The Big Fix
A new, expensive--and largely untested --heroin detoxification technique that promises addicts relief from withdrawal symptoms "while you sleep" is getting a cool reception among state regulators and Denver's established substance-abuse professionals. In particular, an aggressive marketing campaign promising to cure people who are already being treated in methadone clinics is angering Colorado drug abuse professionals, who regard methadone as a legitimate therapy for heroin abuse--not just another addiction.
So far, two physicians in Denver have opened so-called Rapid Opiate Detoxification clinics. The clinics, which charge $3,500 to $4,500 per person, guide addicts through the painful and sometimes dangerous opiate withdrawal symptoms while they are under general anesthesia. Both doctors have used heavy advertising campaigns to attract new patients.
Recently, however, a representative from the state Alcohol and Drug Abuse Division (ADAD) asked one of the new clinics to change its advertising tactics, which included bus bench ads placed in front of a state-funded methadone clinic. "I've asked the doctor to water down his ads," explains Fred Poddle, an ADAD program administrator. "It makes methadone look like an addiction--the ads are kind of slanted toward making people look like methadone addicts."
Last week, the director of the Cherry Creek Rapid Opiate Detox clinic, Dr. Ivor Garlick, removed those bus-bench ads. (Garlick, who also is the medical director of Aurora Behavorial Health Hospital, did not return Westword's calls.) Yet the local debate over Rapid Opiate Detox may just be heating up.
In addition to raising basic questions about the procedure--who it helps, and whether it works--by lumping heroin and methadone together as drug addictions that can be helped by ROD, the new treatment takes a dig at methadone. A three-decade-old therapy for heroin addicts, methadone maintenance programs have come under fire lately, most notably by New York City mayor Rudolph Giuliani. Two weeks ago, the mayor criticized methadone as a remedy that merely replaces one addiction with another. Abstinence, he added, was a more "moral" and "decent" way to tackle heroin addiction.
Another Denver-area physician who has opened an ROD clinic, Dr. Peter Westenberger, predicts that the new procedure will become standard. "I think that in the future this will be the norm," he says.
Westenberger, an internist, was licensed to practice medicine in Colorado in 1983. Since that time, he has developed a professional interest in chemical dependency; he also has had personal difficulties with it. In late 1991, the Colorado State Board of Medical Examiners placed him on five years' probation after he admitted abusing alcohol and Valium.
He has since completed treatment for substance abuse, and his license is in good standing. Today, Westenberger is the medical director of Valley Hope Alcohol and Drug Treatment Center, in Parker.
This past March, after special training with a New Jersey physician and ROD pioneer "who has done thousands of detoxes," Westenberger opened his own Rapid Opiate Detox clinic in Englewood. Since that time, he says, he has treated twelve patients.
The cost of his clinic's procedure, which is not covered by insurance, is $4,500. Westenberger says that despite the initial sticker shock the price is well within the range of many heroin addicts. "The average heroin habit costs $100 per day," he points out. "This is only a month and a half's worth of their habit."
Although it is new to Denver, Rapid Opiate Detox was pioneered in 1988 by a group of physicians at Vienna University. Since then, the technique has been aggressively adopted by a Spanish organization known as CITA, which has introduced it into several European countries and a half-dozen U.S. cities.
The idea is simple. For many heroin addicts, the days-long withdrawal can be a major impediment to getting off the drug. At best, its symptoms--nausea and sweats--can be highly uncomfortable. At worst, the addict's blood pressure could skyrocket, and he could die. "And withdrawal is worse these days," says Westenberger, "because the purity of heroin is so much higher than it used to be."
Westenberger says ROD overcomes the obstacles of withdrawal in two ways. First, by administering a drug that quickly "removes" heroin or methadone from the body, the treating physician instigates and intensifies the symptoms. The drug compresses withdrawal from about four days to six hours.
"They go into instantaneous and total withdrawal, of an intensity such that they would not be able to survive if they were awake," he explains. "Their blood pressure shoots off the charts."
Which leads to the "while you sleep" component of ROD. For safety and comfort, the addict is placed under general anesthesia and monitored by both Westenberger and a critical care nurse. Using a combination of close medical attention and prescription drugs, they ensure that the patient lives through the process.
The procedure has been received with caution by substance-abuse professionals. "As far as I know, there have been no problems with it," says ADAD's Poddle. "But there's also no literature to say it's going to work, either."
Indeed, while CITA has claimed success rates of more than 70 percent and more than 5,000 happy customers worldwide, the organization has refused to allow outside studies, claiming its use and dosages of certain drugs are trade secrets. As a result, ROD has not been subjected to any thorough controlled studies.
"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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