Rapid detoxification with naltrexone

By David and Joyce Djaelani Gordon

JAKARTA (JP): More people are referring to naltrexone as a magical treatment for sakaw (drug withdrawal symptoms), and call it "rapid detoxification" or, a newer term, accelerated neuro regulation (ANR).

A common marketing move, yet this is simply selling an old product under a new image. In fact, naltrexone is not magic, and naltrexone is definitely not a cure for drug addiction.

Furthermore, naltrexone is not rapid when you consider the naltrexone medication (pill) one has to take for three to six months after initial treatment. Nor is naltrexone considered a true detoxification by any respectable professional in the field of drug abuse.

Yet, in Indonesia there are currently many doctors, psychiatrists, institutions and clinics offering this naltrexone treatment, to relieve drug abusers of their withdrawal symptoms from putaw (heroin). Many of these people, in reality, understand little about addicts, less about the disease of addiction, correct methods of detoxification, or how a genuine process of recovery is appropriately applied.

Most of these individuals are medical people but not trained addiction specialists. Many are simply following a technique or method, as to what they have been told is the correct method for detoxification, based purely upon the medical model of detoxification, not on a process of recovery.

Many are just naive about addiction, and believe what they are prescribing is the correct method of treatment for detoxification. Many are dangerously incorrect in their assumption.

And there are those who are in the rapid money business, and using the rapid detoxification as a rapid money printing press.

The truth is that rapid detox can often be an extremely dangerous procedure. This warning is especially accurate with the outbreak and epidemic of hepatitis C that has invaded the drug addict community throughout Indonesia.

Hepatitis C can now be found in approximately 80 percent of the injecting drug users in the Greater Jakarta area and is spreading at an accelerated rate throughout our nation.

Naltrexone is hepatotoxic, meaning a poison/toxin to anyone with active hepatitis or liver problems. Naltrexone is what is known as an opioid blocker and antagonist. Simply defined, naltrexone blocks the effects of opiates and opioids.

This means that after the initial naltrexone treatment, and while participating with the ongoing naltrexone medication treatment, if a person uses an opioid, the effects will be not be felt by the user.

The effects of the opioid are naturalized by the naltrexone. But naltrexone does nothing to block the effects of other drugs that drug abusers and addicts often use. It does not block methamphetamines, and neither does it block the effects of marijuana.

Remember that most addicts are poly drugusers or people who use more than one drug and/or narcotic. This basic understanding of addicts, their lifestyles and patterns of behaviors appear to escape the attentiveness of most people.

So it is very important to understand naltrexone simply blocks or neutralizes the effects of an opiate, like heroin.

Currently, rapid detox is being used to help relieve withdrawal symptoms during first stage drug and/or alcohol detoxification. There are four stages of detoxification.

Also remember that naltrexone will have no effect on individuals who use alcohol, marijuana, amphetamines, ecstasy, LSD, Nipam (flunitrazepam), cocaine and/or other illicit drugs.

Nor does naltrexone, by itself, guide a drug abuser to change friends, alleviate the desire to use other illicit drugs, change habits and patterns of behavior, seek a pathway that leads to a thorough and long-lasting recovery from drug abuse, repair damage done to family and loved ones, offer any ongoing program of after care, or take away the social or peer desires to be part of a group.

Naltrexone should never be randomly used in Indonesia. It definitely should never be used by any doctor or psychiatrist that is not a fully trained addiction specialist.

No institution, hospital or clinic should ever use naltrexone, unless they have a fully trained and qualified specialist on staff. Naltrexone should never be used with young drug abusers or addicts, if they have only been using opioids a year or two, and are in generally good health otherwise.

Naltrexone should never be used if there is no ongoing program of recovery and after care for the abuser and their family. Naltrexone should never be used when anyone has active hepatitis, or liver dysfunction.

The abuser and their family are strongly advised to carefully read the fine print of any contract/agreement of consent furnished by any person or organization before they sign and commit themselves, or a family member, to undergo a rapid detoxification treatment.

