ADDICT DIED AFTER RAPID OPIATE DETOXIFICATION

A heroin addict who survived the IRA bus bombing in London last year died
as a result of "inadequate care" after rapid opiate detoxification
treatment at a private hospital, an inquest jury decided last week. But the
jury delivered a verdict of "misadventure."

Addiction specialists called for a review of the controversial treatment
after the death of Brendan Woolhead, who had been addicted to heroin for 13
years (10 May, p 1365). Patients undergoing the treatment are put under
general anaesthetic for six to eight hours while the opiate antagonist
naltrexone is administered.

The technique is said to clear opiates from the body within 48 hours,
leaving the patient to wake up with the worst of the withdrawal symptoms
over. It has never been subjected to a randomised controlled trial, and the
death has now made such a trial unlikely for the near future.

The inquest was adjourned last April after two specialists, Professor
Griffith Edwards of the National Addiction Centre and Professor Robert
Kerwin from the Institute of Psychiatry, said that the treatment at the
Wellbeck Hospital in London was reckless and grossly negligent.

The case file was sent to the director of public prosecutions for
consideration of possible manslaughter charges against the anaesthetist in
charge of the treatment. But no charge was laid after a toxicologist said
that he was certain that Mr Woolhead had taken opiates smuggled into the
clinic during treatment.

The anaesthetist had reluctantly agreed that Mr Woolhead could take one
final heroin fix at home before booking in for treatment. But police told
the inquest that large quantities of heroin or methadone were found in his
bloodstream, indicating that he had taken the drug after waking up from the
anaesthetic. His girlfriend, Gillian Cox, denied smuggling in the drugs.