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'Rapid detox' a quick fix for opiate addiction?

June 23, 2011

 

'Rapid detox' a quick fix for opiate addiction?

By Robert Davis, USA TODAY

Andy Sachs is not the stereotypical opiate junkie. He gets his drugs from a pharmacy, not a street dealer. He began taking his medicine for severe pain, not for the high. And the drug he's hooked on is more widely used than heroin. Six million people a year take OxyContin.

Sachs, 26, a Las Vegas mortgage banker, is among the newest breed of opiate junkies — those created, fueled and (Sachs hopes) cured by modern medicine.His way out of addiction may be unusual as well: He chose a controversial treatment designed to rid him of his drug dependence in two days.

Until just a few months ago, he says, he had never before abused drugs. But Sachs, who played basketball, football and rugby in college, started taking OxyContin last winter after back surgery. The drug is a potent painkiller most often prescribed to people whose pain has failed to respond to medicines such as Vicodin and Percocet. But in recent years, it has made headlines for being "diverted" from legitimate needs to being abused.

There is no estimate of how many people end up abusing the drug, but the Drug Enforcement Agency has tracked increases in both OxyContin-related deaths and emergency-room visits.

Federal drug agents have tried to crack down on the illegal trade of the drug, and government health officials have increasingly urged doctors to warn patients about the risk of becoming addicted to it.

Sachs knows that risk firsthand. After six months on OxyContin, after several failed attempts to wean himself from the drug, he knew he needed help. He had seen a television report on patients at a controversial clinic in California. At the time, he says, "I thought I would never have it that bad."

But he was wrong. And so he picked up the phone and called the Waismann Institute, where the rich, the famous and the desperate go for what is known unofficially as "rapid detox" — a term the center rejects as overly simplistic.

People who are hooked on opiates can sleep through their withdrawal. Doctors use drugs to break the opiate's bond on the brain, and the patient wakes up with a dummy drug blocking the cravings. Patients are in and out of the hospital in two days.

Several variations of the treatment are offered at a handful of clinics that advertise on the Internet, and an unknown number of doctors nationwide perform the procedure secretly.

Rapid detox has many critics. The medical establishment is leery of a quick fix that costs as much as $10,000, is not covered by insurance and has not been compared in peer-reviewed clinical trials with traditional treatments.

"There have been some studies that suggest that ultra-rapid detox may be OK," says H. Westley Clark, director of the Center for Substance Abuse Treatment at the U.S. Department of Health and Human Services. "But other studies have showed limited results."

Critics also point to six deaths at a New Jersey rapid-detox center where 2,350 patients had been treated over seven years.

Federal officials called those deaths unacceptable.

Money and risks aside, "it's one thing getting people drug-free," says Ron Jackson, a social worker at Evergreen Treatment Services, a Seattle methadone clinic. "It's another trying to keep them drug-free."

Prescription for trouble

OxyContin can be tough to beat.

The drug is one of the most powerful tools in a pain doctor's arsenal. The drug releases medication slowly as the pill melts in the small intestine.

But, federal drug officials warn doctors, one in 3,000 people who take opiates for pain become addicted. The body gets accustomed to the drug and begins to tolerate it. If the root cause of the pain does not heal, the person will have to take more and more of the drug to feel relief.

"When you start raising the dosage, now you've committed yourself to using this drug for life," says Clifford Alexander Bernstein, a pain specialist who performs the detox treatment at Waismann. "The best you can hope for with this drug is that the dose doesn't escalate."

Description: http://www.usatoday.com/_common/_images/clear.gif

  Are you hooked?

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A person may be considered "dependent" on a substance if three or more of the following characteristics are present over 12 months:

Description: http://www.usatoday.com/_common/_images/bullet.gif Tolerance, needing increased doses.
Description: http://www.usatoday.com/_common/_images/bullet.gif Withdrawal, becoming physically ill when not using the substance.
Description: http://www.usatoday.com/_common/_images/bullet.gif Extension, taking the substance over a longer period of time than intended.
Description: http://www.usatoday.com/_common/_images/bullet.gif Failing in efforts to cut down, even knowing use is causing physical or psychological trouble.
Description: http://www.usatoday.com/_common/_images/bullet.gif Spending excessive time getting the substance or recovering from its effects.
Description: http://www.usatoday.com/_common/_images/bullet.gif Giving up professional or social activities because of substance use.

Source: American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders

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Sachs says his doctor never fully explained the drug's risks. He started taking OxyContin in December for back pain. He was prescribed the drug again after back surgery in January. As his dosage went up, his dance with addiction began.

A missed dose made him feel desperate. The underlying pain returned, and the craving for the pill grew stronger.

One day he decided to quit taking it — a move that doctors strongly warn against.

