April 10, 2006
Risky rapid detox vows results
Opiate addiction: 3-day program allegedly kicks
cravings without withdrawals; critics bash the process
By: Carey Hamilton and Kirsten Stewart
Mike Brown's descent into prescription
pain pill addiction began innocently,
when he was given Vicodin by a dentist after a root canal.
"In three days I took all 30 pills and got hooked," he said.
"I couldn't believe the high. It became a quest to find doctors
who would write me prescriptions."
The Salt Lake Valley salesman, then 36, had no history of substance abuse.
His use soon began spiraling out of control when his wife died in 2000,
eight months after she was diagnosed with breast cancer.
Brown's tolerance grew, and he
became physically ill when he tried to quit. Eventually, tired of his
secret, his mood swings and paying $500 a month for OxyContin, Lortab and a doctor's office visit for a fake back injury, he sought help.
His story of addiction is becoming too common in Utah, where prescription
drug abuse is increasing at alarming rates. But the type of treatment
he underwent is anything but conventional.
Brown, now 44, paid almost $15,000 for a controversial medical method
known as "rapid," or "anesthesia-assisted," detoxification.
Dubbed "detox for the Botox set" by Elle Magazine, the procedure
involves placing patients under anesthesia before giving them medicines
that block opiate cravings.
It's expensive and insurance companies
don't cover it, making it off-limits to all but the most affluent.
Brown says it was worth every penny, but others say the risks - including
death - are too great, and contend the low relapse rates touted by practitioners
are overblown.
"I was afraid of getting sick." Clifford Bernstein, an anesthesiologist
and director of the Waismann Institute, where Brown went for treatment in southern
California, has performed about 2,500 rapid detox procedures over the past eight
years. The institute claims to be the go-to place for stars and athletes seeking
to kick opiates. Not counting California, Utah is one of the top five states
where clients are from, it says.
"You wouldn't expect it because [Utah] seems like such a clean-living
place," Bernstein said.
He said the Waismann method is safe and prevents patients from experiencing
the diarrhea, stomach cramps, body aches, extreme anxiety and sweats
that often occur when they quit cold turkey.
These benefits intrigued Brown, who stumbled on the Waismann Institute
on the Internet. "I wanted to be sober so bad, but I was afraid of
getting sick," he said.
He flew down, leaving his 16-year-old
daughter in charge of his 10-year-old son for the weekend. By Tuesday,
he was back at work, and, although tired, he felt he had kicked his
physical addiction. "I was so relieved that I was clean without
the horrible withdrawals,"
said Brown, who has been sober for a year. "Physically, the addiction
was gone, so then it became a mental battle that I still deal with."
In the intensive care unit of an Orange County hospital, patients undergo
an EKG, blood work, a chest X-ray and a stress test. Bernstein administers
propofol, a short-acting anesthetic, and a mixture of medications, including
clonidine, a blood pressure medicine. After about an hour, the patient
wakes up and is given a sleeping pill to rest and other sedatives if needed.
Patients typically stay for three days. They are then contacted by a
counselor for six weeks and prescribed Naltrexone, which blocks the euphoric
effects of opiates.
"The Waismann method is not a 12-step program," Bernstein
said. "It's medical treatment to get you off the drugs and block
withdrawals. Our patients aren't treated like drug addicts. Most don't
need to go to rehab."
No quick cure: The prospect of a quick fix may be alluring to addicts.
But it is among the chief complaints for critics.
"There's no easy, quick cure for opiate addiction. Rapid detox may
help a person get clean, and maybe not go through the pain of withdrawal.
But the reasons people get addicted are complex and call for long-term
care," said Brent Kelsey, assistant director of Utah's Division
of Substance Abuse and Mental Health.
That's where psychological counseling or
support groups, such as the famed 12-step Narcotics Anonymous (NA)
program, come in. Although there is no shortage of NA chapters in Utah,
pill addicts tend to set themselves apart from street-tough heroin "junkies," and
shy away from such programs.
But the physiology of addiction is the same
for everyone, said Doug LeCheminant, a clinical social worker at The
Church of Jesus Christ of Latter-day Saints.
"The body doesn't distinguish between an illicit substance or prescription
drug," he said.
The LDS Church offers its own version of the 12-step program, and LeCheminant
said it works equally well for clients who use prescription narcotics.
Because they're confidential, voluntary and community-driven, support
groups don't conduct studies. But an impromptu survey of 6,500 NA members
at the group's 2003 national meeting found more than than half had been
drug-free for more than six years.
Rapid detox is also dangerous, said Herbert Kleber, a psychiatry professor
and director of the Division on Substance Abuse at Columbia University.
In a study widely considered the most definitive, Kleber measured the
effectiveness of anesthesia-assisted detox against other medical methods.
"The benefit does not outweigh the risk of using anesthesia,"
Kleber said. "It's very expensive, and there is no evidence that
people do any better on it. And it's less safe; people die."
Other options: No rapid detox programs are
offered in Utah, but another promising medical protocol available here
involves Suboxone, a pill that dissolves under the tongue and blocks
cravings for the drugs. Some people stay on Suboxone, or generic buprenorphine,
for the rest of their lives.
But there are a limited number of doctors who prescribe it, and people
without insurance have trouble getting it.
While there is no shortage of detox choices in Utah for people with money,
the working poor and uninsured are left fighting for spots in the state's
public drug treatment system. It treats 19,000 people a year, but state
officials estimate for every person helped, there are four others waiting.
Bernstein, of the Waismann Institute, says what sets his business apart
is that patients are under medical supervision in a hospital and aren't
sent home the same day.
For more information, please 
call (310) 205-0808 or (888) 987-HOPE or 
send us a confidential email.
chamilton@sltrib.com
kstewart@sltrib.com
