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Heroin

In response to the growing use of heroin in Los Angeles and across the United States, two local hospitals have introduced competing, high-tech methods for treating opiate addiction.

Within the last four months both Century City Hospital and Cedars-Sinai Medical Center have begun offering so-called rapid detoxification for people hooked on heroin, methadone, opium and several types of prescription pain killers.

No U.S. health insurance plan regularly covers rapid detox, so the $6,500 to $7,500 cost of the procedure must so far be covered by the patients themselves. But should managed care embrace the treatment, backers say, the hospitals could make considerable sums treating L.A.’s growing addict population.

That possibility got a boost late last month when Aetna U.S. Health Care agreed for the first time to pay for the detoxification of one of its members at the Cedars-Sinai clinic, after several traditional detoxification methods previously performed on the patient failed.

“I don’t know if this opens the flood gates,” said Dr. Michael Meyers, national director of addiction services for CITA Americas Inc., which operates the Cedars-Sinai clinic. “But it bodes well for consumers and speaks well of Aetna itself. It’s the first time an insurance company has agreed this is not an experimental process.”

Aetna officials could not be reached for comment.

So far Century City Hospital has treated about 30 patients, while Cedars-Sinai has treated about 50. But those figures are just the tip of the iceberg, both agree.

“If you look at the numbers, the U.S. heroin (addict) population is minimally at 600,000, maximum about 1.5 million,” said CITA Americas Chief Executive David Yerushalmi. “Probably 20 to 25 percent of that is in Los Angeles.”

Add in another 25,000 or so methadone addicts and the immediate pool is enormous, Yerushalmi said.

While the rapid-detox procedures at Cedars-Sinai and Century City Hospital differ a bit in the details, the fundamentals of the process are consistent.

It works like this: A patient addicted to, say, heroin, is admitted to a hospital’s intensive care ward and put under general anesthesia.

Any of several “opiate antagonist” drugs, like the popular naloxone hydrochloride, is administered to the patient intravenously over a period of six to eight hours by an anesthesiologist and nurses.

During that time the antagonist gloms onto any heroin or opiate byproducts in the person’s body, especially in the brain, where addiction takes root. The antagonist neutralizes the opiates and together they are flushed from the body.

The addict awakes sober, sometimes for the first time in years, but far from cured.

Another drug is given to the post-detox patient to neutralize the effects of any subsequently taken opiates, but “they’re going from being totally inebriated to totally straight,” said Dr. George Graf, chief executive of Addiction Medical Group Inc., which formed last year to start and operate the Century City Hospital clinic.

“They’re usually extremely anxious, their ability to cope is very limited and most of all, they don’t know what the hell to do now.”

Indeed, proponents of the method at both hospitals insist that rapid detox is only the first step in kicking an opiate drug habit.

“It’s immoral to just detox someone and not follow it up,” said Jill Brandenburger, a registered nurse and addiction therapist who specializes in helping people in L.A.’s entertainment industry get clean.

Brandenburger said she has already referred several patients to Cedars-Sinai for the new therapy.

“They’re wholly competent in what they’re doing,” Brandenburger said after watching one of her clients go through the procedure at Cedars-Sinai. “I found it entirely productive.” (Brandenburger said she is also impressed by the Century City Hospital team, but will visit that facility in the coming weeks to watch a procedure, before making any referrals to it.)

Follow-up is key to making the new process pay off. According to an unpublished report on the procedure prepared by the National Institute on Drug Abuse, “unless medication and psychosocial support are instituted after detoxification, there is a low probability that any detoxification procedure will produce lasting respite.”

Rapid detox’s strength is its speed. Traditional detoxification can take 10 days or more, and can produce painful withdrawal symptoms. Because of that, up to 80 percent of traditional detox patients drop out before getting clean and before the months-long process of readjusting to life without drugs.

To prevent relapses by rapid-detox patients, both Century City Hospital and Cedars-Sinai require their patients to participate in six months of follow-up counseling as part of their treatment, though the hospitals acknowledge they can’t force people to attend counseling sessions.

The opening of rapid-detox clinics at Cedars-Sinai and Century City Hospital mirrors the growth in the number of opiate addicts nationally.

In May the National Household Survey on Drug Abuse reported that the number of people experimenting with heroin grew five-fold between 1990 and 1995. The federal government’s Drug Abuse Warning Network similarly reported that between 1993 and 1995 the number of heroin-related emergency room visits grew from 63,200 to 76,000. The U.S. Department of Health and Human Services reports that heroin use rose 27 percent in 1996.

Based on those sorts of statistics, Yerushalmi has predicted that CITA Americas could generate more than $30 million in net profits in 1997. Graf said he did not know how much money his group would make in its first year.

For the time being the two centers are the only ones in Los Angeles offering the treatment, making each the other’s prime competitor. Both groups have retained public relations firms to spread the news about their services. And representatives of each clinic privately admit they want to be the treatment of choice for L.A.’s entertainment industry crowd.

“I don’t know what their (Cedars-Sinai’s) long-term goal is, but I’m in this for the long haul,” Graf said. “At the end of the day I see them as competition.”

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