< Back to Press Room

Click here to read the original article

'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?

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

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

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

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

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

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

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.


Spread the word. Help us education, research and save lives.

Facebook   Twitter
Donate Now

Media Coverage

November 16, 2012
Physicians take lead role in confronting opioid misuse, but still face hurdles: This is the second in a series exploring the intersections between effectively caring for people living with chronic pain and the rise in unintentional poisoning deaths due to prescription painkillers. (The first post is here.) The series will explore the science and policy of balancing the need for treatment as well as the need to prevent abuse and diversion. This week’s story looks at clinical efforts to reduce the risk of opioid abuse and overdose while still caring for patients; the next story will explore the role of public health officials in curbing opioid abuse. Read More

November 14, 2012
AMA webinar spells out 8 ways physicians can curb opioid misuse: The Association holds the first in a series of webinars to teach doctors more about appropriate pain management. Read More

September 17, 2012
FDA Warns of Serious Skin Burns from Topical Pain Relievers: FDA Warns of Serious Skin Burns from Topical Pain Relievers Read More

July 3, 2012
Methadone deaths may have peaked, feds say: CDC » Doctors are more cautious about prescribing methadone for pain because of federal, state warnings. Read More

April 9, 2012
Filling In the Gaps on Pain Prescriptions: Filling In The Gaps On Pain Prescriptions Read More

April 5, 2012
Opioid Rotation Practices Linked to Fatalities: Opioid Rotation Practices Linked to Fatalities Read More

April 3, 2012
Switching Opioids Increases Risk of Overdose Death, Study Says : Switching Opioids Increases Risk of Overdose Death, Study Says Read More

April 2, 2012
Changing Opioids Causing More Overdose Deaths : Changing Opioids Causing More Overdose Deaths Read More

April 1, 2012
Doctors kill thousands due to 'death tables,' Utah expert says in new study : Reference tool responsible in death toll from prescription painkillers Read More

April 1, 2012
Opiate conversion charts killing patients : Opiate conversion charts killing patients Read More

March 8, 2012
What Whitney Houston Teaches Us: Whitney Houston has died from an as-yet unknown cause, but prescription medications are rumored. Her struggles with substance abuse are well documented, because she honestly shared them with the public in hopes of finding her road back. Celebrity deaths bring to our attention the national public health crisis with prescription drugs, and the list is growing: Health Ledger, Anna Nicole Smith, Corey Haim, Mike Starr. These people are not apart from or above us but hold a mirror up to our own lives. Most healthcare practitioners and counselors know a client, a friend or even a family member who has met the same tragic fate. Read More

March 2, 2012
LifeSource Co-Founder Lynn R. Webster, M.D. Receives Inaugural AAPM Presidential Excellence Award for Education: The American Academy of Pain Medicine initiates award to honor Dr. Webster’s work on the AAPM Safe Opioid Prescribing Initiative. Read More

January 12, 2012
The Chronic Pain Problem : Millions of Americans are affected by debilitating chronic pain, and diagnosis and treatment remain a challenge. Read More

November 2, 2011
Study shows Utah a leading state in painkiller deaths : A new study shows that painkiller abuse has not only reached epidemic levels in the United States, but overdose deaths continue a disturbing rise. Read More

November 1, 2011
Prescription Painkiller Overdoses in the US: Overdose deaths from prescription painkillers have skyrocketed during the past decade. Read More

September 14, 2011
Family: Player died from methadone overdose: Family members say a North Carolina high school quarterback died after a big victory last month after accidentally overdosing on some of his grandmother’s pain medication. Read More

August 26, 2011
Dr. Webster Pain Med Safety Interview: Host: Dr. Brian Grieves Radio station # (715) 524-2194 About: Dr. Brian Grieves is a radio show host at WTCH-AM, an affiliation WOTE-AM, both radio stations at Wisconsin. Every Saturday he gives his professional advice on "Health Talk" to his avid listeners in Shawano. Prior to working as a chiropractor, Grieves earned his Bachelors degree from the University of Wisconsin, a doctorate degree from Northwestern College, and his Masters Degree in Public Health from the University of Massachusetts. Read More

June 30, 2011
Dramatic increase of prescription-drug abusers seeking treatment: Dr. Webster joins KCPP to discuss trends in prescription drug abuse. Read More

June 23, 2011
'Rapid detox' a quick fix for opiate addiction?: USA Today Read More

June 15, 2011
LIFESOURCE ANNOUNCES NEW STUDY FINDINGS AVAILABLE ON DEATHS RELATED TO PRESCRIPTION OPIOD THERAPY: Nonprofit organization strives to address one of the nation’s biggest healthcare problems Read More

April 27, 2011
American Pain Foundation Announces New NSAID and Acetaminophen Pain Medication Safety Module and Public Service Announcement for PainSAFE Read More

April 20, 2011
U.S. Aims to Reduce Overdose Deaths, But Will the New Plan Work?: U.S. Aims to Reduce Overdose Deaths, But Will the New Plan Work? By MAIA SZALAVITZ Wednesday, April 20, 2011     The Obama administration announced on Tuesday a new initiative to reduce prescription painkiller Read More

April 19, 2011
Striving Toward Quality Pain Management: The epidemic of untreated chronic or recurrent pain has lasted for decades, yet millions of people are still not adequately treated. One significant barrier to effective pain management is that clinicians and patients are often reluctant to talk about pain... Read More

