A New Assault On Addiction

MARGE CATRAMBONE HAD BEEN BATTLING alcoholism for years when she volunteered, in early 1990, to take part in an experiment at the University of Pennsylvania. The fortyish sales manager kept attending her Alcoholics Anonymous meetings, but for three months she also took daily doses of a drug called naltrexone. "Once I started," she recalls, "everything turned around. It stopped my desire to drink, the craving." Five years later, Catrambone is still sober-and the medication that helped her is gaining new stature as a weapon against addiction. Last week naltrexone's maker announced that the Food and Drug Administration has approved it as a chemical treatment for alcoholism-the first one approved in four decades. And a few mavericks are now claiming that their own naltrexone regimen can get heroin addicts through withdrawal in a matter of hours, enabling them to start new lives the next day. Caveats abound, but as one addiction specialist exults, the drug has "amazing social implications."

Naltrexone is nothing new. Researchers learned 20 years ago that it could rob drugs like heroin and morphine of their pleasurable effects, by covering the receptors they attach to in the nervous system. The DuPont Merck Pharmaceutical Co. started marketing the drug as Trexan in 1984, after studies showed it could help heroin addicts avoid relapse once they had been through withdrawal. Since then, however, several trials have shown that problem drinkers have just as much to gain from the treatment. In a 1992 Yale study of 104 alcoholics, for example, 51 percent of those who got counseling and a daily naltrexone pill stayed dry for three months, compared with just 23 percent of those receiving counseling and a placebo. And when the naltrexone takers did revert to drinking, they were only half as likely to drink heavily. In short, the drug enabled them to slip without falling.

On the strength of those findings, DuPont Merck is now rechristening the drug ReVia, and promoting it as a dual-purpose abstinence booster. With some 11 million Americans suffering from alcoholism, demand for the drug should now soar. For all the excitement, though, no one is calling naltrexone a cure, for patients have to stay motivated to take it. "If this drug isn't used with a comprehensive treatment program," says DuPont Merck president Kurt Landgraf, "the failure rates are very high." And naltrexone poses hazards of its own. The common side effects are minor, ranging from nausea to joint pain, but it can cause liver damage at just five times the recommended dose.

ReVia's package insert warns repeatedly that the drug should not be used by anyone "currently dependent on opioids," such as heroin and morphine. Because it fences of the nervous system from opiates circulating in the body, the medication can send an addict instantly into severe, life-threatening withdrawal. Yet in Spain, Israel and Mexico, a small band of clinicians are working together to exploit that very phenomenon. These doctors check their patients into intensive-care units, place them under heavy sedation to shield them from pain, then use naltrexone to induce "ultra-rapid detoxification." Instead of shaking, sweating and retching for 10 days or more, the recipients purportedly go home clean after a brief hospital stay. Though only 11 cases have been described in the medical literature, CITA, the Spanish-based firm that developed the treatment, claims it has detoxified 1,000 addicts since 1992.

The procedure isn't performed in the United States, but a few Americans are now traveling to Mexico to gamble $10,000 on it. Last week it was "Monica's" turn. On Sunday night, the 22-year-old heroin addict entered the Hospital Las Americas in Ensenada, and by 2 o'clock Monday afternoon she was ready to start treatment. As tubes pumped oxygen into her lungs and others drew bile from her stomach, Dr. David Luna Gonzalez began injecting her with naltrexone. For six hours, she writhed unconsciously while medical workers monitored her heart rate and blood pressure. And when test doses of a drug resembling naltrexone no longer affected her, the doctors knew her withdrawal was complete. After finishing the process, the young woman awoke briefly, demanding to know why no one had started the treat ment. "We did," a counselor assured her. "It's already over."

Weathering withdrawal is just the first of many challenges a recovering addict has to face. But if "Monica" receives support, and a daily dose of naltrexone, she could someday tell a story like Marge Catrambone's. Naltrexone may not be a cureall, but its potential now looks far greater than anyone would have guessed.

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