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