The Detox Doc

When Dr. Lance Gooberman set out to market “rapid heroin detoxification” to middle-class addicts along the East Coast, he came up with an ingenious strategy. He posted billboards along roads leading out of town.

His strategy worked. In just two years, he has treated 1,000 addicts, many of them suburbanites who saw the signs after completing deals in the drug markets of Baltimore, Philadelphia, and Camden and Newark, N.J.

“We’re targeting suburbanites,” said Gooberman, who operates a full-time “detox” practice in this crusty, small town just miles from the drug markets of Camden and Philadelphia. “People are coming out of the city saying, ‘Oh . . . I did it again.’ ”

Nobody disputes the success of his pitch, which holds out the possibility of a less painful withdrawal to people who can pay $2,800 upfront. How well this works is a matter of intense debate.

In simplest terms, the addicts who flock to his office begin their recovery in a deep, anesthetized sleep that lasts four hours.

Surrounded by heart monitors and oxygen equipment, they lie on beds where they are given naltrexone, a drug that compresses into a few hours a physical withdrawal that would normally take days. As they sleep, they remain oblivious to the nausea, stomach cramps and irritability that would grip them if they were awake.

Patients also receive a naltrexone implant, a time-release tablet that robs heroin of its satisfying buzz for about a month. When the pill wears off, they can invest $475 in a new one, take daily pills for less or attempt abstinence on their own.

Gooberman, 43, says he is giving patients a comfortable start to recovery, the crutch some people need to even contemplate getting clean. Critics allege that he is holding out the false hope that recovery comes painlessly and without a lifetime of work.

“The only thing that detox accomplishes is it wipes out the physical dependence,” said Tony Tommesello, director of substance abuse studies at the University of Maryland School of Pharmacy. “But the hard part is the psychological drive that compels people to seek drugs. That’s what therapy is about.”

None of this has diminished Gooberman’s belief that he is onto something. He sees the day when doctors all over the region, even the world, will refer addicts to him.

Although his billboards might create the impression of a “quick fix,” Gooberman says he is only giving addicts a palatable way to clear the hurdle of withdrawal. After that, patients must cope with a psychological craving.

For this, he recommends the 12-step recovery programs offered by Alcoholics Anonymous or Narcotics Anonymous. He says many of his patients have remained clean for months, but acknowledges that others slip back into heroin use.

“I’m not holding this out as a cure,” Gooberman said. “What we’re doing is breaking down the barriers to getting clean. And the first big barrier is this horrendous sickness that I want them to sleep through.”

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One recent morning, Karen Alexander pulled up to the plain office building that houses Gooberman’s clinic. She had driven from Bloomington, Ill., with her 24-year-old son, Bradley, a heroin addict for two years.

“It was just time to do something about it,” Bradley said. “I’d tried to kick [heroin] a couple times but I’d last about three days. You get so you can’t take it. You get chills, you throw up, you can’t sleep. It’s just kind of hard to explain.”

His grandparents paid the bill.

Bradley describes his family as comfortably middle class. His mother works for an elected official. His father is a farmer and moonlights as a forklift operator at a Nestle plant. Bradley once worked construction, lived on his own and surrounded himself with material possessions: two motorcycles, gold jewelry and purebred dogs.

All this fell apart when he accepted a friend’s offer of heroin.

In Gooberman’s office, the doctor clutched Bradley’s shoulder.

“You’re starting a whole new life,” Gooberman said.

“Beats the old one,” Bradley replied.

Gooberman and a nurse anesthetist began the procedure. They placed an oxygen mask over his face and stuck an intravenous tube in his arm. His eyes fluttered and closed. Finally, the nurse inserted a breathing tube.

Bradley slept for four hours, showing no signs of the changes occurring in his body. Naltrexone, delivered through a fast-acting injection as well as the slow-acting implant, works by pushing heroin molecules off the brain receptors they normally occupy. This triggers a sudden, intense withdrawal.

When Bradley awoke, he spent a half-hour in bed shaking off the anesthesia. A few hours later, he left Gooberman’s office on his mother’s arm.

“I feel great,” Bradley said a few weeks later. He said he hadn’t suffered further withdrawal symptoms--nor any craving for drugs.

“I have no intentions or urges,” he said, adding that he has attended daily Narcotics Anonymous meetings.

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Gooberman, who grew up in southern New Jersey, earned his medical degree in Mexico, then trained at a teaching hospital in Camden. After practicing internal medicine for several years, he heard of a rapid detoxification method that was being offered in Vienna.

There, doctors sedated patients with long-acting drugs that left patients too groggy to go home the same day. The overnight stay pushed the cost toward $10,000--too high by U.S. standards in an era of cost containment.

Gooberman made two innovations. He used a short-acting anesthetic that enabled him to discharge patients the same day and cut costs by more than half. And he offered a naltrexone implant that, as long as it lasts, relieves patients of the responsibility of taking a daily dose.

Gooberman took out newspaper ads, rented billboards and opened a Web site. Business boomed, then declined when competitors opened rapid-detox centers in a dozen cities including New York and Miami.

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New Jersey’s Board of Medical Examiners has investigated allegations that Gooberman falsely advertised a procedure that couldn’t be accomplished in four hours. The state’s anesthesiologists criticized him for putting patients to sleep in an outpatient procedure and using nurse-anesthetists rather than doctors.

Ultimately, the state dropped its investigation. A spokesman for the state agency declined to comment.

Meanwhile, two of his patients died after leaving the clinic. Gooberman said they took cocaine, which may have triggered a fatal heart rhythm. In a counseling session before each treatment, he warns patients not to use cocaine but says he can’t control what they do when they leave.

No one--neither critics nor fans--can judge the program’s long-term success. In a follow-up study, Gooberman found that 80% of patients he could reach were still off heroin 30 days after treatment.

The study was conducted by phone and relied on people telling the truth.