A fairly ‘clean’ portrayal

“The Cleaner,” pilot episode, A&E;, July 15

The premise: William Banks (Benjamin Bratt) is a former heroin addict who forms a group of “extreme interventionists” to help teenage addicts to beat their addictions. Doing so, he believes, will help him stay clean as well.

Banks points out that drug addiction has a 75% relapse rate and a 25% mortality rate. In the pilot episode, Banks saves the life of Heather Lewis (Hazel Dean), who is brought to his house close to death. Team member Akani (Grace Park) reports that Heather has been “smoking ice and snorting H,” references to methamphetamine and heroin, respectively.

Heather is unresponsive and doesn’t appear to be breathing, and her pupils are noted to be abnormal. Banks injects her neck with a liquid medication, and she slowly recovers.

The medical questions: Can addicts stay clean by helping others with drug addiction? Do methamphetamine and heroin addicts have a high relapse and mortality rate? What are the effects of methamphetamine and heroin on the pupils? Are coma and breathing suppression likely caused by heroin? Is the coma easily reversible by injection?

The reality: “For some who have battled addiction, it can be rewarding and even helpful to care for others, though the heroics are usually limited to offering support, counseling and guidance,” says Dr. Marc Gourevitch, addiction specialist and professor of medicine and psychiatry at New York University School of Medicine. Adds Dr. Karen Miotto, director of UCLA’s Alcoholism and Addiction Medicine Service: “If a person has a solid recovery, helping other addicts may be not only satisfying but a way to ‘give back’ for offenses and wrong actions done while they were using.”

Addictions to methamphetamine and heroin have high relapse rates, and both have poor prognoses without treatment. Miotto agrees with the show’s portrayal of relapse, pointing to a 75% to 80% relapse rate in most programs, such as methadone, that lack medical treatments.

Mortality is about 5% to 10% per year for both drugs, less than the show is suggesting though still significant. In regard to pupil size, methamphetamine and heroin have opposite effects: Heroin initially constricts pupils and methamphetamine dilates them. But Miotto points out that as a heroin-induced coma deepens, the pupils also begin to dilate. In the case of a multiple drug overdose, as is likely in Heather’s case, pupil size does not point to a particular drug.

Yet one drug effect often predominates. “The opiate may overwhelm the methamphetamine excitation,” says Dr. Timmen L. Cermak, president-elect of the California Society of Addiction Medicine. Heroin overdose can suppress breathing and lead quickly to death. A medicine to reverse heroin overdose, Narcan (an opiate antagonist), can be given by injection into a muscle or intravenously, but the preferred route is always intravenously.

Narcan can reverse opiate overdose and respiratory depression within minutes. Intramuscular shots are futile unless there is adequate circulation to carry the drug to the heart.

NYU’s Gourevitch says, “Increasingly, heroin users and their partners are being given such medication kits to use if they have or witness an overdose.” But injecting into a vein in the neck is not part of any protocol. “Injection into the neck is generally only done on TV,” Miotto says.

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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear.” In the Unreal World, he explains the medical facts behind the media fiction. He can be reached at marc@doctorsiegel.com.