UROD Story:  The Lies and My Ordeal - by J.D.

"New treatments" for addicts? - by Robert G. Newman, M.D., M.P.H.

Employment Drug Testing:  Know Your Rights - Aaron Rolnick

Dear Methadone Today  - Letter

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Doctor's Column  - October 2000, Vol. V, No. X
   OrLAAM Complications
 
 
 

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In April 1995, I paid $4,000 to Dr. Lance Gooberman, the highly specialized doctor in the world of ultra rapid [opiate] detox.  I would like to share my story about what he did to me.

When I called and spoke to him, he told me I would be heroin free in four hours and that I would be going out to dinner that night.  Boy, I was the happiest guy in the world when he said that to me.  He told me to be at his office at 6:00 a.m. to start the procedure.

At 6:00 a.m., I'm taken back to a room to put on a giant diaper and a patch on my back for pain [I'm thinking "what pain; there's not supposed to be pain"].  Anyway, I go into another room and hop onto a bed where Dr. Gooberman is standing and assures me I'll have a new life when I wake up.

As I'm laying in bed, the doctor says that should anything go wrong, there's a hospital two blocks away and they would rush me there.  He never told me this when I spoke to him about the procedure days before [lie#2].  Next, a mask was put over my mouth and Dr. Gooberman squeezed my throat.  In the meantime, they were looking for the $4,000 that I was supposed to pay him, so they sent in my friend that took me there.  According to my friend, when she entered the room and looked at me, my eyes were taped shut, my body was shaking uncontrollably, tubes were in my nose, I was sweating terribly, my body was four times its normal size, and my eyes were black and blue.  She asked Dr. Gooberman if I was okay because she thought I was going to die.
At 9:30 a nurse was shaking me to get up; at 9:45 she got me out of bed, and the diaper I was wearing was full of human waste [to put it nicely], and there was a smell coming from my body that made me throw up.  I was put into a bathroom, with my clothes in a milk case on the floor and told to clean myself up and get dressed.  I was dizzy and in pain but left alone to clean myself up and get dressed, so I called my friend to help me.  From there I was put in a wheelchair and thrown [like a piece of garbage into a dumpster] back into the car that took me there.  That was the humiliating part of it.

Dr. Gooberman had told me I would be swimming in my bed - when I got home thirty minutes later - and that I was.  For about thirty hours, my body would stretch out like I was swimming UROD Story (from p. 1)
and screaming at the same time; the pain was unbearable - it was like I had been hit with the flu twenty times at once.  I had body aches, a headache, the runs every fifteen minutes which caused my ass to bleed, and when I would piss, my penis would burn like there was no tomorrow.  In addition, I could not sleep or eat for twelve days, and I could not talk for the first three days due to the pain in my face and nose.  On three occasions, my friend was ready to call an ambulance because she was so afraid I was going to die!  I should have died --I was one of the lucky ones (six of his patients allegedly died).
When I left Dr. Gooberman=s office, he gave me two prescriptions--one for three needles to inject for the runs [they did not work] and one for trazadone, an anti-depressant that would make me sleep [yeah right].  In addition, the [naltrexone] implant became infected and had to be removed at the emergency room.

The first nine days, I had a fever between 104-107E --my body was on fire.  There is honestly no way to express the pain in my body other than being hit with the flu twenty times all at the same time.  All I remember is wanting to die--to take a gun to my head and pull the trigger.  All this went on for twelve days, during which several calls were made to Dr. Gooberman, who did not return them until two days later and then all he said was that I had to ride it out.  I begged this man for help and all he kept saying was there was nothing he could do and to ride it out; he promised me I would be okay in a day or so!
Well it took fifteen days before I took my first shower and was able to get out of bed.  On my sixteenth day, I was at it again using heroin and after another two weeks was strung out again--so much for the $4000 I spent.  He told me that once your body is clean of heroin, you won=t have the craving for it [lie #4 or 5].

I spent about six months using again until a friend of mine told me about a clinic where you can get METHADONE and not get sick anymore.  The next day I went there and was put on methadone maintenance.  Since I started taking methadone, I lost all my craving for heroin and getting high; I am able to live a normal life again without chasing drugs.  It's been close to five years now, and I have been clean and live the good life that we all should be living.

