Clean and sober in 48 hours?

Lisa Hill, a 27-year-old prescription drug addict, lies in a hospital bed in Tustin, about to undergo her third detox attempt. A few minutes later, doctors give her anesthesia, stick a breathing tube down her throat and then administer a liquid dose of Naltrexone. During the next few hours, the drug cleans Hill’s body and brain of any remnants of the painkiller Vicodin that she has been hooked on since a car accident in 2000.

If Hill were awake, she’d be suffering hours of severe headaches, vomiting, shakes, sweats and relentless abdominal pain. The doctors, though, don’t wake her for several hours, and later give her sleeping pills to make it through the night. In the morning, she wakes up, takes a shower and goes home. A few hours later, she no longer craves.

The treatment takes two days, from start to finish.

This new and controversial drug detoxification therapy is known as “rapid detox.” Advocates say it’s the next generation in drug treatment, far easier and more effective than traditional methods, such as 28-day programs or methadone clinics. It’s primarily used for people addicted to opiates, such as heroin, morphine or Oxycontin -- a highly addictive prescription pain medication -- because those habits are considered the most difficult to kick. Other detox programs that promise speedy treatment for people addicted to cocaine and alcohol are beginning to be offered across the country, although such programs are not yet common.

“This is more successful than traditional treatments. And it’s more humane,” says Clare Waismann, director of the Waismann Institute in Beverly Hills, who brought the treatment to the U.S. five years ago from Israel, a major center of research into rapid detox programs. The number of patients undergoing treatment at the institute’s clinic in Tustin has tripled in the last two years, Waismann says.

Popularity and criticism

The concept of rapid detox is appealing for a number of reasons. As the name suggests, the treatment is faster and more convenient than alternatives. Patients could enter treatment on a Thursday and be back to work by Monday, without disrupting their lives for weeks or attracting the attention of bosses, co-workers and friends. Although medical insurance doesn’t cover the treatment, which costs about $10,000, the programs are less costly than some of the longer and fancier drug treatment programs.

Moreover, by most accounts, traditional treatment methods don’t work for many patients. By some estimates, as few as 15% to 30% of opiate addicts complete traditional treatments. Rapid detox clinics claim success rates of up to 60%, although those claims have not been validated by rigorous scientific studies.

Despite its growing popularity, many physicians and some prominent addiction specialists are critical of rapid detox therapy. A key concern is the lack of clinical studies demonstrating the benefits and risks of the treatment. Several smaller studies, here and abroad, have been inconclusive. Researchers at Columbia University are doing a larger study comparing one-year success rates of rapid detox and traditional therapy, but their work won’t be completed for another year.

Because there is a small risk to any patient undergoing anesthesia, many doctors say they won’t recommend rapid detox until more is known. “Our view is that there just isn’t adequate scientific evidence about [rapid detox] and that currently it involves an unacceptable level of health risk,” says Dr. Lawrence Brown, president of the American Society of Addiction Medicine, which serves as the American Medical Assn.’s expert on addiction medicine.

Nevertheless, supporters of rapid detox say demand for their programs is growing. There are no federal statistics on the number of patients who have undergone the treatment, but officials at several major clinics estimate that 5,000 people in the U.S. have had rapid detox therapy this year. Several dozen clinics, from Miami to Seattle, now offer rapid detox treatment, and one company, Los Angeles-based CITA Biomedical, says it is expanding its program nationwide next year.

Treatment’s key element

At the heart of the treatment is Naltrexone, a nonaddictive, non-mood altering drug that helps break down the physical effects opiates have on the body over time. Opiates attach to receptors, or proteins, in the brain and produce a sensation of feeling “high.” Naltrexone, known as a narcotic antagonist, helps to block those receptors and to quickly clean the patient’s system of any opiates.

After treatment, patients take Naltrexone once a day for up to nine months. Alternatively, they can have a Naltrexone pellet inserted in their abdomens that releases the drug over six weeks. If an addict takes an opiate while on Naltrexone, doctors say, they will not experience a sensation of feeling high.

While the drug-assisted withdrawal itself takes as little as four hours, additional time is required to prepare patients for treatment. Because many addicts often are in poor health, they must first undergo extensive medical tests, including electrocardiograms, liver and lung exams and pregnancy tests, the day before detox. They are then given muscle relaxants, sleeping pills and an opiate so their bodies don’t start to go through withdrawal symptoms before treatment. The next day, the treatment usually takes place in a hospital intensive-care unit, overseen by an anesthesiologist and a team of nurses and technicians. (Most rapid detox programs operate through private clinics that contract with hospitals.)

