Instant Detox

Wired / Joshua Davis

Bryan Peterson sat on the toilet in the master bathroom of his Palm Springs, California, home and tried to find a vein between his knuckles. It was virgin territory - he had never injected himself in a spot he couldn't cover up. But now that he'd been fired from his job in the estimating department of a construction company, he didn't care about covering up anymore. Plus, he couldn't find a vein in his arms, which were swollen with pools of pus and heroin. The thin, translucent blue veins snaking across the back of his hand filled him with joy. He slid the needle in beside his knucklebone. It hurt.

Two weeks later, he'd blown out all the tiny veins in his hands and feet. Unable to absorb all that fluid, they burst, adding more blood to the already toxic mix festering under his skin. He started plunging the needle deep into his bicep, shooting heroin directly into the muscle. The drug seemed to sizzle as he injected it.

Peterson was 36 and had been addicted for three years. Before that, he was just a normal working guy who liked to play guitar in a local rock band. Over the past two and a half years, he'd tried to kick his habit cold turkey three times and attended a few Narcotics Anonymous meetings. He'd make it through the first step - acknowledging that he was powerless over his addiction - and that was it. Even with the group therapy sessions and encouragement from fellow addicts, he couldn't stay clean for more than 10 days. The withdrawal pains were so unbearable, he fantasized about cutting off his legs to stop the aching. And when the pain subsided for a moment, he was racked with nausea and diarrhea. His body was holding him hostage: Either take the drug, it said, or you'll feel so much pain you'll want to die.

Then one day Peterson was talking to a friend who mentioned a miracle treatment gaining popularity in the Los Angeles area. Doctors were anesthetizing addicts and using an intravenous drug cocktail to induce an almost instantaneous withdrawal from the heroin. Within 24 hours, an addict would be pronounced clean and sober. Peterson borrowed the $15,000 for the procedure from his family, shot up one last time, and headed for Orange County.

"The 12-step program is an outdated 20th-century concept," says Clifford Bernstein, an assistant clinical professor of anesthesiology at UC Irvine and medical director of the Waismann Institute, the nation's leading rapid detox center. "For 70 years, thanks to Alcoholics Anonymous, addicts have been told they're suffering from a spiritual problem. AA assumes that you can talk someone out of their addiction - which is ridiculous. Addiction is a medical problem. If somebody has cancer, you don't try to talk them out of their disease."

Bernstein's steeply angled eyebrows make him look surprised and angry. When he speaks, he's quiet and measured, but his expression suggests amazement at the foolish things people believe. His eyebrows arch even higher when he examines Peterson's ravaged arms.

The procedure is scheduled to take place in the Garden Grove Hospital and Medical Center's intensive care unit, which Peterson now shares with a burn victim, a barely breathing obese woman, and a screaming elderly lady with multiple bone fractures. If he weren't about to undergo rapid detox, Peterson would be considered too healthy to be here. It's been 30 hours since he last shot up, and though he's well into the early stages of withdrawal, he's only suffering from a cold sweat, a dull ache in his leg, and a mounting panic.

The reaction is normal. Opiate molecules have a chemical structure similar to endorphins - a natural hormone that regulates pain and pleasure. When a heroin user shoots up, the opiates in the drug plug into the nerve receptors normally occupied by endorphins. If opiates are administered repeatedly, endorphin production drops. The body has essentially been tricked into short-circuiting the natural pain-pleasure regulation system.

The addiction turns ugly when the opiate is withheld. Without the presence of either the opiates or the natural endorphins, an addict's pain receptors cease to regulate brain signals. The unimpeded flow of stimulation causes acute pain while triggering a cascade of reactions throughout the body: sweating, uncontrollable diarrhea, vomiting, and severe depression. It's not fatal - though it may feel like it - and the addict often relapses just to stop the torment. It usually takes two to three weeks of suffering before natural endorphin production resumes and the pleasure-pain equilibrium is restored.

Considering the ordeal, it's not surprising that quitting cold turkey works only about 5 percent of the time. To improve on that success rate, drug treatment experts have traditionally relied on three approaches: methadone, symptomatic treatment, and Narcotics Anonymous. Methadone, and its modern substitute buprenorphine, are opiates that don't produce a high. An addict taking these drugs has essentially moved from a risky, illegal dependency to a safer, legal one. But if they don't take the methadone, withdrawal begins within hours. For users who don't want to be addicted to any substance, treating the symptoms with a combination of anti-nausea, antidiarrheal, and sedation drugs can help ease the pain of withdrawal. Finally, the support of an NA group is usually recommended in conjunction with all other treatments. These methods have a success rate of 30 percent to 40 percent after a year.

