ULTRA-RAPID OPIATE DETOXIFICATION UNDER ANAESTHESIA (UROD)

Sir--C Brewer and colleagues (Jan 17, p 218)1 accuse me of claiming falsely
that I developed a highly successful method for the detoxification under
anaesthesia of polydrug users addicted to opiates. In November, 1992, I
sent a dossier with protocols, bibliography, and clinical cases of my
technique to experts on drug addiction from the National Addiction Centre,
London, Norbert Loimer and Kurt Lenz from University of Vienna, as well as
others from Spain. As a result, a meeting with these experts took place at
CITA (Centro de Investigación y Tratamiento de las Adicciones) centre,
Seville, in January, 1993. Brewer did not attend. At this meeting Loimer
stated his view that his procedure was aimed at studying the
neurophysiological basis of opiate withdrawal and that it was not valid for
so-called street addicts--a view that he sustained in a meeting organised
by Brewer's Stapleford Centre and held at the Royal Society of Medicine in
London.2 Similarly, Brewer's views were presented in the BBC1 documentary
QED aired in April, 1995, at which he maintained that it was a minor
scandal that British heroin addicts had to travel to Spain to be treated
under anaesthesia. Other more recent attempts at treatment are also very
limited. Brewer's Stapleford Centre treatment protocol, presented by Yugan
Mudalier in Israel, excludes patients on more than 1·5 mg per day of heroin
and states that patients on methadone have to reduce their dose to 20 mg
per day, enter as inpatients for 2 days, and still come out with pain. More
than 15% of my patients use more than 1·5 mg per day of heroin. Are we not
talking about a different treatment, since from the beginning UROD is used
with any type of opiate addicts, even street addicts, and without
limitations as to type or amount of opiate, successfully?

Second, they state that CITA clinics make false publicity by claiming that
UROD is safe and painless, whereas patients have died in the immediate
post-anaesthetic period. No ministry of health has made such an accusation
for the more than 4000 patients treated since 1992.

Brewer and colleagues also state that CITA lies about success rates. CITA
always offers publicly success rates in the short and medium term.3,4 Since
100% of patients who begin detoxification finish it and 57% are still well
1·5 years later, is there enough scope for lying?

They also state wrongly that since CITA only offers a single treatment
excluding other cheaper approaches, our advice to patients may not be
impartial or in the best interest of the patient. CITA clinics in Spain
offer all treatment possibilities, and in the USA UROD is not even given
unless the patient signs up for rehabilitation.5

Finally, they accuse CITA of immorality for aggressive franchising,
requiring non-disclosure agreements from our employees in a "fundamentally
altruistic profession". CITA does not franchise but establishes agreements
with fully informed public and private hospitals, as well as with doctors
from Europe and the USA. These agreements are not only for minimum levels
of excellence of treatment for the patient but also limit the prices and
assure a 6-9 month follow-up by psychologists and psychiatrists. The
agreements also require the collection of data for research, which is
published3,4 and freely offered through the scientific press.5

I have never before criticised any specialist. I have offered through all
channels treatment data for more than 1200 patients, each with more than
100 variables. The Spanish Ministry of Health has evaluated, at my own
request, all stages of treatment and the data. In 6 years since the first
UROD was done, CITA has opened centres in public and private hospitals in
Europe and the USA, and has organised scientific meetings, published
scientific work has developed ultrarapid treatments for benzodiazepine
dependence, and freely offers a computer video for cognitive restructuring
and data for patients and treatment protocols.

Juan J Legarda CITA (Centre for Investigation and Treatment of Addiction)
28007 Madrid Spain

1 Brewer C, Williams J, Carreno E, Bobes Garcia J. Unethical promotion of
rapid opiate detoxification under anaesthesia (RODA). Lancet 1998; 351: 218.

2 Pini P. Controversial approaches to heroin addiction aired in London.
Lancet 1996; 348: 743.

3 Legarda JJ, Gossop M. A 24-h inpatient treatment for heroin addicts: a
preliminary investigation. Drug Alcohol Dependence 1994; 35: 91-93.

4 Rabinowitz J, Cohen H, Tarrasch R, Kotler M. Compliance to naltrexone
treatment after ultra-rapid opiate detoxification: an open label
naturalistic study. Drug Alcohol Dependence 1997; 47: 77-86.

5 Stephenson J. Experts debate merits of 1-day opiate detoxification under
anaesthesia. JAMA 1997; 277: 363.

Checked-by: Mike Gogulski