"I tried to quit June 23 cold turkey," he says. But going from 120 milligrams of OxyContin a day to zero left him in severe withdrawal: His legs jerked, his bowels moved uncontrollably, and he often felt as if he would pass out. The change was torture.

He had gone from a white-collar worker with a back problem to a man who felt he would die without the next dose. "For 2 1/2 days, I was suicidal," he says. "Every waking minute, I was thinking of ways to kill myself and get it over with."

The traditional treatment for opiate addicts, based on scientific research and decades of experience with heroin addicts, is to mix the painful symptoms of withdrawal with psychological treatment in rehab centers. People, feeling sick, sit in meetings designed to help them break bad habits and build a new life.

But Bernstein insists that in certain cases, especially when the dependence is physical and not psychological, "to tough out your withdrawal is archaic."

Opiates act like a key that goes into receptors in the brain, unleashing a rush of endorphins. Those endorphins, amino acids made by the pituitary gland, are the body's natural painkiller.

After the body has been stimulated artificially by an opiate to produce endorphins, it does not respond kindly when that drug no longer turns the process on.

The body craves the drug, and without it — in the case of a drug-dependent or drug-addicted person — the body becomes physically ill.

At the Waismann clinic, doctors use a drug called Naltrexone during their procedure, which they say is different from, and safer than, methods generally referred to as "rapid detox." Those often use other drugs, sedate patients instead of putting them to sleep or finish detoxification in one day instead of two.

"This is not rapid detox," Bernstein says. "This is accelerated opiate neuro-regulation. It's not even in the same league as rapid detox."

The key, he says, is the way Naltrexone blocks opiates. It binds with the keyhole-like receptors and satisfies the opiate craving without causing a release of more endorphins.

Unlike methadone, which Bernstein says is just as addictive as heroin and causes patients simply to swap one drug addiction for another, Naltrexone can be stopped later with no ill effects. All patients get psychological counseling to help them stay clean and sober after they leave the hospital.

Success rate promising for stable people

One concern is that the in-and-out nature of the treatment does not adequately prepare the patient to change his lifestyle or devise strategies to manage future drug-free challenges.

Clare Waismann, executive director of the Waismann Institute, says that heroin addicts have lower success rates than people such as Sachs because they sometimes have more difficult issues back home. The California clinic has treated about 1,000 patients over the past three years. Including the heroin addicts, the success rate at one year is 66%. In other words, about 660 people remained opiate-free for a year.

But take out the heroin addicts and count just those like Sachs, who have a job, a stable life and are just hooked on pain pills, and the results look more promising. The clinic is conducting a study of those cases, and after six months the success rate is 84%.

People like Sachs "just want their life back," Waismann says. "They don't need 12-step programs."

What about the high price tag?

"The guy spending $5,000 a month for pain medication will argue that in two months you have recouped the investment," Clark says. But what about the addict who is not rich, famous or otherwise able to come up with $10,000?

"It creates a two-tiered system where poor people don't have access," Clark says. "That's the issue."

Bernstein says it's true that not everybody can afford the care. But he is happy to help those who can.

"The worst thing that can happen is we keep them off the medications for a while and their tolerance comes down to a more reasonable level so they can take just one Vicodin or two Vicodin and it will work for their pain," he says.

'It's like being a baby'

The day Sachs prepared to leave his Las Vegas home to go to the clinic, he packed up all of the medicine so he wouldn't be tempted when he came home.

South of Los Angeles, in the nondescript medical building in Tustin, doctors and nurses checked his lungs and liver and other bodily systems.

Sachs was nervous, but he knew it couldn't be worse than trying to kick the drug again on his own.

The staff started an IV, put him to sleep and flushed the OxyContin out, replacing it with Naltrexone. When Sachs woke up, the rest was up to him.

"When you first come out of the treatment, your body doesn't know what's going on," he says. "There's an emptiness. You feel dizzy and nauseous. I had a lot of body aches." But he didn't crave the drug.

Back home in Las Vegas, he now works by phone with a Waismann Institute psychologist.

"It's like being a baby. You have to learn everything again," Sachs says. "What do I do to get out of bed?" The drug used to beckon him bright and early. "Figuring out my new daily routine is the hardest thing."

"I'm almost back to normal," Sachs says. "They saved my life."

But experts such as Jackson who treat addiction with traditional methods put such patient testimonials in a broader context. It would take further study, he says, pitting rapid detox against other methods in a randomized clinical trial, before anyone knows for sure how rapid detox works in the long run.

Meanwhile, as baby boomers age and more people take stronger medicines for higher levels of pain, the problem of medically induced drug addiction is expected to continue. People who are prone to drug abuse but have never known it may find out when they take a drug such as OxyContin.

 

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