 Detoxification under the anaestheticA few years ago, there was a lot of media attention for De Hoop. Newspapers and television focused on the way in which De Hoop attempted to bring a possible new development in the Dutch addiction care sector to light: detoxification under anaesthetic. De Hoop supports research after this relatively new form of addiction care because for some addicts, this method seems to lower the threshold to a healthy life.In several other countries, such as Israel, Spain, Italy, the United States, Germany, Great Britain, Puerto Rico and Mexico it is already happening: kicking the habit while addicts are under the anaesthetic and are being made physically clean. This form of treatment is not being performed in the Netherlands as yet but this might change. Because this method seems to be beneficial in comparison to other detoxification methods, De Hoop wanted to look further into it. The firm Renaissance Medetox BV in Amsterdam was contacted. This organisation provides for this detoxification method in the Netherlands. Addicts who want to kick the habit under the anaesthetic and can pay the money for it, are send to Great Britain by the firm in order to kick the habit there in a clinic. According to Renaissance Medetox, an average of seventy per cent of the nearly 5,000 addicts being treated this way internationally is free of drugs a year after the treatment has ended. Zohar Klevan, director of Renaissance Medetox in the Netherlands, says that this detoxification method is very promising, therefore: "It is a safe and reliable method that is more successful than conventional detoxification methods." Interested De Hoop was interested in this method. Could detoxification under anaesthetic be a good addition to the forms of treatment offered in Dordrecht? Could this method even be applied in the Netherlands as a whole? All this prompted De Hoop to meet and consult with Medetox. A decision was made to conduct a small experiment with six opiate addicts having been placed on De Hoop's waiting list. They could volunteer for this treatment. In this experiment, De Hoop was responsible for the psychosocial treatment of the addicts and Renaissance Medetox for the medical aspect of the detoxification method. Stimulate government Teun Stortenbeker, general director of De Hoop, explains: "Six people is a very limited number but it could give a first indication of this treatment's possibilities." Stortenbeker also believes that it could prove that a larger scale experiment is necessary, an experiment which requires the government's permission. "By means of this small experiment, we attempt to stimulate the government and the professional care sector to set up such a larger experiment." De Hoop also wishes to support the Dutch Health Council when it will hand out an advice later this year on the use of medicines in the treatment of addiction. Counteract To whom does this method actually apply? How does the method work? Currently, this detoxification method is only used to treat opiate addicts, i.e. people addicted to heroin, morphine, codeine, methadone and/or opium as well as poly-drug users who are also addicted to heroin. The treatment aims to counteract the negative effects of drug use on the brain. Apart from psychological and social consequences, drug use also has consequences for the brain. If an addict uses drugs over a long period of time, his brain gets adjusted to the constant presence of psychedelic substances. This affects and also changes the brain's normal functioning. This causes the addict to constantly experience an enormous craving for drugs and affects sensorial functions. The addict's emotional life becomes upset which causes behavioural disturbances to materialise. Endorphins The above-mentioned process also applies to heroin addicts. Opiate use causes the body to break down its natural pain killers, the so-called endorphins. However, the body easily and quickly breaks down endorphins while it discards of opiates over a much longer period of time. In fact, this causes the addict to experience a constant craving for the drugs. When an addict kicks the habit without the support of medicaments, his body becomes clean but opiate remains can continue to be present in the brain for five to fifteen years after use. Therefore, the craving for drugs will remain present for a long time. However, also the natural production of endorphins will not be stimulated because there are still opiate remains in the brain. Kicking the habit under the anaesthetic seems to offer a solution to this problem. Working method What is the working method? Firstly, an addict who wants to kick the habit under the anaesthetic will undergo a thorough medical examination. This can mean that someone could receive the message that he is not suited to undergo this treatment due to psychiatric problems, affected liver and kidney functions or with the user's social background, for example. When someone receives permission to follow the treatment, he will go to the clinic where he will be put under the anaesthetic for six to eight hours. During this period, the addict will receive a mixture of medicines. "These medicines will remove the heroin from the body's receptors", dr. Gary Gershon, anaesthetist of the Welbeck Hospital in London, explains. Since May 1996, this private clinic has performed this treatment and has helped over a hundred addicts, including those from De Hoop. Follow-up care Dr. Gershon continues: "The medicines replace the opiates and pass through the body's systems. Eventually, the addict's urine containing opiate remains is collected ." The complete treatment is being performed by qualified medical and nursing staff. The client is expected to use naltrexone during six to nine months following the detoxification. Naltrexone is a so-called antagonist, i.e. it blocks the effects of heroin if an addict should relapse in to use. Experience has learned that naltrexone supports the