April 11, 2011
National Prescription Drug Abuse Expert From Utah To Present At Public Town Hall Meeting In Reading: Medical experts and law enforcement provide insights on adolescent prescription drug addiction Read More

March 22, 2011
National Prescription Drug Abuse Experts To Meet With White House Policy Makers: Experts will address prescription pain medication misuse and accidental overdose deaths with the White House Office of National Drug Control Policy Read More

March 10, 2011
National Prescription Drug Abuse and Overdose Deaths Expert Addresses Healthcare Professionals In Houston: Lynn R Webster, M.D. Read More

February 12, 2011
For Some Troops, Powerful Drug Cocktails Have Deadly Results: February 12, 2011 This article was reported by James Dao, Benedict Carey and Dan Frosch and written by Mr. Dao.   In his last months alive, Senior Airman Anthony Mena rarely left home without a backpac Read More

February 5, 2011
There are ways to help, prevent prescription drug abuse:   CHARLESTON, W.Va. -- Recently The Charleston Gazette ran a series on the emerging epidemic of prescription drug abuse. In a state with the highest rate of drug-related deaths, highlighting prescription drug abuse is an important public Read More

January 24, 2011
Morphine/Oxycodone Combination Superior to Separate Components: Montreal Read More

January 20, 2011
I Am An Addict:   Millions of older Americans are making this confession. Families are being torn apart. The good news: There's help Clean and sober for more than five years, Ron Dash has rebuilt his marriage and his life. “When I saw what Read More

January 10, 2011
Patients suffer when doctors are too scared to prescribe pain pills : Patients suffer when doctors are too scared to prescribe pain pills Monday, January 10, 2011; 8:36 PM    Every American should be concerned about the kind of message sent by the Jan. 2 front-page article "Doctors who pre Read More

December 15, 2010
Chronic pain patients, providers get new website:       Kathy Hahn Read More

December 9, 2010
Should an Overdose Antidote Be Made More Accessible?:   I've been writing about naloxone — the antidote to overdose of heroin, oxycodone or similar drugs — for more than 10 years, most recently for TIME here. The dru Read More

November 9, 2010
Addiction to painkillers hobbles more patients : ST. LOUIS — Nichole Marie Case unwittingly became dependent on opioid painkiller drugs. She's not alone. The National Institute on Drug Abuse estimated in 2008 that 1.85 million people in the United Stat Read More

October 25, 2010
Opioid safety is focus of $1 million-a-year educational initiative :   Opioid safety is focus of $1 million-a-year educational initiative Industry-supported PainSAFE targets how physicians and patients can avoid abuses and misuses of pain treatments. A group that represents patients living with pai Read More

February 11, 2010
The Effect of Academic Detailing on Curbing Opioid-Related Deaths in Utah

February 11, 2010
Root Cause Analysis for Unintentional Overdose Deaths Involving Opioids in Chronic Pain Patients Reveals Disproportionate Methadone Involvement

February 11, 2010
Costs of Oral Pain Medications Pre-IT Pump Implantation Compared to Post-IT Pump Implantation: A Retrospective Analysis

February 11, 2010
Select Medical-Legal Reviews of Unintentional Overdose Deaths

February 11, 2010
Comparison Of The Theoretical Cost Of Morphine And Prialt

November 18, 2009
To Help Healing, Doctors Pay More Attention to Pain. Morning Edition. National Public Radio.: The old notion that pain is somehow "good" for you should be put to rest for good, say health officials. They are increasingly recognizing that control of pain leads to more rapid recovery for hospitalized patients, and can even cut costs. Read More

November 28, 2006
National Expert from Utah Spearheads Educational Campaign: FDA Issues Methadone Warning: Providing Safe Access to Pain Medications. SALT LAKE CITY, Utah – November 28, 2006 – The Food and Drug Administration issued a warning yesterday to healthcare profe Read More

October 24, 2006
Prescription Medication Deaths Are On The Rise: Six Steps You Should Know: National Expert Calls for "Zero Unintentional Deaths" with Brigham City Physicians  SALT LAKE CITY, Utah – National pain medicine expert Dr. Lynn R. Webster will present his education campaign entitled Read More

October 18, 2006
Local Pain Medicine Specialist Calls for Zero Unintentional Deaths: National Education Campaign Comes to Brigham City Community Physicians. SALT LAKE CITY, Utah – October 18, 2006 – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Directo Read More

October 18, 2006
National Expert Calls for Zero Unintentional Deaths: National Expert Calls for "Zero Unintentional Deaths" with Hawaiian Physicians SALT LAKE CITY, Utah – National pain medicine expert Dr. Lynn R. Webster will present his education campaign entitled “Zero Unintentional Overdose D Read More

September 27, 2006
Methadone Related Deaths On The Rise : Six Steps You Should Know SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® & Pain Clinic in Salt Lake City, announces six steps to avoid acci Read More

September 20, 2006
Local Pain Medicine Specialist Calls for Zero Unintentional Deaths: Statewide Education Campaign Goes National SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® & Pain Clinic in Salt Lake City, announced that h Read More

September 18, 2006
Local Pain Medicine Specialist Calls For Zero Unitentional Deaths: National Education Campaign Comes to St. George Community SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® & Pain Clinic in Salt Lake City, a Read More

June 8, 2006
Dr. Lynn R Webster Kicks Off Statewide Education Campaign: LOCAL PAIN MEDICINE SPECIALIST CALLS FOR ZERO UNINTENTIONAL DEATHS SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® &a Read More

Go to Press Room