A PELLET MAY MAKE FIGHTING HEROIN ADDICTION A LITTLE EASIER

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.

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."