The New Drug In Detox
Illawarra Mercury
Tuesday March 2, 1999
RECENT media reports revealing shocking photographs of a young boy injecting heroin on the streets of Sydney brought home to many the sordid world of drug abuse.
Drug addiction, with its enormous economic, personal and public health consequences, has plumbed new depths in Australia with about 50,000 heroin addicts and 25,000 methadone addicts - figures which are increasing by about 10 per cent each year.
Whether it is heroin, methadone, morphine, opium or any number of other opiate-based drugs and medications, the social costs of addiction, including growing disability and unemployment, medical diseases, illnesses and death, affects us all.
The Illawarra, which is a short drive from ``drug havens" like Cabramatta, is being hard hit with increasing drug-related crime and drug overdoses are a common occurrence.
But hope comes in the form of a new treatment which has been highly successful in trials which have been conducted across Australia for the past two years.
The treatment, which has been developed by the Centre for the Investigation and Treatment of Addiction (CITA), involves a three-step program including selection and preparation, rapid detoxification and an after-care program using the medication Naltrexone along with cognitive behavioural therapy.
Naltrexone, which yesterday was registered as a maintenance drug by the Therapeutic Goods Administration, prevents physical opiate cravings and blocks the feeling of euphoria experienced by drug users.
CITA clinical director Ross Colquhoun said while the registration of Naltrexone was a step in the right direction, the prescription of the medication needed to be controlled properly.
``Now GPs can prescribe Naltrexone it is even more important to establish and utilise existing detox and after-care programs for them to refer patients to," he said, ``Doctors will be highly reluctant to prescribe it unless they are aware of programs, such as CITA."
Mr Colquhoun said the international organisation, which has treated 10,000 patients across the world, had an outstanding success rate.
``The success rate of withdrawal with methadone is seven per cent - with the CITA system it is 100 per cent," he said.
``Follow-up statistics show that two out of three patients on the CITA program maintain opiate abstinence 18 months after detoxification which is substantially higher than traditional treatment figures."
Mr Colquhoun said CITA's philosophy was based on the disease model of addiction which promoted a safe, effective and humane treatment approach.
Patients who have come through the selection process are given the choice of undergoing Ultra Rapid Opiate Detoxification (UROD) or Rapid Opiate Detoxification (ROD).
``UROD is a safe and painless anaesthesia-assisted rapid detoxification system which eradicates the side effects and the memory of drug withdrawal," he said.
``Instead of about six days of acute withdrawal, patients undergo a complete withdrawal within four to six hours.
``Once detox is complete the patient takes Naltrexone for the next six months to minimise psychological and physical cravings and protect against impulsive use.
``ROD is a six-hour procedure with a 24-hour hospital stay which is carried out under heavy sedation in a high-dependency unit with one-on-one nursing.
``CITA also offers a medicated home detox for those people who are assessed as having a good chance of success. However few people manage to get through this type of detox."
According to Mr Colquhoun, the key element in the success of the CITA program was the Structured After-care Reintegration Treatment (START).
``After detox the patient is immediately initiated into START, an intensive after-care program which assists them in returning to a drug-free life, in re-establishing their careers, unifying families and remaining abstinent," he said.
Mr Colquhoun maintained that despite the success rate the CITA treatment was not a miracle cure, just a holistic approach based on years of research.
``Traditional detox methods, such as medicalised detox and long-term rehabilitation, have a low success rate as patients revert to drug use shortly after they return to their normal lives," he said.
``CITA, on the other hand, offers a holistic approach that aims at abstinence and the reintegration of patients into a normal lifestyle through techniques like cue exposure.
``The Naltrexone maintenance combined with long-term after-care helps patients to cope with daily life, without drug use."
Mr Colquhoun said there were many local myths surrounding opiate addiction: the first that it was a Sydney problem; secondly that it only affected the lower socio-economic groups in society.
