Pubdate: Fri, 15 Oct 1999
Source: New York Times (NY)
Copyright: 1999 The New York Times Company
Contact:  http://www.nytimes.com/
Forum: http://www10.nytimes.com/comment/
Author: Paul Zielbauer

DOCTOR DEFENDS HEROIN DETOXIFICATION PROCEDURE AND VOWS TO RESUME IT

CHERRY HILL, N.J. -- A New Jersey doctor who specializes in a heroin
detoxification treatment that state officials have linked to six deaths
since 1995 defended the procedure on Thursday as medically sound and said
he hoped to resume performing it in local hospitals as soon as possible.

On Oct. 1, the State Attorney General's office filed a complaint against
the doctor, Lance L. Gooberman, an experienced internist in Camden County,
charging that his unusual outpatient treatment, known as rapid opiate
detoxification, was dangerous and was not followed up with proper
outpatient care.

On Wednesday, Gooberman signed a consent order that bars him from
performing the procedure without permission from the state's Board of
Medical Examiners, which operates under the auspices of the Attorney
General's office.

But at a news conference he called on Thursday, Gooberman, seated beside
his lawyer, said he "was trying to help patients to the best of my ability"
and defended the safety and effectiveness of the treatment, which he has
advertised on billboards around South Jersey as the quickest way to beat
heroin addiction.

Gooberman, 47, was the only doctor in New Jersey, and his clinic was one of
only two or three in the New York metropolitan region, to offer the treatment.

The state's complaint, which was first reported in The Star-Ledger of
Newark today, says that in the five years since Gooberman began treating
patients with the rapid detoxification procedure, 6 of those 3,200 patients
have died, all within hours or days of their treatment. Though the
complaint cites no evidence directly linking Gooberman to the deaths, it
says that the treatment is "neither approved nor recommended by any
government or professional body."

The complaint also names David W. Bradway, an assistant in his Camden
County outpatient clinic who served a 14-month jail term about 20 years ago
after he was convicted of manslaughter in a friend's fatal drug overdose.
New Jersey restored Bradway's medical license two years ago.

"At the end of this procedure, we want these gentlemen no longer to be
medical doctors in New Jersey," said Mark Herr, a spokesman for the
Attorney General's Consumer Affairs Division.

Gooberman's lawyer, Alma L. Saravia, must submit a reply to the complaint
by Oct. 21.

An administrative law judge will then issue a recommendation on Gooberman's
fate to the State Board of Medical Examiners, which will decide whether to
allow him to continue practicing medicine.

Criminal lawyers in the Attorney General's office will also review the
civil complaint, Herr said.

Rapid detoxification differs from traditional heroin-addiction treatment by
anesthetizing patients and injecting them with drugs known as opiate
antagonists. The drugs chemically scrub away opiates that attach to neuron
receptors in the brain after sustained drug use and create addiction. To
conclude the four-to six-hour procedure, Gooberman surgically imbedded a
pellet in the patient's abdomen that, as it dissolved over two months,
released a drug, naltrexone, which blocks opiates in the bloodstream.

After recovering from anesthesia, patients were discharged to a friend or
relative, with no immediate medical follow-up, the state's complaint said.
Patients returned every other month to have new naltrexone pellets
implanted. The complaint says the pellets are not approved by the Food and
Drug Administration, but Gooberman defended their use as legal.

Instead of waiting two to five days for the worst withdrawal symptoms to
begin subsiding, as in other treatments, Gooberman's patients typically
needed only a few hours, he said.

Edwin A. Salsipz, an addiction medicine specialist at Beth Israel Medical
Center in Manhattan, said Gooberman was one of the first doctors in the
United States to use rapid detoxification, a treatment first developed by
an Austrian doctor in the late 1980's.

"It certainly is not what I would call standard traditional treatment,"
said Salsipz, who added that he was familiar with Gooberman and his work.
"Most of the people I know who are the well-respected people in the field,
so far as I know, do not favor this method."

Rapid heroin detoxification, he said, appeals to addicts who want a quick
cure. "The advantage was supposed to be that you had this hard-working
person who had to have this done over the weekend and then go back to work
without anybody knowing," Salsipz said.

The effects of the treatment can be severe, he said. Compared with
methadone treatments, which gradually wean addicts from heroin opiates,
Gooberman's procedure starts drastic changes in the body that can lead to
severe respiratory or heart problems, he said.

"Why do something rapid and drastic when you can take a few more days or a
week to do it and in a way that's been proven to be effective?" he said.

The procedure costs $2,900 to $3,600, significantly less than methadone
treatments.

Despite the state's complaint against him, Gooberman, who earned his state
medical license in 1980 and is certified by the American Society of
Addiction Medicine, is seeking to resume the procedure soon.

Under the terms of the consent order, he may continue inserting the
naltrexone pellets in patients who have already had the detoxification
treatment but can administer new treatments only in a hospital, and only
with prior approval from state officials.

"It's my hope that in the future, the rapid opiate detoxification procedure
will be available in hospitals throughout the tristate region," he said,
reading from a printed statement.

Despite his shellshocked countenance, Gooberman appeared ready to handle
all the attention now focused on him. Last week, he hired a public
relations concern to handle media questions, and today he asked two former
heroin addicts whom he had treated with the rapid detoxification procedure
to sit with him before the cameras.

"I'm just glad I went through this procedure before it got stopped," said
Richard, 49, a 30-year heroin user from North Wildwood, N.J., who the
doctor treated two years ago. "I've been through so many detoxes, so many
methadone programs, so many hospitals, and they couldn't find my answer,"
he said in a quaking voice.

Stephanie, 20, a former addict and prostitute from Philadelphia, said
Gooberman inserted another naltrexone pellet in her earlier on Thursday. "I
don't know where I would be without him," she said.
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