RAPID HEROIN DETOX PROVIDES SOLID RESULTS, SOME MISGIVINGS

"Kick In Your Sleep" Is What The Radio Ad Touted.

This "one-day procedure," it promised, "gets you past the peak of cold
turkey withdrawal in a matter of hours, while you sleep
comfortably."

Twenty minutes after he heard that commercial, John was dialing the
number.

John, a 23-year-old Connecticut heroin addict who asked that his real
name not be used, was instantly hooked on the ad's image of sleeping
through the mind-bending pain of heroin withdrawal - and its
inevitable vomiting, chills, diarrhea and relentless insomnia.

"It's like your intestines are squirming like worms," John said,
describing the withdrawal symptoms he battled in an earlier try at
detox that took five days and kept him clean for about eight months.

The new ads boast a controversial and cutting-edge treatment for the
nation's growing problem of heroin addiction. The treatment crunches
the most painful first four days of detox into four hours, and allows
patients to sleep under general anesthesiawhile a powerful
heroin-blocking drug is pumped into them intravenously.

Critics say the ads paint a deceptively rosy picture, and that some
companies are jumping into the complicatedbusiness offering little
more than drive-through detox - without the necessary weeks, and often
months, of follow-up counseling.

But even the critics concede that the procedure's heroin-blocking
drugs, known as Nalmefene and Naltrexone, seem to control heroin
cravings like no others.

While the experts debate, the new radio ads popping up around New
England appear to be hooking the hooked.

The founder of the Nutmeg Intensive Rehabilitation Center in Tolland,
Conn., the company that recently launched a rotating radio blitz of
the Boston, Worcester, Hartford and New Haven markets, said calls have
been pouring in.

"This heroin affliction is a Yale-to-jail drug. The drug deals are
being made in washrooms of corporate America," said David L. Simon,
an anesthesiologist who opened his clinic in November 1996, and who is
eager to expand into the Boston market.

He's not alone.

UniQual, a Framingham-based company that opened in September 1997,
also recently launched an aggressive radio advertising campaign in the
Boston, Worcester and Portland, Maine, markets. UniQual and Nutmeg are
the only companies in the New England area - and two of an estimated
dozen nationwide - offering rapid heroin detox.

Fueling the competition is a ripe market.

During the past decade, heroin use in the United States exploded,
according to the federal government. Between 1993 and 1997, the
number of heroin users grew threefold, with the fastest-growing
segment of users between the ages of 12 and 17, according to the
Substance Abuse and Mental Health Services Administration.

Keenly aware of the drug's demographics, officials at both rapid-
detox companies said most of their advertising until now has been in
college and alternative newspapers.

But the price tag for the procedure doesn't fit into most students'
budgets. Nutmeg, the Connecticut company, charges $3,400 for the
outpatient procedure and limited followup. The Framingham company,
UniQual, charges $6,500, which includes the detox and an overnight
stay in the hospital, a month's worth of Naltrexone to fight cravings
and up to six months of followup counseling.

Though health-insurance companies often cover traditional heroin
treatments like methadone, they've been leery to touch rapid detox.

"We're evaluating it," said Patti Embry-Tautenhan, spokeswoman at
Harvard Pilgrim Health Care, the state's biggest HMO. "It's very new
and very experimental."

The new ads by Nutmeg and UniQual stress rapid, pain-free detox. The
fine print - about other withdrawal symptoms - is reserved for those
who call to ask about the treatment. Both companies' literature and
Internet sites also warn addicts about post-procedure pain, and both
urge addicts to stay on the cravings-buster, Naltrexone, while seeking
followup treatment.

One early critic of rapid detox said his own study has convinced him
the procedure now holds promise - but not without substantial risks.

Psychiatrist David Gastfriend, director of addiction services at
Massachusetts General Hospital, said rapid detox and the Naltrexone
followup blocks cravings better than any other treatment he has seen.

But, Gastfriend said, in the seven rapid detox patients he has
followed during the past year, one suffered a seizure after the
procedure, and another experienced difficulty breathing during sleep,
or sleep apnea. All of them battled "marked withdrawal symptoms" for
at least two weeks.

Also, despite intensive three-month followup counseling, three of the
seven have gone back to using heroin, Gastfriend said.

"The big flaw in providing this procedure without (followup) treatment
is that the patient has a fantasy that they're cured, and they don't
have the structure to succeed," said Gastfriend.

Of the 300 patients treated at Nutmeg in Connecticut, 75 percent
remained heroin-free for the four months Nutmeg tracked them. At
UniQual, 65 percent of the 40 patients treated remained heroin-free
for at least six months.

Those results are strikingly better than the 30 percent success rate
often reported for conventional heroin treatment, although the
National Institute on Drug Abuse says that success rate more than
doubles to 62 percent -if addicts stay on methadone for at least two
years.

Institute spokeswoman Sheryl Massaro said the federal government is
sticking with its backing of more conventional heroin treatment, for
now.

"We're not saying the (rapid detox) concept is totally out the
window," Massaro said. "But the safety issues need more research."

She said the government lacked data on deaths or serious injuries from
rapid detox, and was not yet tracking them.

John, the Connecticut addict and former car mechanic who was hooked by
the new rapid detox ads, hopes to be one of the procedure's success
stories. After two stints in jail for drug trafficking and one failed
attempt at conventional treatment, John went through rapid detox at
Nutmeg Jan. 27.

He had a bumpy wake-up, refusing the doctor's urgings to stay at the
facility overnight until he felt more stable. John, who is hiding his
heroin habit from his wife, also failed to fill the critical six
prescriptions, costing $200, that block the heroin cravings, blunt
insomnia and ease anxiety, vomiting and diahrrea.

The next day, he said he felt even worse than when he tried
conventional detox.

Later that day, he followed the doctor's orders, filled the
prescriptions and arranged for counseling.

A week after rapid detox, John said he still was thinking constantly
about heroin, but had no cravings for it.

"I feel great," he said. "I guess I'll think about (heroin) the rest
of my life. I think about it and then I think about what it's done to
me. Now, as soon as it comes to my mind, I push it out."

Graphic; Shooting up

Heroin use in the United States has exploded during the past decade,
and may actually be substantially higher than these numbers suggest.

1993 - 68,000

1994 - 117,000

1995 - 196,000

1996 - 216,000

1997 - 325,000

The Substance Abuse and Mental Health Services Administration
estimates the actual number of heroin addicts in 1997 was 408,000.

Source: The Substance Abuse and Mental Health Services Administration.