New opiate treatment gets positive results
UROD offers fix for expensive addiction
Staggering relapse rates of roughly 80% make working with heroin addicts a major challenge for case managers. Many heroin addicts try yet fail to break their addiction each year due to the pain of withdrawal symptoms and a lack of adequate support systems. A new company has entered the U.S. market with an opiate detoxification program that seems to successfully address both those issues.
The Center for the Investigation & Treatment of Addiction (CITA) International, a Spanish company with treatment centers worldwide, brought its Ultra Rapid Opiate Detoxification (UROD) procedure to the United States in August 1996, opening its first U.S. treatment center at Metropolitan Hospital Center in New York City. The success of that program has lead to the opening of additional centers in Miami, Chicago, and Los Angeles.
Just what is UROD and why are Wall Street analysts predicting big profits for CITA International? UROD costs $7,500 per patient for the detoxification process and six months of counseling and support and boasts a 70% success rate at 12-month follow-up, says Bennett L. Oppenheim, PhD, a psychologist who serves as national director of rehabilitation for CITA Americas and director of CITA New York, a detoxification and rehabilitation company based in Fort Lee, NJ.
Compared to the relapse rates of roughly 80% experienced by other opiate rehabilitation programs, CITA’s relapse rate of 30% proves UROD is between two to 10 times more effective than traditional methods, Oppenheim says.
Sleeping through the pain
Traditional heroin detoxification programs require up to 10 days of hospitalization and have a success rate of about 50%. "Because withdrawal is so painful, many patients never make it through the complete detoxification process," he says.
UROD literally allows heroin addicts to sleep through their withdrawal symptoms. Patients are placed into a light sleep state under the care of a board-certified anesthesiologist. A proprietary formula of anesthetics, muscle relaxants, narcotic antagonists, and complementary medications are administered to patients who remain asleep for approximately five hours as the procedure cleanses their bodies of active opiates. To complete the detoxification process, patients receive doses of naltrexone, which replaces heroin in the brain’s opium receptors.
"Patients wake up 100% opiate free and remain in the hospital overnight under the care of trained clinicians," Oppenheim says. "The program addresses many of the fears addicts have about rehabilitation. Many addicts try repeatedly to stop their addiction but fail due to the pain of withdrawal symptoms.
"With UROD, patients go through all the ormal withdrawal symptoms, but because they are under general anesthesia, they don’t feel anything."
Get a six-month commitment
The UROD procedure is terminated only after a naltrexone challenge. "When patients show no signs of withdrawal following the naltrexone challenge, the process is complete," Oppenheim explains.
The morning after the detoxification procedure, a therapist meets with the patient in the hospital and the aftercare program begins, he notes. "In fact, in some ways the aftercare program begins before the detoxification program. We won’t detox anyone who does not commit to the complete six-month after-care program."
In addition, to be considered for the program, patients must have a significant other who will act as a sponsor in their rehabilitation efforts. "The sponsor agrees to work with us, to keep us informed of any signs of relapse, and the patient must agree to waive any confidentiality in regards to their sponsor," Oppenheim says.
Patients leave the hospital with a prescription for naltrexone and continue daily naltrexone therapy for the full six months of aftercare. "The naltrexone therapy supplements the behavioral therapy by keeping the opiate receptor sites in the brain satisfied. The naltrexone also facilitates brain rejuvenation," he says.
The morning after
For the first several days after the UROD procedure, patients report varying levels of fatigue, loss of appetite, and other discomfort.
"It takes patients several days to regain their full strength. They are going from complete intoxication to complete sobriety in a matter of hours, and they are very vulnerable. We recommend that someone stay with them during that time and try to get them in for their first therapy appointment two to four days after the procedure," Oppenheim says.
The aftercare program includes a total of 16 visits. "The first is the predetoxification orientation and assessment visits, the second is the hospital discharge visit, and the other 14 are spaced depending on the needs of the patient," Oppenheim notes. "A patient considered at high risk for relapse may have all 14 visits front-loaded in the first month to cover the initial crisis and then be linked to supplemental and adjunct therapy and services in the community," he says.
However, the 14 counseling sessions are usually spaced over a six-month period and consist of 10 individual sessions and four group sessions. Out-of-state patients are linked to an appropriate after care program in their own geographic area, Oppenheim says.
Does multi-addiction thwart success?
Skeptics say the program may not be as successful in the United States as it has been in Europe and the Middle East, where addicts are not likely to use heroin in combination with any other drugs; American addicts tend to be polysubstance abusers.
But Oppenheim rejects that argument. "Our aftercare program focuses on the social and psychological triggers that cause the use of opiates and other substances. In addition, we network patients to programs such as Narcotics Anonymous for supplementary support. We address the issue of their substance abuse history and help them establish a network of friends who are not associated with drug use."
Getting the greenbacks
CITA is now struggling to get health plans to reimburse for its promising new heroin rehabilitation program. "Right now it’s so new no insurance carrier will cover the costs, but if a patient has private mental health coverage, we can bill for the counseling and discount the total cost by $900, making the total $6,600 instead of $7,500."
Although new to the United States, CITA International has successfully treated more than 5,000 heroin addicts worldwide using the UROD procedure, with about 65% of addicts remaining sober at 18 months. The Italian government recently agreed to cover the cost of the UROD procedure. CITA hopes that U.S. payers soon will do the same.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content