effects of detoxification under the anaesthetic. Furthermore, the physically detoxified clients are required to have follow-up care for six to nine months in order to learn how to deal with their psychosocial problems. Painless The advantages of this method seem to be clear: this relatively painless detoxification method lowers the threshold for many addicts who recoil from breaking with their addiction. Also, the total detoxification period has been shortened considerably: instead of two weeks, the physical detoxification only takes about 36 hours! Detoxification under anaesthetic also seems to lessen the craving for the substance or even to make it disappear. Thirty-one year old Martin is one of the people having detoxified under anaesthetic through De Hoop. His story contains a clear message: "I have been addicted for ten years and five years of which I spent to kick the habit. I have tried several times but each time I failed. Either I did not make it through the detoxification or I struggled with myself so much that I started using again after a month of having been clean. It is completely different this time. I just do not know what is happening to me but my craving for heroin has completely disappeared." This remarkable result enables the client to focus entirely on further treatment and makes sure that the client does not have to waste any effort to fight against craving. Rich addicts However, a number of people is not very enthusiastic about the method. One of these people is P.J. Geerlings, medical director of the Jellinek Institute. "I think that eight hours of anaesthetic is a serious procedure. No good evidence-based scientific research has been conducted after the additional advantages of the use of anaesthesia to support detoxification as yet. And as long as this has not been done, you should not offer this kind of treatment. We tend to disregard all legal conventional procedures for each medicament where addicts are concerned." Geerlings also objects to the high costs for detoxification under anaesthetic. Geerlings: "I object to the whole commercial set-up. You have to pay a lot of money for it. In the Netherlands, we fortunately have a good health care system that is accessible to everyone, including people who do not have much money. The current situation only enables rich addicts to detoxify under anaesthetic." Waiting list These objections seem to be justified although De Hoop also fully recognises the need for further research. With this experiment, De Hoop only aimed to bring new life to the discussion about this detoxification method. And the costs? The treatment certainly costs money but this only applies to the treatment as it is currently taking place. If the total treatment period could be shortened by two months, the costs for detoxification are broken even. Moreover, if addicts need less time to complete the full treatment, more addicts can be admitted on an annual basis. Because of the enormous waiting list, this is certainly not a luxury. As far as the commercial aspect is concerned, De Hoop wants this method to be accessible for every addict and to be included in the health care system, provided that this method has proven to be successful. Data Why does De Hoop not just wait for the Dutch Health Council's advice? Stortenbeker: "That is exactly the problem. The Health Council will never be able to hand out an advice on detoxification under anaesthetic followed by admission in clinical care. We are now able to provide them with data, however limited they might be. More important is that help is needed now, there are long waiting lists right now. We can offer addicts a protective structure that is perfectly tuned to detoxification under anaesthetic. This is very important for addicts who do not have a good social network - and there are many addicts like this in the Netherlands." Relapse Many former addicts have a large chance of relapsing into use, especially in the period immediately following detoxification. In the protective environment provided by admission in clinical care or by part-time treatment, the former addict can be counselled in the period immediately following detoxification without constantly being confronted with drug use. Subsidy Together with Renaissance Medetox, De Hoop has applied for a subsidy at the Dutch Ministry of Health, Welfare and Sports in order to make it possible for a larger scale experiment to take place in the Netherlands. This application says that, under joint responsibility, the two organisations wish to conduct an experiment with detoxification under anaesthetic and by using naltrexone. This experiment would have to scientifically monitored. Striving for abstinence At the end of January 1997, De Hoop and Renaissance Medetox together organised a workshop about ‘detoxification under anaesthetic'. During this meeting, professor doctor J. Gray of the Institute of Psychiatry of London University talked about his experiences with this detoxification method. By means of a video connection, there was direct contact with the Welbeck Hospital in Great Britain where the treatment is taking place. The workshop was aimed at representatives from the Dutch Ministry of Health, Welfare and Sports, the Dutch Ministry of Justice, the Dutch Health Council, the Dutch Health Insurance Funds Council and the Dutch National Hospital Facilities Board. The Ministry of Health, Welfare and Sports would involve the contents of the meeting in its final decision about the subsidy. When this issue went to press, the Ministry's decision was still unknown. However, Stortenbeker has high expectations: "The Netherlands is increasingly less focused on the aim of abstinence. We welcome a method that supports the striving for a life free from addiction. We still believe that nobody should have to learn to live with drugs. We should never acquiesce in addiction." Published in De Hoop Magazine, no. 2, 1998 |
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