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Julia M Aharonov, DO  
Female, 51
Southfield, MI

Specialties: Addiction, Drug abuse and dependence

Interests: My family

MDS Rapid Drug Detox
888-637-6968
Southfield, MI
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Tramadol: Misuse, Abuse and Addiction

Sep 11, 2011 - 60 comments
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tramadol

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Addiction

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abuse

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misuse



I am becoming somewhat frustrated with the way a lot of my colleagues practice medicine.  Disenchanted, angry would be the other words that could be used.  We all get ostensibly that same training and all of us are supposedly in it to help our patients.  So, how come have I been getting so many letters lately on my addiction forum from desperate people unable to quit taking the tramadol pills that their own kind doctors have so freely prescribed for them?

These doctors seem to forget their pharmacology training.  They also forget to use their independent thinking and ability to look up information for themselves.  They assume that if the medication is not a controlled substance (and it very well should be as we will discuss), then it is not an opiate, it is not addictive and they can just give it like candy without any consequence to their patient.

Here are just a few excerpts of many letters that I have been getting just in the last few weeks:

"I have discovered that if I go more than 10 or 12 hours without my tramadol I begin getting a headache which progresses to nausea, upset stomach and a generally not feeling well, to the point that I have to lie down.  Sometimes I even have cold sweats and chills.  I have found myself taking one just to relieve those symptoms I am concerned that I am dependent on the tramadol and it doesn’t look like I am going to get rid of the pain, and the need, any time soon."

"I have been taking 10-15 Tramadol 50MG for about 5 years now and I am trying to get off of them. I have tried tapering down and that is not working... I have gotten myself to the point that I am out of medication and I am now dealing with the withdrawal symptoms without any relief. I cannot handle the restless leg and the sweating and chills along with not sleeping. I have called my dr to see if he can call me in anything to help with the symptoms but I don’t think he will help me out."

"He is sick of taking tablets and wants to feel 'normal', so he has decided to stop the tramadol. This has left him being sick, hot cold flushes, unable to sleep, lethargic and in pain all over, unable to eat or drink anything as it comes straight back up."

All of these desperate people were prescribed tramadol by their "caring" doctors for legitimate reasons such as migraines, chronic pain, endometriosis, etc.  There is an appropriate use for each and every medication on the market,  including the strongest narcotics, which I used in my daily practice for controlling acute pain in postoperative patients.  Some patients in intractable, chronic or cancer pain need to be on long term opiates under close supervision of a physician.  However, pharmaceutical companies have been successful in persuading the FDA in not scheduling tramadol, also known by its brand name Ultram, as a non-controlled substance. Its mode of action is often described as "unknown", even though it is already well know that it acts on μu receptors just like any other opiate drug. It is also well known that increases both serotonin and norepinephrine at the receptor level.

In May 2009, the United States Food and Drug Administration issued a warning letter to Johnson & Johnson, alleging that a manufacturer's promotional website had "overstated the efficacy" of the drug, and "minimized the serious risks". The company which originally produced tramadol, the German pharmaceutical company Grünenthal GmbH, was the one supposedly guilty of "minimizing" its addictive nature, although it allegedly showed little abuse liability in preliminary tests. The 2010 PDR contains warnings from the manufacturer, which were not present in previous years. The warnings include more compelling language regarding "the addictive potential of tramadol, the possibility of difficulty breathing while on the medication", a new list of more serious side effects, and a notice that tramadol is "not to be used in place of opiate medications for addicts". Tramadol is also "not to be used in efforts to wean addict patients from opiate drugs, nor to be used to manage long-term opiate addiction".

Besides the addiction, tramadol has serious side effects and is contraindicated to be taken concomitantly with some other medications as well as if the patient has certain medical conditions. It decreases seizure threshold and can cause seizures in susceptible individuals. It can also cause serotonin syndrome in people taking SSRI antidepressants. Of course, it possesses all the possible side effects of the regular opiate: hallucinations, drowsiness, insomnia, headaches, swelling of the throat and face, nausea, vomiting, muscle tightness or weakness, rash, and constipation.  When consumed in higher doses, Tramadol can cause a euphoric feeling as well as shallow breathing and death from overdose.