The famous Dr. Gooberman is awaiting trial for the deaths of those poor six people.  At a medical hearing, he told the state board of medical examiners that doctors from all over the world call him and ask how to do ultra rapid detox (UROD), so chances are that today, doctors all over the world are trying his research and like him, but they really don't know what they're doing.  IN MY OPINION - IF YOU'RE THINKING ABOUT UNDERGOING UROD, YOU MAY DIE FROM UROD, AND THERE IS NO PAINLESS WAY TO DETOX FROM OPIATES OTHER THAN METHADONE.  There are other web sites [in addition to MIE and including Methadone Today] you can read that are about UROD and what people go through.  Read all you can on the subject before you even think about going for it!  Also think about the people who have died from it.

Thank you for letting me share my story with you.  If I change one person's mind, I may have saved a human life (besides the risk of dying from UROD itself,  the pure hell of suffering may result in the person taking his or her own life).  UROD is used today to fill the doctor's pocket with money - it's been proven it does not work, so please research it thoroughly before you do it.

Editor's Note: For clarification's sake, we must state that it has not been proven that UROD "does not work," (e.g.: is ineffective) at least from a medical research standpoint.  Notwithstanding the author's strong opinion, which is understandable given his experience, it is probably not true that UROD is always ineffective--no doubt there are patients who have had success with the procedure.  However, we have been hard pressed to find UROD success stories;  overall, we believe that this author's experience is fairly representative and that UROD is generally an inhumane and ineffective treatment.
 
 

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Having devoted the past thirty years to obtaining care for addicts, I support strongly every approach--newly proposed or well-established--that offers help and hope to those who need it.  The level of excitement and enthusiasm recently generated by Buprenorphine and Naltrexone, however, is difficult to understand.

A front page article in the widely-read newspaper USA Today (May 31, 2000) quotes the Director of the National Institute of Drug Abuse (NIDA) as saying that Buprenorphine and Naltrexone "could be the biggest advance in the last 10 years."(1) And yet, both medications have been used to treat narcotic addicts for a quarter-century!  Nor is this enthusiasm new:  In 1981, Buprenorphine ". . . was described by NIDA officials as 'the next generation compound' . . . [with] high promise as the most effective drug yet for weaning heroin addicts from their addiction. . ."(2)

The USA Today article attributed to another respected expert in the field the following:  "You almost can't overdose on heroin when you're on Buprenorphine. . . . People can function totally normally and be very alert if it's properly dosed."  Precisely these characteristics, however, have been known for 35 years to apply to methadone.  The tragic catch with methadone, of course, is that the majority of patients are not "properly dosed," particularly in America, and Federal and State agencies that grant (and can revoke!) the right to prescribe methadone permit this practice to continue.

Furthermore, notwithstanding the rosy picture portrayed by its advocates, Buprenorphine has a considerable potential for illicit diversion.  Reports of widespread black market availability have come from Germany(3), Scotland (where as many as 95% of narcotic addicts used the drug, and 43% "preferred" it)(4), Spain (over 70% of addicts had experience with illicit Buprenorphine)(5), the United Kingdom(6) and New Zealand (more than 50% of applicants for treatment "currently" using)(7).  As for safety, a review by experts from around the world found that "Buprenorphine appears to produce side effects which are similar to those seen with other morphine-like compounds. . .[and] there is apparently no completely reliable specific antagonist for Buprenorphine's respiratory depressant effect."(8)

The record with respect to clinical effectiveness is mixed.  A few countries (France, for example) rely heavily on Buprenorphine, while in Hong Kong in the early 80's, the initial experience of a pilot study was so disappointing it was discontinued.  At any rate, there is not the slightest reason to believe that Buprenorphine will be any more successful than methadone maintenance, drug-free therapeutic communities, acupuncture or any other modality in achieving long-term post-treatment abstinence.

Finally, a word about the combination of Buprenorphine and Naltrexone.  It is clear that the latter will do absolutely nothing to enhance the therapeutic effectiveness of the former.  Will it reduce the likelihood that the prescribed medication will be injected in order to produce euphoria?  Probably--but this too is hardly a new concept.

In America, Naltrexone was combined with methadone in the early 1970's, but that formulation was soon abandoned.  Why?  Not because the theory was flawed, but because it was clear that "the problem" being addressed--injection of methadone to produce euphoria--was essentially non-existent!  To the extent that adding Naltrexone to Buprenorphine is not equally irrelevant, it could only be because of a significant potential for intravenous misuse of Buprenorphine that does not exist with either the tablet or liquid methadone used in the United States.

