LITTLETON — Each private room has a queen bed covered in a plush, gray comforter, plus a flat-screen TV and a remote control to browse Netflix and Hulu. For lunch and dinner, restaurant menus circulate and meals arrive via Uber Eats.
Guests can log into their jobs from their rooms, or read a book beside a window looking into a grassy courtyard. In the group kitchen, there is popcorn, frozen fruit for smoothies and a Keurig coffee machine.
But this welcoming space isn’t a hotel.
It’s a $1,950-per-night detox center tucked into a discreet medical office building in Littleton where clients who can afford it are coming clean off fentanyl, or whatever drug they are ready to rid from their system. The clinic is increasingly treating fentanyl addiction as the counterfeit drug epidemic assaults Colorado. More than 900 people died of fentanyl overdoses in 2021 in this state, at least four times as many as three years ago, according to the state health department.
Gallus Medical Detox has the feel of a spa, though in the middle of the center, nurses work in a glass-enclosed control area where they monitor patients’ blood-oxygen levels and heart rates via multiple, beeping screens. The setup — a medical facility that is a step down from an emergency department but a step up from a nonmedical rehab center — is among the latest treatment options for people addicted to opioids.
Gallus began in Scottsdale, Arizona, then expanded to Las Vegas, Nevada, and Littleton. It just opened two more clinics, in Dallas and San Antonio.
At Gallus, nurses can pump nausea medication, the anxiety medicine lorazepam, antibiotics, pain medication and vitamins into patients’ bodies intravenously to ease the misery of detox. They also can give medications through injections. And nurses — all with experience in critical care — can begin an “accelerated microdosing protocol” by giving fentanyl-addicted patients under-the-tongue doses of suboxone, a drug that stops cravings by blocking the brain’s opioid receptors. Because the doses are so small, fentanyl-addicted patients don’t have to suffer through withdrawals before they begin suboxone.
Detoxing from fentanyl takes about seven days, and most patients leave Gallus on no drugs — including suboxone, said Shannon Weir, the company’s director of clinical education.
This is what makes the detox approach controversial — patients who relapse after detox have a much higher risk of overdosing and dying than patients who take medication-assisted treatment for opioid addiction. The most common, and proven, way to get off fentanyl or heroin is to get on a prescription for suboxone, a daily pill, or methadone, a daily cup of pink liquid dispensed at a clinic. Suboxone and methadone act on the opioid receptors in the brain, the same receptors activated by heroin, morphine and other opioids.
Patients who have just detoxed have no tolerance for their drug of choice, so any relapse is risky.
“It’s long and it’s also very miserable”
Medicaid, the government insurance program for low-income people, will cover the cost of outpatient treatment for suboxone or methadone. Medicaid isn’t accepted at Gallus, which requires patients to pay up front and then reimburses them if their private insurance company ends up covering the treatment. In some cases, patients can receive scholarships from foundations to pay for the detox.
The fentanyl detox process typically takes more than twice as long as alcohol detox, because the synthetic opioid is stored in fat tissue and released over time.
“It’s long and it’s also very miserable,” Weir said. “We’re definitely behind as a nation in having enough places for people to treat this disorder. It’s also treating them well and helping them through the detox. They keep using because the detox is so awful. They’re afraid of that.”
The company uses a “proprietary” protocol to treat addiction that was developed by its founder, Dr. Patrick Gallus. The key is in how they regulate patients’ symptoms around the clock, bringing them comfort faster because medications delivered intravenously or by injection work faster. Nurses can see each patient in their room through a video monitor, and staff lead optional yoga and meditation sessions, and encourage patients to write in journals or select a blank card and envelope from the basket in the living room and write to a friend or relative.
There are no structured therapy sessions like those in a rehab facility because patients cycle out quickly, only staying at Gallus for as long as it takes for the medical detox to work — typically from two to eight days. The office’s clinical director, a licensed clinical social worker, talks with each patient daily, including about their treatment goals and the dangers of relapsing when their bodies have been detoxed and have no tolerance.
Success is measured by how many patients leave Gallus and enter a rehab program, whether that’s a sober-living house, residential treatment or an outpatient therapy plan. Companywide, 87% go directly to an aftercare program, a gigantic improvement over the 25% of patients who enter treatment after detoxing in a hospital, according to Gallus’ research.
“I’m super proud of what we do, because we do it like nobody else,” said Bee Humphries, a registered nurse who has worked in the industry for 32 years and now works at the Gallus clinic in Littleton. “We do have a unique program that doesn’t lead them to where they’re leaving on medication.”
