|
To the Editor: In the past few months, the Australian electronic and
print media have hailed ultrarapid opiate detoxification (UROD) as
being able to "cure" 60%-100% of heroin addicts. These claims were
initially made as part of a professionally organised media campaign
by CITA/ATT, a Spanish-Israeli organisation, but have been
repeated by opponents of harm-minimisation addiction
treatments.1 While there is no conclusive
evidence as to the efficacy of UROD, CITA/ATT has attempted to patent
and franchise what it considers to be "its" treatment.
In UROD, opioid addicts are anaesthetised for several hours and given
naltrexone to precipitate withdrawals. Naltrexone is a
long-acting, opioid antagonist with little or no agonist activity
that is effective orally. It has not been approved for use in
Australia. While there are benefits in terms of speed and reduced
suffering, there are no published reports comparing the long-term
outcome after UROD with other methods of rapid opioid
detoxification. UROD is expensive and has obvious risks; a patient
died during treatment in the United Kingdom.2
After UROD, patients are given up to a year's maintenance treatment
with naltrexone, usually 100 mg on Mondays and Wednesdays and 150 mg on
Fridays. While the available evidence is contradictory, there is a
suggestion that socially stable addicts with no psychiatric
comorbidity may benefit from postdetoxification naltrexone
treatment. In two randomised, placebo-controlled, double-blind
trials the treated group tended to use less heroin, but the
differences were not statistically significant.3,4
CITA claimed UROD was discovered by a Spanish
psychologist, Dr Juan Legarda.5 However, rapid opiate detoxification was first described
by researchers working at Vienna University in a series of papers
published in the international peer-reviewed literature between
1988 and 1991.6 Dr Legarda's
first and only published account dates from 1994 and refers to the work
of the Vienna group and others.7
CITA/ATT sought to franchise "its" treatment (international patent
application PCT/ES94/100108),5 and has threatened to sue a
British and American physician who offer patients similar services.
CITA/ATT has also attempted to issue national franchises for the
"CITA Method". A United Kingdom version of the franchise agreement
stipulated "the Method" must remain secret. A minimum 240
detoxifications had to be performed in the first six months and
one-quarter of all payments were to be paid to the parent company. The
British licensee would have been obliged to spend no less than US$50
000 in the first year and US$25 000 in subsequent years marketing and
advertising "the Method".2
The CITA/ATT marketing campaign represents a
corruption of the scientific process and is unethical. The
profession should condemn this and similar attempts to use the mass
media to bypass the peer-reviewed literature. However, despite the
concerns raised by the CITA/ATT media campaign, a local, randomised
trial of UROD versus another form of rapid, antagonist-assisted
detoxification is warranted.5
Such a study should include a double-blind, placebo-controlled
trial of postdetoxification naltrexone maintenance.
John R M Caplehorn
PhD Student, Department of Public Health and Community Medicine
University of Sydney, NSW 2006
E-mail: johnc@pub.health.su.oz.au
- Ackerman P. Aim must be abstinence when it comes to drugs. Sunday
Telegraph 1997 March 23; 143.
-
Tyaransen O. The strange and terrible saga of Brendan Woolhead.
Hot Press (Dublin) 1997 May 14; 12, 13, 62.
-
National Research Council Committee on Clinical Evaluation of
Narcotic Antagonists. Clinical evaluation of naltrexone treatment
of opiate-dependent individuals. Arch Gen Psychiatry 1978;
35: 335-340.
-
Shufman EN, Porat S, Witzum E, et al. The efficacy of naltrexone in
preventing reabuse of heroin after detoxification. Biol
Psychiatry 1994; 35: 935-945.
-
Brewer C. Ultra-rapid, antagonist-precipitated opiate
detoxification under general anaesthesia or sedation.
Addiction Biol 1997; 2: 291-302.
-
Loimer N, Schmid R, Presslich Q, Lenz K. Continuous naloxone
administration suppresses opiate withdrawal symptoms in human
opiate addicts during detoxification treatment. J Psychiatr Res
1988; 23: 81-96.
-
Legarda J, Gossop M. A 24-h inpatient detoxification treatment for
heroin addicts: a preliminary investigation. Drug Alcohol
Depend 1994; 35: 91-93.
©MJA 1999
Make a
comment
|
