Naltrexone® Used for "Ultra-Rapid Detoxification" of Heroin Addicts

TREATMENT SUMMER 1996

Addicts can be rapidly withdrawn from heroin by giving them an antidote, Naltrexone®, while anesthetized or sedated a medical conference in London was told on July 9 ("Naltrexone used during sleep," Reuters, July 9, 1996).

"The worst is all over in a few hours," said Dr. Colin Brewer, a British psychiatrist who spoke at the conference by the Association of European Psychiatrists and Britain's Royal College of Psychiatrists. Brewer claims that addicts no longer suffer the physical effects of withdrawal when they wake up 6-8 hours after the treatment. Over 3,500 delegates attended the international conference.

This treatment, called "ultra-rapid detoxification" in the United States, uses Naltrexone®, an "opiate antagonist." "Opiate antagonists" function on the brain cells that heroin acts upon, and lock into receptors that receive the body's natural opiates, endorphins, blocking the action. Endorphins and heroin are considered "agonists," chemicals that lock into the receptors firing a neural charge involved with pleasure (usually associated with food or sex). In contrast, "opiate antagonists" attach to the same receptors and block the circuit, some with more than 100 times the affinity of heroin, said Herbert Kleber M.D., professor of psychiatry at Columbia University in New York (Faye Flam, "Getting off drugs -quickly," Philadelphia Inquirer, April 29, 1996, p. A1).

Dr. Lance Gooberman, who runs the Rapid Opiate Detox Treatment Center in Merchantville, PA, claims that about 65% of his patients have avoided heroin since their treatment. According to his staff, more than 300 people have received "rapid detox" at the center as of April 1996. Gooberman and other American doctors do not need new approval from the FDA because their treatments use approved drugs.

However, Dr. Charles O'Brien, a psychiatry professor at the University of Pennsylvania argues that the treatment is a quick-fix method that does not cure the addict. "I don't see any value in this new treatment," said O'Brien. Other critics point to a National Institute of Drug Abuse (NIDA) report which warned of complications with the procedure that are "unacceptable" considering the unproven nature of the treatment. The NIDA report notes that "detoxification is not a cure for opiate addiction." Furthermore, the NIDA report says patients may be at risk of choking or cardiac changes when given large quantities of detox drugs in combination with anesthesia.

Patients are informed about the small risks and possible side effects of anesthesia, including vomiting and diarrhea, according to Dr. Gooberman. He said the speed of the process and the "10 to 20 percent mortality" rate of heroin addiction make the process worth the risks. One of Gooberman's patients, a 33-year-old financial consultant, said the risks were minuscule compared to the risks of looking to score drugs on dangerous streets.

Gooberman sends his patients home with a supply of Naltrexone®, so that if a patient should relapse, the drug would neutralize the effects of the heroin. He also refers his patients to Narcotics Anonymous. Kleber and Brewer agree that the best approach to avoid relapse is to give the addict the antidote under supervision of a family member.

Dr. Robert Newman, an addiction specialist at Beth Israel Hospital in New York says the treatment is not enough. "Relapse is the rule rather than the exception," he said. "The idea that people can leave with a bag of Naltrexone® pills and the number of the local chapter of Narcotics Anonymous and stay off heroin, that's wishful thinking."

Variations of "ultra-rapid treatment" have been performed in other countries, including Spain, Israel, Mexico, Italy and Puerto Rico.