In sum, there may well be a role for Buprenorphine in the treatment of narcotic addiction but no basis for believing that it is superior to methadone as a maintenance medication.  There is nothing to suggest that a "cure" (i.e., permanent post-treatment abstinence) is more likely to be achieved with Buprenorphine than with methadone or any other treatment of addiction.  While Naltrexone may be useful in the treatment of addiction, there is neither an empirical nor a theoretical basis for believing that it will enhance the therapeutic effectiveness of Buprenorphine or other agonist maintenance medications.

Countless reports from around the world have documented that methadone has an unparalleled ability to attract and retain narcotic addicts in treatment and to assist them in assuming healthy, self-fulfilling and socially productive lives.  One of the major hurdles that methadone patients face is the stigma associated with their treatment.  Misinformation regarding methadone and inaccurate or misleading comparisons with other medications strengthen that bias to the further detriment of patients and society at large!

The greatest limitation of methadone is the artificial legal constraint imposed on its availability.  There is no reason to continue to limit methadone prescribing to "comprehensive programs," thereby excluding community-based physicians from providing this treatment.  Support for office-based treatment of narcotic addicts with Buprenorphine is to be applauded.  The same rationale for permitting Buprenorphine to be prescribed by all licensed practitioners, however, applies equally to methadone.

*Footnotes were omitted for space reasons.

Editor's Note:  We must question the objectivity and motives of supposed "experts" (like those cited in USA Today) that sing the praises of Buprenorphine while criticizing methadone and  omitting certain facts.  Though I would certainly not place Buprenorphine treatment and providers on the same level as UROD (rapid detox), some of the same caveats are in order.  A provider of Buprenorphine treatment who is truly interested in the well-being of patients will not condemn methadone treatment, exaggerate the benefits of Buprenorphine treatment, or deceive patients in any way.
 
 

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Dear Methadone Today,

This one place takes methadone clients in, knowing full well they're on methadone and then when this so-called reverend gets them used to having a roof over their heads again, she demands that they get off the methadone.  She threatens to throw them out if they don't.  Needless to say they end up out on the streets again anyway.  I've had two clients that ended up back on heroin because of her demand for a detox, and she threw them out anyway.  I get so angry at the people like this.

What can we do to change this?  Phoenix could use some education.  Thanks for your support. - D.H., Phoenix, Arizona

Editor's Note:  DONT [the organization that publishes Methadone Today) and other methadone patient advocacy organizations have literature that may be useful for such educational purposes.  Some people have a closed mind, but others may change their mind once they've read the facts.  Another suggestion we have is to try to get a story on the news:  how this reverend is jeopardizing patients' recovery.

On a larger scale, there are educational campaigns that organizations such as ARM have considered--for instance, taking out full page newspaper ads or even airing commercials on television explaining that methadone maintenance is a medical treatment and is not merely "substituting one addiction for another."  Commercials might also attempt to humanize methadone patients--rather than the stereotypical methadone patient, it would show that methadone patients come from all walks of life.  If you are interested in volunteering for ARM, write to the address on page 4 of Methadone Today.
 
 

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Addiction Treatment Forum, "Patients Battling Stigma & Prejudice," (Vol. VIII, #4, p. 1) reported on a research study by Nancy Nieuman, MA, CPC, which found that:   "more than 66% (two-thirds) [of the patients surveyed] reported denial of employment or loss of existing jobs due to methadone-positive urine tests."  This is a high percentage, especially considering that such employment discrimination is a blatant violation of the Americans with Disabilities Act (ADA).

Given that this is such a common problem, methadone patients need to educate themselves about their legal rights and how to protect those rights.  The research study cited above found that most patients were indeed not aware that discrimination based on methadone-positive urine test results if caused by prescribed methadone was illegal.  Methadone clinics could play a role in such education by arming their counselors with handouts and information on the ADA to be passed out to patients.  This is the first step as, obviously, patients will not take action if they do not know that the employer violated the law or what to do about it.

The next issue is what methadone patients should do to protect themselves if undergoing an employment drug test.  Ideally, the patient should find out whether methadone is going to be tested for.   Taking methadone will not cause an opiate-positive test result. To be detected, methadone must be specifically tested for.  It is often not tested for, and there is no sense in revealing that one is on methadone if it is not necessary to do so.  Sometimes employers or the clinic conducting the drug test will present the employee with a list of the substancesfor which they are testing.  But obviously, finding out whether methadone is going to be tested for is often not possible.