Still, there are risks. It is known that at least seven people have died in the United States soon after undergoing rapid detox. Six of those deaths occurred at one New Jersey clinic not located at a hospital; the physician involved was later disciplined by the state medical board for failing to take adequate medical precautions. While doctors and researchers familiar with those cases say it is difficult to know if the patients died because of the treatment, some critics of the therapy believe it could have played a role.

And because rapid detox programs are not regulated as consistently as alternative treatments, such as methadone clinics, some doctors are doing the procedures in their offices, without the support staff and emergency equipment required in hospitals. Most doctors strongly recommend against undergoing rapid detox therapy outside a hospital.

Opiate addiction rising

Drug experts do agree that something has to be done to deal with the growing number of opiate addicts around the country. There is, after all, a serious health risk to remaining a drug addict.

According to the National Institute for Drug Abuse, there are more than 1 million opiate addicts in the United States and that number is rising. Some of the reasons include the large number of Americans, from baby boomers to the elderly, who are getting hooked on pain medication for chronic pain.

Oxycontin, a potent painkiller that health authorities say is increasingly abused, is also playing a role. Overall use of the drug rose by 140% last year, according to a recent federal survey on drug use.

Popular alternative treatment methods, such as methadone clinics, have significant drawbacks. For one, the number of Americans seeking methadone treatment far exceeds the number of openings at government-approved treatment clinics. As a result, most clinics have long waiting lists. What’s more, methadone takes nearly a month to clear the addict’s system, compared with a week to 10 days for other opiates, including heroin. Roger Brenner, 47, says he was addicted, on and off, to everything from cocaine to heroin for more than 30 years. Six years ago, he started methadone, hoping to break his heroin habit, but later found that it was more difficult to quit methadone than the other drugs he had taken. The Vista, Calif., service manager underwent rapid detox treatment for methadone three years ago. Although he felt “like a truck had hit him” when he woke up after treatment, he said the method worked like “a miracle.” Brenner says he has been clean since.

As more is known about rapid detox, doctors say they are learning that the treatment works better for some patients than others. People who have recently become addicted to painkillers, and older addicts, who are often weary of using drugs and are more motivated to quit, have better success. One group some doctors are hesitant to treat with rapid detox is longtime chronic pain sufferers. Many still experience pain after detoxing and return to drugs to ease their suffering.

Such is the case with Lisa Hill, the Costa Mesa woman who underwent treatment at the Waismann’s clinic in Tustin. Although Hill says she didn’t feel cravings for the drug immediately after treatment last month, she ultimately thinks the therapy failed. She still experiences pain in her back and leg, and she acknowledges that she returned to taking a prescription painkiller, a few weeks ago. “I feel there was too much hype around rapid detox,” she says.

The Waismann Institute disagrees that the treatment didn’t work, and says that Hill showed no signs of opiate withdrawal after the procedure, such as abdominal pain or a runny nose.

Doctors say one of the most important aspects of rapid detox is the care provided to patients after the procedure. Depending on the clinic, post-treatment counseling is provided for two weeks to six months.

Critics of rapid detox say that intense post-treatment therapy is the single most important part of addiction treatment and should continue for up to two years. After all, many patients haven’t felt the pain of even a toothache, or clear emotions, for years and quick sobriety can be a big shock. “Detox is different from treatment. For some addicts, six months is a drop in the bucket,” says Dr. Gifford Gervitz, an expert in the field who conducted a small research study on rapid detox at Tufts University in Massachusetts three years ago. Gervitz says that his study had favorable results but that with only 20 patients, it wasn’t large enough to be conclusive.

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Rapid versus traditional detox

While most treatment experts recommend traditional detox therapies such as 28-day programs, a new “rapid detox” is growing popular. Under anesthesia, addicts are given the drug Naltrexone, which rapidly cleans their systems and breaks their cravings.

Length of treatments: Traditional, 28 days; rapid detox, one to two days.

Cost: Traditional, from $5,000 to $30,000 per month (covered by some insurance plans); rapid detox, $10,000 (no insurance coverage).

Success rates: Traditional, 15% to 30% of patients remain clean for one year; rapid detox, as high as 60%, as reported by several clinics, but the numbers haven’t been confirmed in scientifically rigorous studies.