Nonetheless, the physicians persist on thinking about this medication in the way they got used to when it first came out and the way it was "sold" to them by the pharmaceutical reps. They have this warm and fuzzy feeling of safety when they write for tramadol and keep reassuring their unsuspecting patients that it is safe, non-addicting, sort of like strong version of Tylenol. (I actually heard it described like that to residents on pain rotation!)

Well over thirty million tramadol prescriptions were dispensed in US pharmacies alone last year according to government statistics and those numbers continue to rise.  But not only is it widely available by prescription, anyone, even teenagers or children can obtain tramadol simply by clicking the computer.  Incredibly, it is there on hundreds of websites, some without prescriptions at all for as low as few pennies a pill. Authorities are saying that millions and millions of tramadol tablets are being diverted for illegal uses.

It is shocking, but true.  Tramadol abusers compare its high favorably to heroin, morphine and OxyContin and they say it lasts somewhat longer.  No wonder the popularity of tramadol as addictive substance is growing by the day.   Physicians continue to be unconcerned and when faced with patient complains often pooh-pooh them and simply refuse to treat symptoms of withdrawals.

As you have read in patient letters above, the withdrawals from tramadol are no different from any other narcotic.  It is nasty, it lasts a long time and most people can get though it cold turkey.  In fact, because of the serotonin re-uptake inhibition of this drug, the depression aspect of withdrawal after tramadol is much more severe and lasts much longer.  It needs to be specifically addressed.  So what are we doing to our patients? Are we acting in your best interests? We must treat this medication with care it deserves as we must treat each patient with the care s/he deserves.

My hope is that FDA will soon reassess the scheduling of tramadol and address the availability of it on the web. The medical industry has to look at itself and evaluate the education of its doctors about the side effects and drug interactions. We also have learned how to listen to our patients, which is not easy with the busy schedules and busy waiting rooms.  However, no matter how busy, a doctor cannot practice good medicine if he does not take time to educate him/herself and carefully listen to the patient.



Confidentiality during Rapid Drug Detox. Resonable Concern?

Sep 08, 2011 - 3 comments
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confidentiality

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rapid drug detox

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Addiction

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drug addiction

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jcaho org

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HIPA Privacy law



Today we had a call from a patient who did not want to give his name or other information while booking his procedure with us.  While we promise utmost confidentiality to all our patients, was he going overboard?  Upon thinking about it, I remembered a letter I answered just a few weeks ago on my MedHelp Addiction Expert Forum and I realized that he was probably right to keep thing super private. We built our own  facility as a free standing clinic, so that no governmental agency has a right to come in and examine our patient charts, like they would have a right to do in a hospital or in a JCAHO  accredited facility.  So, here is the letter I got and my answer. I think you will find it interesting.

My wife is taking 25 10mg Vicodins a day it started with a prescription and then she got hooked. She wants to quit cold turkey but I don't think it would be wise at this point. She is afraid to see a doctor about her problem because she just invested 8 years of her life in college and 2 weeks ago she graduate from Berkeley with a master’s degree and now applying jobs. My question is if she went to the doctor to get help, which she really wants to get off these, will  it be between the doctor and her only or will any future employees be able access this information about her problem? I really or we really need some help with this. I would really appreciate your help.

Thank you.

This was my answer to this gentleman’s letter:
Your wife's concern is, unfortunately, well grounded.  There are certainly very strict HIPAA and privacy regulations as well as simple doctor-patient confidentiality, however as soon as any information hits the insurers, all bets are off.  All insurance companies share their vast information about all of us with each other and all the underwriters, so even though the employers or schools may not find out; if you ever what to buy life/health or other insurance the information will be there. And if it is there for them, who else is it there for?