If you discover that methadone is going to be tested for or you are not sure.  If at some point you are asked by your employer or the clinic conducting the drug test to provide a list of prescription medications, do not fail to list methadone in the hope that everything will work itself out.   If they do test for methadone, you will most likely test positive for it unless you are on a very low dose.  Methadone patients sometimes lie/fail to list methadone because they figure they have nothing to lose, but in doing so they are giving a valid excuse for employers to fire/refuse to hire them (i.e., they are not firing you because you are a methadone patient or opiate addict; they are firing you because you were dishones--whether this is the true reason or not, this gives them a way out of a discrimination charge).

If the drug testing clinic does ask you to provide a list of prescription medications, this may indicate that your employer will only be informed of "positive" drug test results caused by illicit rather than prescribed drug use (another reason to include methadone on such a list).  Some drug testing clinics will only ask for a list of prescription drugs if a "positive" drug test result occurs - again, this may indicate that your employer will only be informed of "positive" drug test results caused by illicit drug use and they will not find out that you are on methadone.  The worst situation is when the drug testing clinic never asks for a list of prescription medications and sends the "raw" drug test results to your employer, not only revealing that you tested positive for methadone but leaving it for you to explain to your employer that the "positive" test result was due to a prescribed medication and not illicit drug use.  This is particularly bad in the case of a pre-employment drug screen, since your employer may label you as a "druggie" even before you have a chance to tell them that the "positive" test was due to a prescribed medication.  Hopefully your employer will realize that methadone maintenance is a legitimate medical treatment or at least understand that firing/not hiring you because you are in methadone treatment would violate the ADA.

What to do if you are fired/not hired after a drug test?  Naturally, if they haven't told you why you were fired/not hired, you should ask them. . . and if they mention the drug test results, ask them to specify what substance(s) were found.  If they do mention that you tested positive for methadone, reiterate that you are on methadone by prescription and that you can bring verification if necessary.  Assuming your employer does not back off of its decision to fire/not hire you, you might want to state that you feel that it is unfair for them to discriminate based on a medical treatment and that you are going to consult with your attorney about whether their actions violate the Americans with Disabilities Act.  If the drug test in question was pre-employment and your employer won't give a reason for not hiring you, you may have a good claim under the ADA.

In most cases, employers do not conduct pre-employment drug screens until they have already decided to hire the applicant, contingent on passing a drug screen and/or medical exam.  Therefore, an employer is going to be hard-pressed to explain why you were not hired after going through with the drug screen.  This is why you do not want to lie/withhold information--that goes not only for prescription medications but also for information filled out on your application or resume.  If you lied on your application, you may have given them a way out of a discrimination suit (i.e., the employer may claim that they did not hire you because they discovered that you lied on your application).

If you were currently an employee when the drug test was conducted, you should file a grievance with your union if in a union shop.  In a union shop, you are at a real advantage--not only because you have the grievance procedure but also because you have a contract on your side, the collective bargaining agreement, which stipulates that employees can only be fired "for just cause."  Therefore, you [or actually your union] don't even have to prove that your employer violated the ADA, only that there wasn't a just reason for you being fired.

If you are not in a union shop, you can still sue under the ADA.  Either way, you should ask your employer why you are being fired.  If your employer does give you reasons besides the drug test results, think about the following: how has the employer dealt with other employees who have been in similar situations (i.e., if you are being fired for being five minutes late to work twice in the last two months, how has your employer dealt with other employees who were tardy?  Did they only give a written warning to other employees for similar infractions, and how many late days did other employees have before being fired or suspended?)
If you do initiate a lawsuit and even go to court, be prepared--keep a written log as events happen--in case you eventually do pursue a lawsuit.  In court, you will have the burden of proving that you were discriminated against based on methadone/opiate addict status.  Chances are, you will not wind up in court--whether because you can find just as good a job elsewhere, you don't feel it's worth it, etc.--but it doesn't hurt to be prepared.

Hopefully you will never need this information.  Many employment drug tests do not test for methadone and certainly not all employers are going to discriminate against you because you are in methadone treatment.  But you should know your rights and be prepared.  You shouldn't have to accept discrimination in employment or anywhere else.

Editor's Note:  If you have experienced employment discrimination, please send us your story.  For that matter, if you have any questions relating to opiate agonist treatment (methadone, OrLAAM, or Buprenorphine) send it in and our Medical Advisors will try to answer them.
 
 

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