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. - --- MAP posted-by: Richard Lake