N E W Y O R K, April 20, 2001 -- A controversial and expensive rapid detox method of helping heroin and other addicts shed their drug habit has an important new convert.
Texas Tech University Health Sciences Center, a 300-bed hospital in Lubbock, is apparently the first major, academic medical center to offer the method to flush opiates from an addict's system while the person is under anesthesia.
Heroin, codeine and Dilaudid, among other analgesic drugs, belong to the class of compounds known as opiates, which act on special receptors in the brain. The human body has these receptors because we naturally manufacture chemicals to manage pain.
Anesthesia for 4 to 6 Hours
"The treatment lasts anywhere from 4 to 6 hours," says Dr. Alan Kaye, chair of the anesthesiology department at Texas Tech. When a patient wakes up there is limited nausea, vomiting and no physical dependence on the drugs, he explains. The patient may remain in the hospital for a few days.
Traditional outpatient or inpatient opiate withdrawal, in which a patient is more slowly weaned from a drug, can be painful and even life-threatening, if a patient is not carefully watched.
But the rapid method — which physicians and private companies now offer addicts at small hospitals in about 20 locations throughout the country — has come under fire recently.
Critics say the treatment, which can cost between $3,000 and $8,000, is unproven and costing addicts money they could be spending for standard withdrawal programs. Health insurance generally does not cover the procedure.
Expensive and Potentially Risky
"There is a risk for generalized anesthesia and I am not sure the relapse rates rapid detox programs achieve are any better than what I get with my patients," says Dr. Rick Beach, a specialist in addiction medicine in Pensacola, Fla.
Addicts failing to stay free of drugs after treatment is a significant problem, he says.
The state of New Jersey is also trying to take away the medical license of rapid detox proponent Dr. Lance Gooberman because seven of his patients allegedly died from the procedure. A malpractice case against the physician is also ongoing.
The Merchantville, N.J.-based physician treated 2,350 heroin addicts with the rapid detox method between 1994 and 1996. He claims, though, a 0.3 percent death rate, a number comparable to other outpatient surgical facilities.
Follow-up Is Key
What is different about Gooberman's method, compared to Texas Tech's and other facilities, is that he did not monitor the patients sufficiently after they received the anesthesia, Kaye says. At Texas Tech and other programs, psychotherapy and follow-up is intrinsic to the care.
Started in Europe in the 1980s, rapid detox came to the United States in the mid-1990s. Today several American firms, including Ultramed and CITA, (or the Center for the Investigation of Treatment and Addiction) and private physicians offer the treatment in Arizona, Washington, Colorado, New York, New Jersey, Connecticut, Oregon, Virginia and a few other places.
Kaye studied with Dr. Andre Waismann, who has treated more than 8,000 addicts in Israel using rapid detox. At Texas Tech, Kaye also is performing research trying to better understand how the method works and to improve it.
Concerned that thousands of Americans are using this unproven treatment, the federal National Institute of Drug and Alcohol Abuse in 1999 funded a 3-year research project led by addiction expert Dr. Herbert Kleber at Columbia University to study its possible risks and benefits.
A Humane Alternative
There are an estimated 750,000 to 2 million opiate addicts in the United States, with 130,000 in methadone therapy and another 250,000 seeking methadone therapy.
Rapid detox is not a quick fix for an addict. Once the physical part of the addiction is treated, the patients are given an opiate antagonist — or a drug that competes with the drug for the receptor in the brain — that decreases cravings.
Addicts must also meet with a health care professional to take care of their psychological addiction.
"It is tragic how many people suffer from heroin addiction," says Kaye. "This is the most humane, safe and scientifically rational way to attack the problem."