``Drug addiction transcends gender, socio-economic status, race or age. The profile of a typical client seen by CITA is a person in the 18 to 40 age group who is a professional or a trade person with a good job, a reasonable education and a good family background. Heroin addicts are not all criminals, though the drug will turn some to crime to raise the money needed for drugs," he said.
``And drug addiction is certainly not a problem which is confined to the streets of Kings Cross or Cabramatta. It is a major social dilemma, increasingly affecting country and regional areas.
``We are particularly aware of the proliferation of the drug in the Illawarra. The region's proximity to Cabramatta and the supply of the drug makes it an easy target."
Those interested in the Naltrexone program should contact CITA on (02) 9410 2482.
Will it work for you?
The CITA program is the world's most advanced and successful treatment for opiate addiction, although it may not be suitable for all patients.
CITA therapy director, Dawn Colquhoun (pictured), is based in Wollongong for after-care therapy. Mrs Colquhoun also offers free assessments for those interested in joining the program.
However, the following guidelines may help you evaluate if the program is right for you.
* Patients should have a strong motivation to quit.
* Patients should acknowledge there is no quick fix and will need to make a determined effort to transform their lifestyles.
* Patients should be at the advanced stage of addiction where opiates are used more as a means of alleviating anxiety and discomfort than to achieve a high.
* Patients should have a vocational goal to embark upon during after-care as boredom and lack of purpose contribute significantly to the risk of relapse.
* Patients should have a family member or close friend who will commit to providing the necessary support for the entire duration of the program. The support person should not be an opiate user.
* Patients will need to have the financial capacity to meet the program costs. The procedure starts at $6,500 for a Rapid Opiate Detoxification and a group after-care program and goes up to $8,700 for an individual program. It might be possible to approach Medicare and private insurance companies for partial reimbursement of certain treatment components.
Adam's story
Adam, a university graduate from Sydney's North Shore, was looking forward to a promising career when he had his first `flirt' with heroin.
Just months later, his PhD studies cast aside, Adam was under the spell of the drug which turned his life upside-down.
Today, the 32-year-old looks back on that tragic period of his life, eternally grateful that he made contact with the Centre for the Investigation and Treatment of Addiction (CITA).
``There are two types of junkies. Those who have some sort of problem, like a mental or social problem and then those who use for hedonistic reasons. The result, however, is the same: once bitten you're gone," he said.
``Drug addicts are like vampires. They have to get up and get blood to satisfy their cravings and then they go back to their coffin to sleep before waking, whereupon they resume their hunt for blood. They are really like the living dead.
``When you are on heroin you are in state of pseudo euphoria with an underlying feeling of depression because you know that you cannot live without biting someone's neck."
Adam said his heroin addiction overrode every other facet of his life.
``You become an extremely selfish parasite as you only give unto yourself and not others," he said, ``You don't realise that you are literally killing yourself."
After trying traditional detoxification methods to no avail, Adam turned to the successful new CITA program.
``I was using $300 of heroin a day, one gram, as well as 75ml of Methadone," he said.
``Methadone, as a cure for addiction, may work in its most idealistic form but in the majority of cases it is a prison sentence in itself and it certainly didn't work for me."
CITA arranged a Rapid Opiate Detoxification for Adam last December before starting him on the Naltrexone and counselling program.
Adam is no longer dependant on drugs and has been busy getting his life back together.
``The CITA program was the only thing that worked for me," he said.
``The medical operation detoxes your system while the Naltrexone use acts like a plaster cast on a broken arm.
``In conjunction with counselling, which was invaluable, I have left my tormented life behind and I feel reborn.
``Only when you have known sickness can you enjoy health and know joy."
As an up and coming professional, Adam's story is valuable because it breaks down the stereotypical view of a heroin addict as a lower-class person from a broken family who is unemployed and ill educated.
Heroin addicts come from all walks of life. They could be working in your office, serving at your local store or looking after your financial affairs. They could be your brother, your father, your lover or your child.
© 1999 Illawarra Mercury