On the other hand doing this cold turkey is very unwise, as you rightly said.  Your wife will quickly find out that the symptoms of narcotic withdrawal are rather gory and may be intolerable.  One way of attempting it is tapering use slowly and consistently, without breaking a set pattern, i.e. incrementally increasing the time periods between the pills.  Another is switching to a medication like Suboxone and paying out of pocket, again making sure that you are working with a reputable physician and staying the course of consistent tapering of medication.  Many believe that it is easier to taper Suboxone since it is not a pure agonist (opiate), but also a blocker of opioid receptors.

In our practice we see many people who get addicted to Suboxone as well, and turn to us for detox. So please be careful and be persistent in tapering if you choose to go that way.  Another option is to do it with medical assistance like detox under anesthesia.  It is completely confidential, but of course, not covered by insurance.  You can get more info on the web or on my website.  You can also read my blog on the matter.  Good luck to you and your wife and please be in touch, let me know what happens.

Post Rapid Opiate Detox Naltrexone Therapy. Do I need it and what are my choices?

Aug 28, 2011 - 7 comments

Rapid opiate detox is a safe and effective procedure used to release opiates from the body. The detoxification drug treatment procedure involves administering intravenous medications that remove and block the narcotics from the opioid receptors in the central nervous system while the patient is safely and comfortably asleep. The detox is done under anesthesia to avoid extreme discomfort and pain that usually accompanies opioid withdrawal. A complex mix of medications, honed over years of research and experience is given to counteract the manifestations of the withdrawal before and after the detox procedure,

A small implant containing Naltrexone is usually placed under the skin while the patient is still under sedation. The Naltrexone implant slowly releases medication to continually block opiates from getting into the central nervous system opioid receptors. This helps the patient overcome the physical symptoms of drug addiction and tremendously reduces opiate cravings . The Naltrexone implant will dissolve entirely in approximately two months.

Some opiate users decide to detox on their own and deal with the horror of withdrawals without being treated with the rapid opiate detox method. For these patients we highly recommend the use of the Naltrexone maintenance treatment. These patients are highly vulnerable to going back to the use of opiates, because their psyche has not yet fully adapted to the new state of "being a non-user". Consequently some sort of insurance policy or a defense shield  has to be in effect to protect such patients. As an opiate blocker, Naltrexone will provide such a protection.

I recommend one of these two routes for the administration of Naltrexone:

Our first preferred route is the Naltrexone pellet implant that is placed underneath the skin through a minor surgical procedure. This pellet will provide protection for two months as the medicine is absorbed gradually. This protection is provided on a continuous daily basis as the patient proceeds with daily business and activities. This method is economically affordable for the two month protection period.

The other method of Naltrexone treatment is the injectable route which protects only for one month at an expensive price of $1200.00. At MDS Rapid Drug Detox center we provide such services for those patients who proceed to detox on their own without undergoing the rapid detox method. The patient has to be challenged with an opiate blocker to determine eligibility for the procedure. We prefer to place a pellet implant as it provides opiate blockage for two months at $1000.00. We suggest implants for a period of six to twelve months to allow time for full psychological adaptation.

Another choice, of course, is the daily oral Naltrexone. This choice demands daily re-commitment on the part of the patient, which in my opinion is a heavy burden to load on anyone, especially a recent addict.  Unless there are some very good medical reasons against the two previous choices, we always recommend to stay away form this particular option.

Some of those medical reasons may be a pending surgery which may necessitate narcotics for acute pain control, or that the detox was done not for the purpose of complete withdrawal from all narcotic, but for the "resetting" of the body of a patient with chronic pain.  Such patients develop extremely high tolerance to narcotics and a need for extraordinarily high dosages.  In such cases our procedure can be done to "reset" the amount of receptors they have developed as well to reevaluate the actual pain the experience.  After chronic use of narcotics patients develop condition termed by the doctors as "hyperalgesia", so that the pain they experience does not correspond well to the actual psychopathology that exists. By taking them off of all the narcotics for the period of six to eight weeks allows their doctors to evaluate and help treat them better and more appropriately.

