IMPLANT MAY HELP HEROIN ADDICTS

A Pellet That Prevents Users From Getting High Is Being Offered In N.J.

Alicia Watkins had just pulled the hypodermic needle from her arm when
the bathroom door swung open. Through a heroin-induced cloud, Watkins,
then 21, saw her mother drop to her knees in the doorway and burst
into tears.

Her half-closed eyes allowed her to see the shame creep across the
faces of her stepfather and grandparents as they stared at the black
leather belt she had strapped around her left arm as a tourniquet.
That was Easter Sunday last year. Today, Watkins, who grew up in
Chatsworth, boasts that she has been clean since November. And the
woman who says she spent roughly $45,000 on drugs and danced in
Philadelphia strip joints to fuel her daily habit for three years
credits the support of her family and a 5-inch pellet surgically
implanted in her abdomen for the recent success in the fight against
her addiction. Some in the medical community believe that this pellet,
or a variation of it, may be the first step in the transformation of
the treatment of the nation's estimated 600,000 heroin addicts and,
along the way, help clear the clogged arteries of the criminal justice
system. Watkins' pellet is based primarily on a drug called
naltrexone, which prevents her from getting high on opiates such as
heroin by blocking the drug's path, much like gluing the keyhole of a
lock. Already, local justices are requiring addicts to use naltrexone
implants as a condition of probation.

And officials in New Castle County, Del., are thinking of making it a
requirement of probation for adolescents who test positive for heroin.

The public defender's office in that county is also conducting a study
of the effectiveness of naltrexone implants with up to 30 inmates.
Heroin addiction has risen dramatically in recent years.

The National Institutes of Health estimates that there are more than
600,000 addicts nationwide, with only 19 percent receiving treatment.

In 1993, there were about 144,000 heroin addicts, institute statistics
indicate. The NIH also estimates that the cost of heroin addiction on
society runs $20 billion annually, with $1.2 billion spent on health
care alone. James Cornish, a professor of psychiatry at the University
of Pennsylvania, who is researching forms of heroin treatment for the
National Institute on Drug Abuse (NIDA), said he expected more courts
in the near future to offer naltrexone to offenders as an alternative
to jail. Cornish and other addiction specialists believe that
naltrexone -- which works only on opiate drugs and not on cocaine --
may drastically reduce the number of inmates with substance-abuse
problems. "The treatment of opiate dependents could be radically
different in two to three years," said Frank Vocci, director of the
medications development division at the NIDA. "The whole landscape is
changing," he said. "There is a push afoot now to increase the
availability of treatment.

If the courts are to start remanding people[into treatment], that will
increase the amount of people being treated for heroin addiction." To
date, about 80 percent of the criminals in federal prisons are drug
addicts, according to the Department of Justice. The key to successful
treatment with naltrexone, according to Cornish, who cites recent
studies, is to make the addict have a vested interest in fighting the
disease.

He said addicts with families and jobs usually have the best success
rates because they have something tangible to lose. Now, Cornish said,
with some courts giving addicts a choice between jail time and using
naltrexone, addicts who normally would slip through the cracks are
asking to go on naltrexone to avoid losing something dear to them --
their freedom. The prospect of helping addicts, while making a tidy
profit, has lured Lance L. Gooberman, a physician who operates an
addiction clinic in Merchantville, into the mix. Gooberman, 47,
creator of the pellet and a recovering addict, specializes in
addiction medicine.

He also has appeared on numerous television talk shows -- chatting
with Montel, Geraldo and Ricki Lake -- and his name appears on eight
billboards, including signs in Philadelphia and Camden. Gooberman, who
charges $375 for the pellet implant and conducts the half-hour surgery
in his Merchantville office, said he had performed about 2,800
implants in the last three years.

He is seeking approval from the Food and Drug Administration to market
the device worldwide. Cornish said naltrexone was studied for 20 years
before the FDA approved it for addiction treatment in an oral form
1994. He said the drug has relatively no side effects, and is
"absolutely" safe and effective. While Gooberman's pellet is based on
naltrexone, Cornish is hesitant to endorse it because he's not sure of
its effectiveness. "I have absolutely no information about the pellet
he uses," Cornish said. Gooberman said his naltrexone implant blocked
the path of opiate drugs for 60 days. He said it was a more efficient
form of heroin treatment than methadone, which is administered through
a drink, because the implant takes the human element out of the
equation. "If an addict wants to get high, all they do is stop taking
their medicine," he said. "But with the pellet, they can't." For
example, a study of 252 heroin-addicted patients taking naltrexone
orally was cited in a NIDA report, and it said that all had stopped
taking naltrexone within nine months. "They didn't want to stop
getting high," Cornish said. Now, he said, with the courts offering
naltrexone as an alternative to jail, and with the advent of
long-acting naltrexone formulas such as the pellet -- Cornish is also
studying a liquid form that is injected into muscle and lasts 30 days
- -- a viable alternative to methadone may be readily available. In
1972, the first methadone centers were opened.

Methadone is administered orally once a day. It is an opiate itself,
and despite being in use for more than 30 years, it is still
considered the treatment of choice by the medical community, Cornish
said. But it has major drawbacks.

It takes three months for it to alleviate an addict's dependence, and
it often requires a lifetime of use, according to NIH literature.
Gooberman said naltrexone was better than methadone because it did not
cause dependence. He said naltrexone did not alter a patient's mood,
or make people sick when they stopped using it. He also said people
taking it cannot overdose on heroin, no matter how much they take.
Watkins, who tried methadone treatments twice and lasted only about a
week in the programs, said: "It doesn't stop the cravings.

It doesn't help." And what she needed was help. A self-described "big
partyer," Watkins was hooked on heroin by age 19. "I was always
looking for the bigger and better high," she said. By her own account,
she went into rehab eight times in four years, but she always went
back to the drugs -- until now. John Sitzler, Springfield Township
prosecutor, recommended to Municipal Judge Richard Andronici that
Watkins be required to have Gooberman's pellet implanted at least
every 10 weeks for one year as a condition of her probation for two
drug arrests. Watkins said she does not mind that she has to pay $375
every 60 days for the pellet, or that it is mandated as part of her
probation, because the pellet is keeping her clean. A week after she
had the pellet procedure, Watkins said, she popped some pills --
Percocet, a narcotic painkiller -- but "nothing happened, except that
I got violently sick." Now, with the help of her family and
support-group meetings, she believes she has her life back together
and plans to move to Florida. "I wish everyone had the money to get it
done," she said. "I've been to rehab a bunch of times, and this is the
only thing that has worked."