MEDICINE 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.

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.

While the drug-assisted withdrawal itself takes as little as four hours,
additional time is required to prepare patients for treatment. Because many
addicts often are in poor health, they must first undergo extensive medical
tests, including electrocardiograms, liver and lung exams and pregnancy
tests, the day before detox. They are then given muscle relaxants, sleeping
pills and an opiate so their bodies don't start to go through withdrawal
symptoms before treatment. The next day, the treatment usually takes place
in a hospital intensive-care unit, overseen by an anesthesiologist and a
team of nurses and technicians. (Most rapid detox programs operate through
private clinics that contract with hospitals.)

Still, there are risks. It is known that at least seven people have died in
the United States soon after undergoing rapid detox. Six of those deaths
occurred at one New Jersey clinic not located at a hospital; the physician
involved was later disciplined by the state medical board for failing to
take adequate medical precautions. While doctors and researchers familiar
with those cases say it is difficult to know if the patients died because
of the treatment, some critics of the therapy believe it could have played
a role.

And because rapid detox programs are not regulated as consistently as
alternative treatments, such as methadone clinics, some doctors are doing
the procedures in their offices, without the support staff and emergency
equipment required in hospitals. Most doctors strongly recommend against
undergoing rapid detox therapy outside a hospital.

Opiate addiction rising

Drug experts do agree that something has to be done to deal with the
growing number of opiate addicts around the country. There is, after all, a
serious health risk to remaining a drug addict.

According to the National Institute for Drug Abuse, there are more than 1
million opiate addicts in the United States and that number is rising. Some
of the reasons include the large number of Americans, from baby boomers to
the elderly, who are getting hooked on pain medication for chronic pain.

Oxycontin, a potent painkiller that health authorities say is increasingly
abused, is also playing a role. Overall use of the drug rose by 140% last
year, according to a recent federal survey on drug use.

Popular alternative treatment methods, such as methadone clinics, have
significant drawbacks. For one, the number of Americans seeking methadone
treatment far exceeds the number of openings at government-approved
treatment clinics. As a result, most clinics have long waiting lists.
What's more, methadone takes nearly a month to clear the addict's system,
compared with a week to 10 days for other opiates, including heroin. Roger
Brenner, 47, says he was addicted, on and off, to everything from cocaine
to heroin for more than 30 years. Six years ago, he started methadone,
hoping to break his heroin habit, but later found that it was more
difficult to quit methadone than the other drugs he had taken. The Vista,
Calif., service manager underwent rapid detox treatment for methadone three
years ago. Although he felt "like a truck had hit him" when he woke up
after treatment, he said the method worked like "a miracle." Brenner says
he has been clean since.

As more is known about rapid detox, doctors say they are learning that the
treatment works better for some patients than others. People who have
recently become addicted to painkillers, and older addicts, who are often
weary of using drugs and are more motivated to quit, have better success.
One group some doctors are hesitant to treat with rapid detox is longtime
chronic pain sufferers. Many still experience pain after detoxing and
return to drugs to ease their suffering.

Such is the case with Lisa Hill, the Costa Mesa woman who underwent
treatment at the Waismann's clinic in Tustin. Although Hill says she didn't
feel cravings for the drug immediately after treatment last month, she
ultimately thinks the therapy failed. She still experiences pain in her
back and leg, and she acknowledges that she returned to taking a
prescription painkiller, a few weeks ago. "I feel there was too much hype
around rapid detox," she says.

The Waismann Institute disagrees that the treatment didn't work, and says
that Hill showed no signs of opiate withdrawal after the procedure, such as
abdominal pain or a runny nose.

Doctors say one of the most important aspects of rapid detox is the care
provided to patients after the procedure. Depending on the clinic,
post-treatment counseling is provided for two weeks to six months.

Critics of rapid detox say that intense post-treatment therapy is the
single most important part of addiction treatment and should continue for
up to two years. After all, many patients haven't felt the pain of even a
toothache, or clear emotions, for years and quick sobriety can be a big
shock. "Detox is different from treatment. For some addicts, six months is
a drop in the bucket," says Dr. Gifford Gervitz, an expert in the field who
conducted a small research study on rapid detox at Tufts University in
Massachusetts three years ago. Gervitz says that his study had favorable
results but that with only 20 patients, it wasn't large enough to be
conclusive.

Patients could enter treatment on a Thursday and be back to work by Monday.