Bernstein says he has a better way to kick opiate addiction - one that painlessly strips the drug from the brain's nerve receptors in 20 minutes. The procedure, which relies on a combination of medicines, is carried out while the patient is anesthetized - a conscious patient would be in so much agony there would be risk of a heart attack. According to Bernstein, the roughly 2,500 patients the institute has treated wake up after an hour and are no longer addicted. Even if an addict were to shoot up after the procedure, there would be no effect. The opiate would be blocked from binding with the receptors already occupied by naltrexone, a drug which must be taken orally for a year. Bernstein says 65 percent of Waismann patients are still clean after a year.

Critics dismiss those numbers and denounce the Waismann method as a scam that takes advantage of desperate addicts. But the American Society of Addiction Medicine has come out in support of the treatment, and the society's former president claims that it's one of the most innovative developments in the field since the advent of the 12-step program in the 1930s.

With a recent surge in the abuse of opiate-based painkillers such as OxyContin, the institute's business is booming. He has put up billboards across the country and has explained the procedure on MTV, CBS, and NBC. So far, he's drowning out his critics. And, like Lasik eye surgery in the 1990s, rapid detox is making the transition from experimental technique to standard procedure offered nationwide. Competitors have emerged: A rival rapid detox center opened last year in Los Angeles, and there are centers in Colorado, Florida, Illinois, Michigan, New Jersey, and New York. Hundreds of addicts are going through rapid detox each year, and proponents like Bernstein are positioning the approach as a modern, humane alternative to Narcotics Anonymous.

Which makes Peterson an early adopter. Now anesthetized, he lies almost motionless in the intensive care unit. Blue fluid is being pumped through his veins. Withdrawal has never been so easy. But it's also never been so deadly.

In 1988, Austrian physician Norbert Loimer was studying opiate withdrawal when he discovered that injecting addicts with naloxone - the intravenous form of the opiate blocker naltrexone - achieved what he referred to as "acute detoxification." It was accompanied by intense suffering, which he tried to alleviate by sedating the patients. It worked. His experimental process condensed the typical weeks-long withdrawal into a matter of days. Though he believed that the procedure was too dangerous to be offered to the public, he published his findings in a medical journal, where they were read with interest by addiction medicine specialists.

One of them was Lance Gooberman, an American MD who concluded that the danger of Loimer's rapid detox method was outweighed by the fact that addicts were dying on the streets every day. Gooberman knew the risks of drug dependence first hand - he was an alcoholic and had been hooked on methamphetamines before he began treating other addicts. He understood that many junkies wouldn't even consider kicking - conventional detox scared them too much. A faster, less painful withdrawal could mean the difference between going into treatment and death for many. So in 1994 Gooberman took Loimer's experimental work and turned it into a business.

Over the next five years, Gooberman performed more than 2,300 rapid detoxifications in his offices in Philadelphia and southern New Jersey. According to county coroners, seven of those addicts died of complications relating to the procedure. That was enough for David Samson, New Jersey's attorney general, to file civil charges against Gooberman in October 1999, accusing him of "repeated gross malpractice, professional negligence, professional incompetence, and professional misconduct." Samson contended that rapid detox was an unproven treatment that put too much strain on patients' bodies. It just wasn't reasonable, the complaint explained, to assume that a two-week ordeal could be safely condensed into an hour. He argued that Gooberman was promising more than he could deliver and creating "a clear and imminent danger to the public's health, safety, and welfare."

While Gooberman was building his practice on the East Coast, Bernstein was recruited to head up the Waismann Institute in Beverly Hills, California. The institute was founded by Clare Waismann, a Brazilian businesswoman who realized that rapid detox addressed an unmet need. The market was crowded with 12-step programs and methadone clinics, but all of them required addicts to stick with a program. Rapid detox largely removed willpower from the experience - it was a concept Waismann thought would make her institute the dominant detox facility on the West Coast and, eventually, in the nation.

Bernstein was an ideal partner. He had attended a respected medical school (Rutgers), understood opiate addiction, and was a med school faculty member. He was energetic, believed in the treatment, and was ready to devote his credentials and time to winning mainstream acceptance for it.