In those cases we may hold off on implanting the Naltrexone pellet and work hand in hand with the patient's chronic pain physician to determine their needs in the future.

Rapid Detox Testimonial

Aug 10, 2011 - 0 comments

Our testimonials are usually short and sweet.  "Thank you for giving my child back", "thank you for giving my life back to me"... Rarely do we get a testimonial that has such incredible clarity of vision and thought, such clear understanding of the process and such good advice to others, that I just felt the compulsion to share it with all. The patient is a health professional, so I need to explain that an LMA stands for a laryngeal mask airway - a device that protects patients respiration during our procedure, otherwise, read on:


I recently underwent the rapid detox procedure about a week ago. I was on Suboxone and heroin. At the time of the procedure, I had withdrawn from heroin to Suboxone to stabilize myself before the procedure. I had been a hard core heroin addict. The Suboxone was a way to hold me over from spending too much money on heroin. When I had money, I used heroin. When I ran out, I had to get back on Suboxone. The process of getting back on Suboxone from heroin in itself is very hard because you do experience withdrawal symptoms for several days, until the Suboxone stabilizes your body. I went through this process of switching from heroin to Suboxone at least 20 times in the past year. I had some vacation time from work and decided to quit heroin cold turkey, but I couldn’t. When I heard about MDS rapid detox, I decided to go through the procedure. I took Suboxone to stop my withdrawal from heroin until the procedure, which was a week’s time. So in essence, I had been taking Suboxone for a week before the procedure because 3 weeks before, I strictly was only taking heroin. My procedure was (day 1) and I planned to be back at work by (day 5). This is a pretty optimistic goal. I almost backed out of it, until I thought to myself, “I’m tired of being a junky and I want to stop”. So with all of that in mind, I went through the procedure. The staff was great. The facility was great. It looks like a regular hospital. The building looks like an office building, not a hospital from the outside, which was cool because it reassures confidentiality in a sense. The doctors are very experienced, and the staff really takes care of you to make sure you will be fine. You get prepped just like a surgical procedure; the anesthesiologist uses an LMA, which is cool because your throat won’t be sore. Before I knew it, the procedure was done. The day of the procedure you feel out of it because of the anesthesia, but the staff helps you with everything. A healthcare provider goes back with you to your hotel to make sure you are ok. The doctor visits you daily, which is nice. You don’t experience chills, sweats, or any of the hardcore withdrawal symptoms that you all know about. They give you medications to help you sleep through the first day. The second day, you feel a little groggy, and I had restless legs for about 4-8 hours, then it went away. The procedure in essence, compacts about 2 weeks of withdrawal symptoms into thirty minutes during the procedure. The best thing to do after the second and third day is to move around as much as you can. You will be fatigued, but you won’t be suffering. The only things that bug you the most is feeling weak, diarrhea (which can be managed through drinking fluids and meds so it’s not so bad), and just a little jittery, which you can take a med for that also to control that. By my fourth and fifth day I started getting my strength and energy back. I was able to work on day 5. You start getting your appetite back by day 4-5 to where you just want to eat a lot, and drink. After a week I have no cravings for any opiates what so ever. The naltrexone implant really works well. After you leave, you have your meds for you to take home with you to help with the minor symptoms. Ask for a good amount of sleep medication from the doctor because that is another symptom which is present for a while. Try to allow about a week of recovery time to go through this procedure because after a week, you feel about 95% normal. After 5 days, you feel 75% normal because your leg and arm strength is a little week. But it gets better every 8 hours. Withdrawal cold turkey from Suboxone takes about 3-4 weeks physically (trust me, I’ve been through it), but after the procedure, you have to develop a plan to stay clean months down the road. I hope this blog helps. I highly recommend MDS Drug Detox to anybody that has any opiate addiction because why suffer for weeks when you only have to go through mild symptoms for about 1 week? Good luck.