So far this year, half of opioid patients in the Littleton clinic are addicted to fentanyl, which is found in counterfeit pills, heroin, cocaine and other street drugs. The other half are addicted to prescription opioids.
The prevalence of fentanyl is even higher at Gallus’ Arizona clinic, where 80% of opioid patients are addicted to fentanyl. The company attributes the higher rate to the fact that the opioid crisis, and the wave of fentanyl, hit Arizona before Colorado.
The seven-bedroom Colorado office also sees a lot of alcohol addiction, and is noticing an increase in the number of patients trying to quit benzodiazepines, so-called “benzos,” including the prescription antidepressants Xanax.
“To me as a nurse, the most dangerous thing we deal with is alcohol, something you can buy over the counter and is a very dangerous physical detox,” she said. “People don’t understand the magnitude of what the first three days of alcohol detox can look like.”
Upon check-in, each patient gets a drug test, from a urine sample, and a breathalyzer test, as well as an IV for fluids. Some patients are untruthful — or just wrong — about what’s in their system. They say they take benzos, but fentanyl shows up in the drug test, probably because counterfeit Xanax sold online and on the streets are made with fentanyl.
It doesn’t matter if patients just injected heroin or downed vodka in their car. “They can be inebriated, intoxicated on drugs, and we’re capable of helping them through that process,” Humphries said. “We can keep them safe.”
“A risky approach”
A few miles north of the Littleton clinic, which can detox only six or seven people at a time, hundreds of people dealing with fentanyl addiction are getting help through Denver Health. They line up daily for cups of pink methadone, sometimes walking over from a homeless shelter, or they have recurring appointments to pick up prescriptions for suboxone at one of the hospital’s outpatient clinics.
Dr. Josh Blum, a Denver Health addiction medicine physician, called the detox medical center a great option for some, but cautioned against the risk of overdose after detoxing from opioids.
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Patients who use again after detoxing are much more likely to die, he said, pointing toward a study that showed people who detoxed in jail were 120 times more likely to overdose after release. “You may be doing great but your first relapse may be the one that kills you because you have no tolerance,” he said.
Addiction treatment doctors are still battling the public sentiment that taking suboxone or methadone is “just trading one drug for another,” Blum said. The drugs are “maintenance medicine” to treat a disease, the same as insulin treats diabetes, and people don’t say a diabetic is “addicted to insulin,” he said.
Still, some people want to get off of all substances, in some cases because they work as pilots or doctors and don’t want any drugs in their system.
“It’s not wrong,” Blum said. “We just know the evidence really doesn’t support that approach. It’s a risky approach because it demands perfection.”
The way out of the opioid epidemic, for most people, isn’t through medical detox, he said. Instead, state and officials should loosen the stringent regulations and paperwork requirements for prescribing suboxone and dispensing methadone, Blum said. For one thing, patients should have an easier time getting prescriptions to take home, rather than coming daily for their doses of methadone, which the federal government requires must be “dispensed” by a nurse on site, not prescribed.
Colorado also needs more residential treatment centers and sober-living homes, he said.
Fentanyl is nearly the only opioid Blum sees these days at his outpatient clinic, where he takes on a new fentanyl-addicted patient almost every day. And patients almost always know they are using fentanyl, compared to a year or so ago when they often didn’t realize that their heroin or counterfeit pills contained the synthetic opioid.
Also new, Blum said, is that most people are smoking it rather than injecting it. The most common method of using fentanyl is heating it and inhaling the vapors, he said.
Blum’s patients sometimes come to the clinic after a night in the emergency department because of an overdose that was reversed with the antidote, naloxone, or an infection at an injection site. The hospital’s 24/7 counseling team directs patients with an opioid addiction to Blum’s clinic.
The risk of overdose after detox is why Eve Sandler, the clinical director of the Littleton Gallus clinic, works so hard to get patients into a treatment program before they leave. Her goal is usually a residential program, though some patients choose outpatient care.
“Detox is amazing for the physical stabilization and the medical component, but it does nothing in terms of changing the environment they’re going back to,” Sandler said. “Every day that they’re here, I do some brief psychodynamic therapy and motivational interviewing to try to get them more engaged in what that looks like.”
It’s always up to the patient, who is often swayed not just by Sandler but by the family member who brought them to the detox center. Sometimes Sandler gets a heads-up from a relative or an interventionist that an intervention is about to take place. That way, the family and friends holding the intervention can tell the person they already have a private room waiting and a nursing team to ease the pain of withdrawal.
Gallus calls it “dignity in healing.”
“We don’t want people to be suffering and we don’t want them to feel that kind of institutionalized feeling that a lot of facilities have,” Sandler said. “Detoxing is hard. We want to be comfortable.”