Doctor Challenged Over Detox Method


Tuesday, January 2nd 2001, 12:00 am
By: News On 6


MERCHANTVILLE, N.J. (AP) — Dr. Lance L. 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 says his practice — which unlike similar rapid detox programs doesn't require a hospital stay — has successfully detoxified about 2,350 patients over seven years and guided them into long-term recovery programs.

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

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

``We just want to make sure these `cutting-edge treatments' aren't cutting off life,'' says 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 Gooberman's procedure was not the cause of any patient's death.

Sitzler says their patients' death rate was just 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 says.

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 other U.S. physicians perform variations on rapid detox, but in 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 severely stresses addicts' ravaged bodies, and at least a dozen of the thousands of American and European patients who underwent the procedure in a hospital also died. The slower, traditional detoxification and initiating methadone maintenance therapy both have been documented to kill some patients as well.

New Jersey's lawyers 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 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,'' according to the society's executive vice president, James F. Callahan.

Former society president Dr. David E. Smith, a San Francisco addiction specialist, says he regards Gooberman's program as the best in the country.

``There is no evidence of a cause-and-effect relationship between the procedure and any of the deaths in question,'' Smith wrote in a report for Gooberman's defense.

Several patients treated by Gooberman and Bradway have promised to testify on the doctors' behalf.

One four-year heroin addict said she was well enough to tour the Grand Canyon three days after the procedure. Danielle, 19, says Gooberman gave her and her parents extensive information about the procedure's risks and aftermath.

``My parents and I pretty much think we owe my life to that procedure because I had tried rehab eight different times,'' says Danielle, who says she has been drug-free for 19 months.

Bennett Oppenheim, a psychologist who once oversaw treatment at several U.S. rapid detox centers run by a for-profit company, says he now believes the procedure should be done in hospitals, not for-profit centers.

``It cannot be an assembly line,'' says Oppenheim, whose company offers the procedure at a northern New Jersey hospital.

The chief medical officer of Oppenheim's company, Dr. Clifford Gevirtz of Mount Sinai School of Medicine in New York, is expected to testify against Gooberman. Gevirtz says he expects the procedure eventually will gain wide acceptance.

``If it's done properly, it brings people a humane, safe approach to detox,'' Gevirtz says.

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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On the Net:

National Institute on Drug Abuse: http://www.nida.nih.gov

American Society of Addiction Medicine: http://www.asam.org