The reason professionals ask individuals and families to sign a consent form, mostly without proper counseling and appropriate information on the pros and cons of naltrexone, is because rapid detoxification is a dangerous procedure.

And professionals do not wish to be blamed or held responsible in the end should anything go wrong with the initial procedure, or problems, including a relapse, are incurred after the procedure with the ongoing medication the patient is told they must use for months after the initial treatment.

Another warning is most professionals and institutions that are using this rapid detox treatment method are presently not doing thorough blood testing/screening, or thorough physical and mental health examinations before the abusers/addicts are admitted for naltrexone treatment.

Thus, the professional or institutions have no real idea or data about the actual physical or mental health condition of the patient at the time of treatment.

This could prove to be extremely dangerous for anyone undergoing a rapid detox treatment. And most of these treatment centers have no ongoing, follow-up or drug treatment programs. This means that the relapse rate using some drug or substance shortly after a naltrexone treatment is nearly 85 percent within the first 60 days after release from the center, because there is no solid monitoring, ongoing services, recovery program or aftercare programs.

Now it is accurate to point out that naltrexone does, for an extremely expensive price, assist in blocking the effects of an opiate, like heroin, during first stage detoxification. Naltrexone does alleviate the withdrawal symptoms in six to 12 hours.

That is what naltrexone is specifically used for, to relieve withdrawal and craving symptoms. It should be understood that addicts facing withdrawal will take anything to help relieve the pains of withdrawal symptoms. Any fast-acting pills, medication or treatment that allows relief from withdrawal symptoms are always welcomed by most any addict seeking first stage detoxification.

The body's natural process of detoxification from heroin usually takes approximately four to six days.

The initial treatment of naltrexone is most often done in a hospital or clinic setting, and the patient must undergo general anesthesia.

The use of general anesthetics is now frequently avoided by many surgeons and medical authorities worldwide. Knowledgeable medical authorities most often opt for local anesthetics whenever possible, since many now understand that the use of general anesthetics can be potentially damaging to brain cells.

Yet, the use of general anesthetics for six to twelve hours is customary for someone undergoing a rapid detox treatment.

Naltrexone is a substitute treatment for helping drug abusers/addicts overcome the first uncomfortable states of opiate and alcohol withdrawals only.

Naltrexone must never be seen as a cure, or a program of recovery from addiction.

Drug addiction, and recovery from drug addiction, is new to Indonesia. Hepatitis C and HIV/AIDS are also new to Indonesia.

True recovery is a fourfold process: physical, mental, emotional and spiritual/religious.

There are no shortcuts to achieving a life without drugs or alcohol for an alcoholic or drug abuser/addict. Never let anyone tell you otherwise.

Never randomly trust any rapid detox method, and never randomly trust anyone who is selling this kind of expensive method and procedure.

Rapid detox procedures should only be used in rare cases where there are years of long term bouts with chronic addiction and relapse, or there are mental and/or physical indications or complications that absolutely require this kind of procedure and/or treatment.

There are no drugs in the known world that have yet managed to create a sense of local amnesia, that induces drug abusers and addicts to forget about drugs.

For many reasons, the relapse rate is just as high, with or without naltrexone. Because the drug abuser/addict cannot feel the effects of heroin after a naltrexone treatment and ongoing medication, they usually just switch to methampethamines, alcohol or other drugs to get high.

After a period of time, most just stop using the naltrexone medication and return to their drug of choice. Urine tests for heroin would, of course, yield a negative test result for opioids, giving people a false sense of security that the addict treated with naltrexone has not relapsed.

However, it is rationally wise to randomly monitor new recovering individuals for other substances after a rapid detox treatment.

The cost of a natural detoxification process is approximately Rp 100,000 to Rp 300,000, while a naltrexone treatment package is approximately Rp 15 million to Rp 20 million. Naltrexone does not change a person's behavior or pattern of thinking.

Without a viable drug recovery program and family after care program, detoxification from drugs is usually wasted hopes and money. And wasted hopes and money is just that: wasted hopes and money.