Fighting Fire With Fire

Does an unproven treatment that combats drug addiction with drugs promise more than it can deliver?

In late June, Dallas psychiatrist and addiction specialist Harold Urschel presented the first double-blind, placebo-controlled trial on Prometa's impact on methamphetamine addicts. Urschel, who also wrote the only published study on the protocol—it wasn't placebo-controlled or double-blind—monitored 135 people over 30 days and showed decreased cravings and use.

But NIDA's Vocci still isn't convinced. "It's only a one-month study," he says. "You'd probably have to have a three-month study, minimum."

Yet clinicians like Dr. Lenae White, an addiction psychiatrist who has been involved in NIDA-sponsored research and in 2006 founded the Murray Hill Recovery clinic in the Park Cities, say there is more than enough proof that Prometa is a powerful tool for recovery. More traditional medical treatments combined with therapy often have a dismal success rate, she points out, citing the general consensus that within the first year of recovery, fully 80 percent of users relapse. By incorporating the Prometa Protocol and encouraging follow-up care, White says that instead of relapsing and disconnecting from treatment, most of her patients either remain clean and sober a year into recovery or are at least continuing treatment.

"We're reversing the trend," says White, who is a member of the Prometa medical advisory board. "Anything that jump-starts people's recovery is a tool we need to access. If someone wants to give this a try, they should be able to." She informs patients that the protocol is experimental, and most of the patients who opt for Prometa have unsuccessfully tried other treatments and aren't deterred by the cost, which is lower than many 30-day inpatient rehab programs. And, since it's outpatient, they can continue to work during treatment.

A 20-person Prometa pilot program in Collin County last year had 16 meth offenders testing negative for the drug after 90 days, a success rate that Collin County District Judge Charles Sandoval described to The Dallas Morning News as "spectacular." Efforts to expand the program hit roadblocks, however. In January, controversy erupted in Austin over $2 million earmarked to use Prometa to treat meth offenders in the criminal justice system. Skeptics such as Dallas Criminal District Judge John Creuzot called the move premature, and only a few counties accepted funding for Prometa, including Collin, Nueces and Lubbock.

To UT Southwestern's Adinoff, selling Prometa before the double-blind test results are released, peer-reviewed and published isn't just premature, it's unethical.

"They've taken three drugs and put them on the market and come up with some bizarre theories for why it might be working," he says. "It punishes those companies that play by the rules. It takes advantage of people who are desperate."

Despite the concerns, a growing group of doctors and clinicians across the country hail Prometa as one of the greatest tools yet in the struggle for sobriety, and an increasing number of patients say the program is the solution they've desperately sought.

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For Steve, it all started after a Dallas Stars game in 2002. He and his wife were drinking at a relative's house when his cousin took out a clear pipe. "Give this a try," Steve recalls his cousin saying. "You might like it." Steve and his wife had never done drugs aside from marijuana in college. Just for the hell of it, they agreed to smoke the meth.

Steve immediately felt a surge of energy, heightened awareness and clarity. He no longer felt drunk. A few days later, he called his cousin and bought a couple of grams for about $100. "We were going to Vegas the next weekend, and I thought it would be great to take," he says. "My wife was like, 'We're not doing it anymore, it's over.' But it wasn't over for me."

He pretended to quit and became what the treatment community calls a functional addict, working by day and using at night. "I was performing at a higher productivity rate with it," he says. "I was staying up late, turning in a lot of work. I was afraid I wouldn't be able to produce at the same level without it."

He quit once, before their first daughter was born, but the infant brought more tasks and responsibilities. Overwhelmed, he returned to his secret habit. One night, his wife caught him smoking. She threatened to leave.

"My daughter and my wife were my heart, and I wasn't about to lose them," he says. "I went to counseling." He stayed clean for five months, and his wife again became pregnant. When she gave birth, something went awry, and she began to suffer from chronic headaches.

"I now had a wife in bed, two children, she couldn't handle the infant, I got a promotion—I felt an overwhelming pressure to perform," he says. "Using became, in my mind, necessary." He would work all day, pick up the kids from daycare in the afternoon and then smoke meth at night and stay up until 4 a.m. As the months dragged on, it seemed he and his wife lived in different worlds. He felt badly for her because she was in pain, but as they went to one neurologist after another and none of them helped her headaches, his exasperation peaked.

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