DRUG COCKTAIL OFFERS CONTROVERSIAL APPROACH TO ADDICTION

ORANGE -- His right leg pedals the air like he's riding a bike. He mumbles
incoherently and tosses from side to side as he struggles to get comfortable
in the hospital bed.

Richard Leithmann Jr. is beginning methadone withdrawal. The doctor squeezes
a syringe of anesthetic into the IV tube hooked to Leithmann's arm, and a
body ravaged by 25 years of drug abuse finally quiets.

``Without all these medications, he would be crawling the walls,'' Dr.
George Graf says as he adds to the cocktail of drugs coursing through
Leithmann's veins at Chapman Medical Center. ``It (would be) like watching
an exorcism.''

For the next five hours, as drugs hasten the exodus of methadone from his
body, Leithmann will remain under general anesthesia and won't feel or
remember the usual agonies of withdrawal. This revolutionary and
controversial approach to addiction is often called the ``Sleeping Beauty''
treatment because patients awaken free of physical addictions to methadone,
heroin, vicodin and other opiate-based drugs.

For those who have kicked addictions this way, it is nothing short of a
miracle. But for those who work with addicts, it's a risky and unproven
treatment similar to fad diets that melt away the pounds but can't guarantee
to keep the weight off.

``It is not going to be the solution to our country's heroin addiction
problem,'' said Dr. John McCarthy, director of Bi-Valley Medical Clinic,
Sacramento's largest drug treatment provider. ``Heroin addicts detox all the
time -- most of them in jail -- and then return to using.''

Cold-turkey detoxification can be a five-to seven-day ordeal of severe
flu-like symptoms. Drugs can shorten withdrawal to three days, but it's
still an agonizing process. Or addicts can shift to methadone and gradually
wean off it by reducing the dosage.

The new detoxification procedure -- known as rapid opiate detoxification
under general anesthesia -- promises to free addicts of their physical
reliance on opiate-based drugs in less than eight hours, with minimal pain.

The doctors use drugs to blast the opiates off the brain's receptors and to
flush the illicit substances from the body. They administer other drugs to
combat nausea, diarrhea and muscle aches -- although some of these symptoms
are likely to linger after the procedure.

Then, they give their patients naltrexone, an opiate antagonist used to
treat alcoholism that eliminates the craving for drugs. Each patient is told
to continue taking naltrexone after the procedure, because it keeps them
from getting high if they fall off the wagon.

This procedure is so expensive -- $2,000 to $7,000 -- that few addicts can
afford it and most insurance companies won't pay for it. It won't work for
cocaine, depressants, alcohol or benzodiazepines.

But with heroin use on the rise among the affluent, rapid detoxification is
a fast-growing business.

It's available at hospitals and clinics from Europe to Mexico, and in U.S.
cities from Miami to Seattle. Addiction Medical Group Inc. at Chapman
Medical Center is the only company currently offering it in California.

Most providers urge patients to seek counseling or further treatment, and
some offer those services. But there's so little research into the
procedure's long-term success that a group of addiction specialists said it
``is currently without ethical, medical, scientific or financial
justification.''

The specialists, in a 1996 report for the National Institute on Drug Abuse,
said the ``risk of serious adverse events, including death,'' outweighs
known benefits.

They cited one life-threatening reaction to the drugs used in the treatment.
At least one other patient died shortly after undergoing the procedure at
Cedars-Sinai Medical Center in Los Angeles in the past year, and many more
have overdosed after getting ``clean.''

Jake Epperly, national site director for CITA Americas, a company that had a
contract to perform the detoxification treatments at Cedars-Sinai, said the
procedure didn't cause the death. But he couldn't explain what did.

Cedars' spokeswoman Roberta Nichols declined to comment on the death, except
to say that the hospital ``decided not to maintain our relationship with
CITA.''

Epperly said the risk of disease and death from addiction is much higher
than any risk associated with rapid opiate detoxification under general
anesthesia.

``You have to remember that people go under general anesthesia every day to
get tummy tucks,'' he said. ``That is not life-threatening, while being an
addict is life-threatening.''

His company and Cedars-Sinai were sued by former patient Robert Ruiz for
promising results he claims the procedure didn't deliver. The lawsuit claims
that CITA promised Ruiz ``would come out a new man,'' but he didn't.

Epperly and Nichols said they were unaware of the lawsuit, though the
hospital's attorneys have tried to block it in court.

These types of promises and the advertisements by companies offering the
procedure have prompted some addiction specialists to question it.

``It's being marketed in a way that is a little too polished,'' said Karen
Miotto, UCLA director of addiction services. ``It's really steeped with this
for-profit mentality ... and they are trying to make a profit on an
extremely vulnerable group.''

Most providers boast that 100 percent of their patients are detoxified -- a
rate critics say should be expected since unconscious patients can't leave
during withdrawal. A few providers also claim long-term success, saying that
as many as 76 percent of their patients remain drug-free after six months.
But even those who offer the treatment question such high success rates.

Graf said just 34 percent of his group's patients were drug-free after six
months. ``Our rate is low because we are being honest,'' he said.

Brian Zavell, program director for Megama, another company offering the
procedure, said drug abstinence shouldn't be the measure of success for a
``silver bullet'' procedure to end physical addiction.

His company keeps patients for five days to ensure their recovery. After
that, follow-up is done by telephone because most patients come from
elsewhere to get treated at Megama's outpatient clinic in Ensenada, Mexico.

Greg Hayner, chief pharmacist at the Haight-Ashbury Free Clinic, said the
San Francisco clinic has counseled patients who underwent the procedure and
he's troubled by the lack of follow-up.

``Recovery really is a process, not an event,'' he said. ``Addiction is a
chronic disease that needs chronic follow-up.''

That is the case for Michael Dawson, a Santa Ana ex-con who underwent the
procedure at Chapman Medical Center on March 11.

``I first put a needle in my arm at age 16,'' the 49-year-old addict said.
``I didn't take that needle out of my arm until I went to the hospital.''

Dawson, who has spent 23 years behind bars, said he has stayed straight and
out of prison for the past five months by attending Narcotics Anonymous and
other group meetings.

``The treatment did everything it was supposed to do,'' he said. ``But now I
have a lot left to do.''

Kathi England, a 41-year-old Bellevue, Wash., resident, said she has been
straight since undergoing the treatment at Megama's clinic on Nov. 9. She
said the naltrexone she takes has eliminated her heroin cravings.

``I have been through treatment center after treatment center,'' she said.
``Nothing worked. This was an answer to my prayers.''

England also credits her family's and her boyfriend's support with helping
her change her life.

Addiction specialists said that kind of support is critical to long- term
recovery. They said the best candidates for rapid detoxification are addicts
like England who still have a support system, pain patients who became
addicted to prescription medicine or those trying to quit heroin with
methadone.

Leithmann, who underwent the detoxification procedure last week in Orange,
said he tried to quit heroin by shifting to methadone 13 years ago. But he
couldn't quit the methadone.

At age 48, the Tucson resident said, he decided to try rapid detoxification
because ``I have had it.'' A day after the procedure, Leithmann was weak but
surprised at how good he felt.

``I didn't think it would be this good,'' he said. ``I don't remember
anything about the procedure.''

Leithmann said he has tried to kick his addiction at least six times before.
This time, he said, he'll take naltrexone for the next month and continue to
get counseling.

``I have got a whole new life in front of me,'' he said. ``Really!''

Checked-by: "Rolf Ernst"