But the headlines generated by the case against Gooberman weren't making it easy. Gooberman was on trial, but the defendant in the three-year case was really the procedure itself. Most of the testimony concerned the alleged dangers and benefits of rapid detox. And since the FDA does not regulate medical procedures, the case became a battle over the legitimacy of the treatment.

Samson laid out his argument clearly, beginning with the obvious: Opiate withdrawal is a nonlethal condition, but seven of Gooberman's patients had died. Anesthesia alone carries a small risk of death. When coupled with an infusion of novel drugs, there's no telling how dangerous it can be, particularly since there have been no large-scale scientific studies on the procedure's effectiveness. In essence, he was saying that the cure was worse than the disease.

David Smith, a leading addiction doctor and former president of the American Society of Addiction Medicine, disagreed. Smith testified that rapid detox was the procedure of last resort for addicts who had tried everything else and failed. Many of them just couldn't withstand the pain of withdrawal. Gooberman offered them another option. His patients came from a population whose health was already compromised - just treating them was a risk. But the fact that he tried to help them didn't mean he was responsible for their deaths. "How many would have died if they'd stayed on drugs?" Smith asks. "Treatment is not a threat to public health, and the attorney general did a disservice by trying to criminalize it."

The judge in the case agreed that Samson was overreaching. In a 353-page opinion handed down at the end of 2002, he concluded there was no evidence that rapid detox "caused or contributed" to the seven deaths. He called the treatment "potentially promising" - but rebuked Gooberman for a variety of medical oversights, fined him $11,500, and revoked his license for six months. The attorney general appealed, and Gooberman soon settled the case out of court. He agreed to pay $375,500 to the state and $30,000 to the families of the deceased. He also agreed to have his medical license revoked for two years. His reputation was damaged beyond repair. No hospital would hire him, and he disappeared from public view.

That left one man in the media spotlight - just in time for a surge in demand. Bernstein made it through rapid detox's early years without a fatality, and now OxyContin abuse was skyrocketing. The treatment had been legally vindicated, and Bernstein's main competitor on the national stage couldn't practice medicine anymore.

Bernstein smiles as the cameraman holds the shot. It's early in 2001, and the Gooberman case rages on. 48 Hours, the CBS newsmagazine show, is documenting the plight of Troy Swett, a 22-year-old OxyContin addict. Swett has just arrived at the hospital in Orange County to be detoxed, and Bernstein is ready for his close-up. "Congratulations for coming," Bernstein says, shaking Swett's hand. "It's the first step."

In a traditional 12-step program, the first step is to admit powerlessness over the addiction. Now, according to Bernstein, the first step is arriving at the Waismann Institute. This kind of national exposure is important for Bernstein. It's an opportunity to continue redefining how the public thinks about addiction.

During the segment, Bernstein notes that 90 to 95 percent of his patients are clean after a month. The on-air reporter asks about long-term effectiveness, to which Bernstein replies, "People walk out of here, their withdrawal is finished, and they're not craving." And the segment moves on.

But the numbers deserve more scrutiny. They are compiled by the Waismann staff without independent confirmation. They are also based solely on follow-up phone calls, and there's no guarantee that everyone is called. (At least one Waismann client, OxyContin addict Tim Lincoln, says he was never contacted after he returned home to Texas. He relapsed after two months.) Bernstein doesn't defend the absolute accuracy of the success rate stats. "Maybe it's a little off," he says, "but it's still much, much higher than methadone or Narcotics Anonymous programs."

Even substantiated statistics wouldn't necessarily prove that rapid detox is better than conventional treatments. The type of patients who come to the Waismann Institute tend to have more family and social support and can afford the $15,000 fee. They are more likely to get clean in any kind of treatment program. And there's another twist: Bernstein says that about 70 percent of his patients are addicted to prescription painkillers. He admits that the success rate for heroin addicts is probably lower, but he doesn't know the exact figure. Still, Waismann advertises a single success rate - 65 percent - and is therefore luring heroin abusers with a potentially exaggerated promise.

Bernstein cites independent studies to buttress his claims. A study from the University of Miami School of Medicine in 2000 reports a 55 percent abstinence rate six months after rapid detoxification. A German clinical investigation in 2000 found a 68 percent success rate at 12 months. But neither study compared the procedure with a control group, so it's impossible to state whether patients would have been more or less successful with another treatment.

