Pubdate: Sun, 31 Dec 2000
Source: San Diego Union Tribune (CA)
Copyright: 2000 Union-Tribune Publishing Co.
Contact:  PO Box 120191, San Diego, CA, 92112-0191
Fax: (619) 293-1440
Website: http://www.uniontrib.com/
Forum: http://www.uniontrib.com/cgi-bin/WebX
Author: Linda A. Johnson, Associated Press

PIONEER OF RAPID DRUG DETOX PROCEDURE COULD LOSE LICENSE

New Jersey Doctor, Employee Face Trial

MERCHANTVILLE, N.J. -- Dr. Lance Gooberman has devoted his medical practice 
to perfecting "rapid opiate detoxification," designed to reduce the agony 
of drug withdrawal and get more addicts into recovery.

Himself a recovering addict long drug-free, Gooberman said his practice -- 
which unlike similar rapid detox programs doesn't require a hospital stay 
- -- has detoxified about 2,350 patients during seven years and guided them 
into long-term recovery programs.

But during four years, seven of his patients died within days of the 
procedure. Gooberman said they had undetected heart problems or took 
cocaine, triggering a heart attack.

In a civil trial beginning Wednesday, state regulators will try to strip 
Gooberman and his former employee, Dr. David Bradway, of their medical 
licenses.

"We just want to make sure these 'cutting-edge treatments' aren't cutting 
off life," said Mark Herr, director of New Jersey's Division of Consumer 
Affairs, which oversees the state board regulating physicians.

Gooberman and his attorney, John Sitzler, have lined up medical experts to 
testify that accepted medical standards were followed and that Gooberman's 
procedure was not the cause of any patient's death.

Sitzler said the patients' death rate was 0.3 percent, lower than for many 
surgical procedures, and that outpatient procedures involving anesthesia 
are commonly performed in physicians' offices.

Gooberman's program, U.S. Detox Inc., uses medications to rapidly flush the 
opiate drugs -- heroin, morphine, methadone and prescription painkillers -- 
out of addicts' bodies to ease withdrawal symptoms such as diarrhea and 
tremors. The patients are anesthetized during the approximately four-hour 
procedure in his office.

He then implants a pellet of medicine in the abdomen that prevents patients 
from "getting high" if they take opiate drugs during the crucial first two 
months of recovery.

"I'm just trying to come up with a better way to do detox," Gooberman said.

Gooberman, 49, for years was addicted to the stimulant methamphetamine but 
says he has been drug-free for 14 years after a six-week stay in a hospital 
psychiatric unit triggered by a drug binge.

Rapid opiate detoxification was first performed in the late 1980s in 
Europe. Gooberman and other doctors who pioneered it in this country have 
appeared on television talk shows and magazine programs praising the 
method. The procedure also has been depicted on TV medical dramas.

At least a dozen U.S. physicians perform variations on rapid detox, but at 
a hospital and with an overnight stay required.

Some have published articles in medical journals indicating many more 
patients were drug-free after six months than with traditional 
detoxification programs. And a handful of insurance plans have begun paying 
for the procedure.

But even doctors who perform rapid detoxification say it stresses addicts' 
ravaged bodies, and at least a dozen of the thousands of American and 
European patients who underwent the procedure at a hospital also died. The 
slower programs, traditional detoxification and initiating methadone 
maintenance therapy, also have been documented to kill some patients.

New Jersey's attorneys are expected to stress that Gooberman and Bradway 
are the only doctors known to perform detoxification as an outpatient 
procedure.

The state alleges, among other things, that the doctors did not have a 
sufficiently trained support staff and adequate emergency equipment, warn 
patients enough about the method's risks or properly instruct the caregiver 
taking the patient home. The doctors deny all of that.

Rapid opiate detoxification has been approved by the professional 
organization for doctors in their specialty, the American Society for 
Addiction Medicine, as long as it's "performed by adequately trained staff 
with access to appropriate medical equipment," said the society's executive 
vice president, James F. Callahan.

The experts do agree on one thing: More research is needed. Under a grant 
from the National Institute on Drug Abuse, the first national trial 
comparing rapid detox with two forms of slow detoxification began in 
September and is to last three years.
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