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"Further research is needed using more rigorous research methods, longer-term outcomes, and comparisons with other methods of treatment for opioid dependence," an abstract printed this past January in the Journal of the American Medical Association advised.
"We need controlled studies," acknowledges Westenberger, adding, "I wouldn't mind participating in one."
Two years ago, the National Institute on Drug Abuse issued a report warning that the technique posed an "unacceptable" risk of death. And although fatalities from the method seem rare, at least one has been well-documented. In late 1996, a man who'd survived an Irish Republican Army bombing in London checked himself into a Ultra-Rapid Opiate Detox center. He died from heart failure soon after beginning the withdrawal treatment. This past January, a jury found the center liable for the man's death.
Still, even skeptics concede that the procedure may someday takes its place in the range of strategies used to combat addiction. "This could be useful for a select group of patients," concedes Eric Ennis, director of Adult Outpatient Services at Addiction Research and Treatment Services (ARTS), a drug treatment clinic that is part of the University of Colorado's Health Sciences Center's School of Medicine.
But, he adds, not yet. In fact, ROD's entrance into Denver began to bother him almost immediately. "It all boils down to marketing," he says.
"They were using the words 'miraculous cure,'" Ennis recalls. "Well, there is no such thing as a miraculous cure to addiction."
Then the bus-bench ads popped up. Ennis says he suspects their placement on 18th Avenue between Gaylord and Vine was not coincidental. ARTS runs methadone maintenance clinics on either side of the benches, one on 1827 Gaylord, the other on 18th and Vine. Another bus-bench ad appeared across from University Hospital.
The ads' placement was suspect. But what annoyed him the most, says Ennis, was whom the signs--which read "Heroin-Methadone detox while you sleep"--targeted.
"They're treating heroin and methadone as the same thing, which couldn't be further from the truth," Ennis complains. "Heroin is an illicit drug. Methadone is part of a controlled treatment program. It's one thing to take a heroin addict off the street [and into Rapid Opiate Detox]. It's quite another to take someone out of a methadone treatment plan. Methadone is a maintenance treatment, like for diabetes. It's safe and controlled. It's been around 30 years, and it's been studied to death."
Westenberger doesn't think there's that much difference between the two substances, though. "This is for people addicted to opiates--heroin and methadone," he says. "Some doctors believe that there is no way to get off of opiates--including methadone. But we don't."
Besides, he adds, "I have yet to meet one person who's on methadone who is not on heroin, too."
Beyond the marketing, and the issue of whether methadone is a treatment in need of curing, substance-abuse professionals worry that ROD, with its promises of quick and painless therapy, will lure addicts away from the long-term support that most need to stay off narcotics. Ennis points out that detoxification--even if it costs $4,500--is only detoxification, a first step toward getting off drugs.
"It doesn't address the complex psycho-social factors that contribute to addiction," he says. "It removes the drug from your body. That's all it does."
Westenberger agrees. "This is just detox--not treatment," he says. "But our hope is that with a month of clean time these people can get a foothold on sobriety." To help them on their way, Westenberger adds, he guarantees patients four follow-up visits after detox. He also offers the option of a subcutaneous drug implant that blocks the body's opiate receptors, preventing an addict from getting high even if he shoots up.
Westenberger claims that to his knowledge none of the dozen addicts he has detoxed since March have relapsed. Yet Ennis says that "a handful of our clients have come back to us with their heads hung low, who had relapsed." He says ARTS has had four addicts--two who were treated in ROD in other states, and two from Denver clinics--fall off the wagon after ponying up thousands of dollars.
In the battle over ROD's acceptance in Denver, Ennis appears to have won the first battle. After informing ADAD of the bus bench signs earlier this month, two weeks ago Poddle paid a visit to Garlick and convinced him to remove the signs. Last week, Garlick did.
Poddle says there may be more scrutiny to come. Specifically, he says, he is pondering whether the new Rapid Opiate Detox clinics must apply for state licensing. He says he is leaning toward greater regulation.
"I think they're going to have to be licensed--just like the methadone programs," he says. "My thinking is that, during sedation, they're using a controlled substance; even though they're private physicians, they're using a controlled substance."
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