Herbert Kleber, director of the division on substance abuse at Columbia University, takes issue with Bernstein's claims. "I challenge him to take 100 addicts off the street and show a 65 percent success rate," Kleber says. "He won't be able to."

Kleber has just completed the largest scientific study of rapid detox to date, and his numbers don't come close to matching Bernstein's. Using a $1 million grant from the National Institute on Drug Abuse, Kleber followed 105 abusers through rapid detox and two other treatments. He found that after three months, rapid detox fared no better than other methods.

But even if it doesn't work as advertised, it's still a useful treatment that can seem like a miracle cure. Even Tim Lincoln, the relapsed OxyContin addict from Texas, grudgingly admits it served a purpose. Before he went to see Bernstein, he tried to quit twice, only to suffer a week of diarrhea, nausea, and severe depression each time. Though he didn't feel good after rapid detox, he didn't have any diarrhea or nausea. Essentially, Bernstein's treatment allowed him to skip that first and most painful week of the process.

It was an illusory victory - Lincoln relapsed within two months. He eventually found the willpower to suffer through the withdrawal on his own and, with the help of Narcotics Anonymous, is clean now. But for addicts who cannot make it through that first week of withdrawal any other way, the $15,000 procedure may be their only hope. And for white collar addicts - business executives, doctors, celebrities, sports stars - the quick fix promised by rapid detox is a powerful draw.

Amanda, a busy Northern California medical-supply sales rep who asked that her real name not be used, was popping 20 Vicodins a day but didn't want to take a lot of time to deal with her addiction. Before she found out about Waismann, she was preparing for a 30-day detox in Malibu. Bernstein, she says, cured her in a weekend: "They put me under Friday. I was a little groggy Saturday. By Sunday, I was ready to get back to work. And I had no desire for the pills."

While criticism from within the medical community hasn't influenced Bernstein, competition may. In November, Chicago-based Midwest Rapid Opiate Detoxification Specialists opened a center in LA. Jake Epperly, the clinical director, distinguishes his method from the Waismann practice by emphasizing "the absolute necessity of a continuing care recovery program" based on Narcotics Anonymous. Epperly runs his own halfway house in Chicago and markets his group as the only rapid detox service in the US with a 28-day inpatient aftercare program.

Of course, closely monitoring a former user's sobriety is a pillar of NA. Addicts are expected to attend 90 meetings in 90 days and speak regularly with a sponsor who has been off drugs for an extended period.

Bernstein has never offered a robust aftercare program. He trusts in the science, not the therapy. At the Waismann Institute, the $15,000 fee includes 6 to 12 follow-up phone calls from a psychologist. Bernstein is particularly adamant that the Narcotics Anonymous approach is counterproductive. "The last thing I want is for my patients to sit in a room with a bunch of other addicts and spend all their time talking about drugs," he says. "It's like a cult. Plus, that's where all the drug dealers hang out."

But Bernstein is adapting. He says that he is in the process of creating his own Waismann-branded luxury recovery center near a beach in Orange County, where addicts can stay after detox. According to Bernstein, it'll be nicer and more effective than Epperly's program. Rather than attend group meetings, patients will be encouraged to play golf and take walks on the beach.

Epperly scoffs at the approach. "Golfing won't keep them off drugs," he says. "Just because their bodies don't crave it doesn't mean they psychologically don't want it."

Bryan Peterson is sitting in the backyard of his parents' suburban home in the hills outside Las Vegas. It has been two weeks since he underwent rapid detox. The swelling in his extremities has gone down, and the scabs on his arms have fallen off. There are dark bags under his eyes, and his skin looks like yellowed parchment. But he manages a meager smile. For the first time in two years, he's been sober for more than a few days. "Everything just looks a little greener," he says, staring out at the mostly gray desert.

Then he taps his fingers on the glass table in front of him. He lights a cigarette. He's got nothing to do. His next scheduled phone conversation with the Waismann psychologist isn't for three days. Peterson admits that he opened the yellow pages a couple of days ago and found the address of a local methadone clinic. "It's the easiest place to score," he says. But he didn't go, and he says that he feels better every day. By mid-November, he was still clean and he moved with his fiance to Glasgow, Kentucky. It's a dry town - no alcohol is sold within city limits - and it's supposed to be very green.