New Heroin Treatment Raises Questions
RENEE MONTAGNE, host:
Heroin withdrawal is painful. Some medications help ease patients through the experience, and one method claims to be relatively pain-free. However, a study published in this week's Journal of the American Medical Association reports that detoxification that incorporates anesthesia is ineffective and even dangerous. NPR's Patricia Neighmond has more.
PATRICIA NEIGHMOND reporting:
Psychiatrist Eric Collins was interested in taking a closer look at anesthesia-assisted heroin detoxification, because some clinics and specialists were making dramatic claims.
Dr. ERIC COLLINS (Psychiatrist): Some people have characterized it as detox in a day.
NEIGHMOND: And descriptions like that can be very appealing to people in the throes of a debilitating addiction, people who may want to quit but who fear the physical agonies of withdrawal, the powerful stomach and leg cramps, the nausea, weakness and chills.
Dr. COLLINS: The acute phase of withdrawal from heroin lasts five to seven days sometimes. Then there's a residual period for several weeks after where people just don't feel all that well: fatigued and a little irritable and achy and have trouble sleeping.
NEIGHMOND: Collins heads addiction services at Columbia University Medical Center in New York. He recruited a hundred and six heroin addicts who wanted to quit. They were divided into three groups. One group received traditional treatment, Clonidine, an anti-hypertensive drug that decreases withdrawal symptoms. Another received buprenorphine, which fills certain receptors in the brain, much like heroin does, but doesn't stimulate a feeling of high. The third group was put under general anesthesia for about six hours during the most severe phase of withdrawal, but when they woke up, Collins says, their experience was not pain-free.
Dr. COLLINS: They have a variety of symptoms: pain in their back, their muscles, their joints, their stomach, vomit, diarrhea. Most are irritable and edgy.
NEIGHMOND: The symptoms lasted for days and were about the same severity as those experienced by patients in the other two groups. In addition, three patients in the anesthesia group suffered severe life-threatening complications, including a fluid buildup in the lungs. No one died, but researchers say that in the past, patients have died during anesthesia detox. After detox, all the patients received Naltrexone, a medication which blocks the heroin high. But all told, only 11 percent stayed in treatment. The rest likely returned to heroin use. Psychiatrist Wes Burgess is in private practice in Los Angeles. He says success is dismal because treatment is too narrowly focused.
Dr. WES BURGESS (Psychiatrist): People build up baggage while they've been an addict that has to be taken care of. They end up in impoverished conditions. They end up with no housing. They end up psychological straits. Things may have precipitated their being an addict that have to be taken care of. They may have had depression. They may have had panic. They may have had even a psychotic disorder. And heroin covers a lot of ills.
NEIGHMOND: Evidence to date suggests that drug maintenance with Methodone or buprenorphine is far more effective in stopping heroin use than detoxification. Patricia Neighmond, NPR News.