A 'QUICK FIX' FOR ADDICTION

Rapid Detox Clears Out Heroin

NEW YORK The patient strapped to the hospital gurney, breathing
through a respirator, is James, a 40-year-old man addicted to heroin.
The anesthesiologist loads a syringe with 20 milligrams of naloxone
and slowly injects it into the IV in James's right arm. In the next
10 minutes, the drug will enter his system, pry off the billions of
opiate molecules that have been clinging to his brain cells and wash
them away.

This is a rather abrupt way to come off heroin. Were it not for the
anesthesia holding him in a state of unconsciousness, James would be
writhing, shivering, vomiting and perhaps screaming in pain. Even in
his deep sleep, his heart rate and breathing speed go up, his pupils
dilate, his nose runs, his temperature rises, his arms and legs
twitch sporadically and his skin erupts into gooseflesh.

Over the course of the next four hours, as the opiates are flushed
out through his liver and kidneys, his heart rate, breathing and
temperature fall back to normal, his pupils readjust and his goose
bumps recede. When he is awakened, his body is fully detoxified from
heroin - a process that normally can take days or even weeks.

After a night in intensive care, James returns to his family in
Queens and, a few days later, to his job as an executive chef at a
Manhattan hotel restaurant. For a few weeks, he has trouble sleeping,
and he feels achy and weak, as if he had the flu. Every day he
attends meetings of Narcotics Anonymous. And every day he swallows a
tablet of naltrexone, a drug that prevents heroin and other opiates
from affecting his brain.

This is rapid detox, a practice invented at the University of Vienna
in the late 1980s. In the world of addiction medicine, no technique
for treating heroin users has ever been more controversial. Five
years ago, when the procedure was introduced in the United States, it
was offered at only a handful of hospitals. Two years ago, seven
patients died soon after rapid detox performed by one New Jersey
doctor, who had conducted some 3,200 procedures. The technique was
widely condemned.

But it has continued to be practiced. Clifford Gevirtz, an associate
professor of anesthesiology at the Mount Sinai medical school in
Manhattan and the Bronx Veterans Affairs Medical Center, estimates
that about 1,000 procedures a year are done in the United States. In
Europe, 12,000 are performed each year, chiefly in Spain, England,
Germany, Belgium and the Netherlands. But the numbers are likely to
rise, if clinical trials show that the procedure is safe.

"Patients want it," Dr. Gevirtz said, "because it gives them a
compassionate and comfortable way to get clean." Until recently, he
performed detox at Metropolitan Hospital Center here. IN addition to
heroin addicts, ordinary people who became addicted to painkillers
after injuries or operations have also sought the procedure.

Many doctors say that until more research is done, rapid detox, which
costs from $3,500 to $8,000 and is usually not covered by insurance,
is too risky. And, they say, unless strong measures are taken to keep
patients from returning to heroin use, rapid detox, even if it is
safe, may not be worthwhile.

"I view it as more of an experimental procedure," said Patrick
O'Connor, a professor at Yale University School of Medicine, who has
studied rapid detox. "We really need to understand it more before we
start using it willy-nilly."

Mary Jeanne Kreek, an addiction researcher at Rockefeller University,
said: "We don't need this approach. We have several good approaches,
and this one is a waste of money."

Occupying a middle ground are addiction experts who believe that
rapid detox may turn out to be useful for certain patients.

"It's not chicanery or malpractice," said Michael Miller, a
psychiatrist at the University of Wisconsin Medical School who is
chairman of the public policy committee of the American Society of
Addiction Medicine. "There is a good body of science that supports
what is being done and why. The question is: Is it necessary? There
are other methods of detox which are effective, safe and cheap."

Bennett Oppenheim, a psychologist who runs UltraMed International,
which offers rapid detox (and where, until recently, Dr. Gevirtz was
chief medical officer), said his patients included a wide range of
heroin users. At one end, he said, is "the guy who has nothing, but
grandma's paying for his detox," and at the other end are "high-
profile celebrities of sports and entertainment whose names you would
definitely recognize."

A majority, Mr. Oppenheim said, have tried other ways of getting off
heroin, have relapsed and are afraid to face withdrawal again. Or
they are people who want to come off methadone maintenance.

About 980,000 Americans use heroin, the Office of National Drug
Control Policy says. About 175,000 are now enrolled in government
programs where they receive a daily dose of methadone. Dr. Miller
said rapid detox might turn out to be useful for select people who
needed to detoxify quickly. These may include addicts who have
developed severe gastrointestinal side effects from opiates, or those
who need to begin taking anti-depressants for depression.

As for James, it has been nearly three months since his
detoxification. The side effects, he said, were somewhat worse than
Mr. Oppenheim had led him to believe. Nevertheless, he said, after
spending $25,000 on heroin in 14 months, the $7,000 cost of the
procedure was worth it.