1684282?1350782543
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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Patient's Journey: Oxycontin to Tramadol to Suboxone to MDS

Oct 03, 2011 - 0 comments
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Addiction

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abuse

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Naltrexone implant



This blog from our recent patient addresses so many issues that I discuss in this forum that I just had to share it with my readers here. It touches on such issues as Tramadol abuse and addiction, Suboxone dependency and of course the process or rapid detox. Here it is, so judge for yourselves:

To Ann, Dr. George, Dr. Julia (Aharonov), Asher, Mallory, Katie, and Elaine, I owe my life. From the first phone call to MDS I knew that I had found what I had been looking for. I feel it very important to share my story with those who still suffer with opiate addiction and to let you know that there is hope!

After several years sobriety from opiate addiction in the ‘90’s, I made the very bad judgment call and begin taking Tramadol (Ultram) that was prescribed to me by a physician for “migraine headaches”. I had been given this drug several years prior in a treatment facility in order to detox from Oxycontin dependency. I cannot say that I was totally innocent as to the effect I would receive from this drug and, as with any opiate, as the effects began to wear off, I took more and more until I was completely and helplessly hooked with no way out.

After about 2 years of going from doctor to doctor to get enough Tramadol to make it through each day, I found out about the “wonder drug”, Suboxone. I did all the research I could find on this medication and, after 2 years on Tramadol (and anything else that would get me through to my next prescription), I located a psychiatrist who was more than willing to prescribe a high dose of Suboxone. I thought I had found utopia! Not only was I no longer having to work every day to get more of my drug of choice, but it was totally legal and he was totally willing to prescribe the pills every month without question. Little did I know that I had just switched to another opiate and that it would be close to two more years before I could find a solution.

The Suboxone worked well. It kept me at a level that I could continue my daily life with and I dutifully went to each of my very expensive psychiatry visits to get my prescription. However, now in my early 50’s, I began to lose all my zest for life. My libido was at an all time bottom; I was depressed, and sincerely thought that all of this was due to menopause! I went to doctors and no one could help. In fact, I cannot recall, until recently, the last time I had real joy or laughter.

In all fairness, my psychiatrist is a precious man. Sadly, though, he really had no idea how addicting the Suboxone is and, although we weaned me down to 1/3 of a 2 mg strip daily, I could not go any lower and still get out of bed and function. Any lower dose brought me into a deep depression and the only thing I could do to get out of it was to begin to raise my dose again. My doctor just could not understand why I couldn’t just go ahead and quit at such a low dose. He was prescribing 8 strips (2mg) monthly and I still could not completely stop. I reached my deepest despair and began to think I would never be able to do this without a lengthy and expensive drug rehab. Sadly, that was not an option because I had kept all of this secret from my family and friends and could not chance the repercussions of them finding out, especially in the job that I work.

That’s when I believe with all my heart that God (my higher power) led me to MDS. I researched rapid drug detox facilities for over a year but so many of them were so extremely expensive there was really no question as to my ability to do this. Eventually, about a month ago, I located one of the rapid detox programs in Michigan and called. At first, it seemed like I had found what I had been looking for. I scheduled an appointment and began to make arrangements to have the time off work and go to this facility. Because I feel it important for each person to make his or her own decisions, I will not say anything other than the fact that I believe I was led, just a few days before departing for this facility, to call the number on the MDS website. I had been especially attracted to a blog that the anesthesiologist, Dr. Julia, had posted on the site. That changed everything.

From the moment I made that call, I knew that I had found what I was looking for. Ann was my contact person and she was an absolute angel. She answered my questions, helped me come up with solutions, and told me every step of what I needed to expect. We spoke on numerous occasions and there was never a time that she was upset or too busy to speak to me. Confidentiality was of utmost importance and we texted several times as well. This was a huge decision for me and I had my fears and doubts. Ann put every fear I had to rest and from that point I never turned back. I promptly cancelled my other appointment and scheduled my procedure with MDS for the following week.

I took the plunge and eventually decided to talk to my 25 year old son about what was going on and, although I felt a great deal of shame, he embraced me and told me that, without a doubt, he would be going with me to Michigan and that he would see me through the entire process. Funny how I was so afraid to tell anyone that I had a problem and this actually brought him and me closer in the process!

On arrival to the area on the day before my procedure, I underwent an extensive battery of tests to assure that I was in utmost health and that the procedure would be safe for me. I had a stress echo by a cardiologist and went from there directly to the MDS center. Elaine, the receptionist, was kind and very helpful when we arrived. Then, I met Dr. George. What a guy! Extremely professional, yet caring and kind, I knew he was going to take good care of me. I had blood work, a psychological examination from a psychiatrist, and a complete medical workup by Dr. George. I think that one of the most important steps that put me totally at ease was that Ann, “my angel”, came to the center to meet me. I will never forget that selfless act from her because she certainly didn’t have to do that. I met Mallory (I’ll talk more about her in a moment), and with everything looking good, we left for our hotel room that MDS had reserved for us.

Let me say one thing. I followed every single instruction I was given by Ann and Dr. George. I was instructed to drink a bottle of Mag Citrate (a not-so-wonderful-tasting laxative) on Monday night prior to the procedure on Wednesday, followed by another bottle 4 hours later. Trust me, I did not want to do this, but I was determined to take my life back so I did precisely that. It didn’t make for the most pleasant plane ride in history but most of the effects were gone by late morning anyway. Also, I was asked to remain on a clear liquid diet on Tuesday, which I grudgingly did because I was starving!

The day of the procedure, my son took me to MDS and left me in capable hands. He came in and everyone assured him that he could return to the hotel and that I would be well cared for. I was then escorted to a very well established hospital/surgical area and prepared for my procedure. Naturally, I was apprehensive, but the staff at MDS put all my fears to rest. The remainder of “my” angels included Mallory (who I mentioned earlier), Asher, Katie, and Dr. Julia, who came and introduced herself and presented as a very professional woman who deeply cared about the path I was on. Although that was the only time I consciously saw her, I know that I was in very capable hands and that she took very seriously the fact that she held my life in her hands.

Now, about my other angels. Mallory is a complete doll. I have not seen anyone love their job as much as this young woman does in some time. Her bright smile, her confidence and poise were contagious. I had no fears. She assured my son that she would be coming back to the hotel to be with him for the first few hours after my release from the MDS center and she did just that. Asher, an astoundingly knowledgeable and intuitive young man was my paramedic who started my IV and gave me more information about what my recovery would be like. Katie was a new employee and I know they made a very good choice in choosing her as well because she is very eager to learn and was very caring and compassionate as well. The last thing I recall was Asher telling me I would be getting sleepy and evidently he was right because the next thing I knew I was waking up after the procedure.

Now, let me be very blunt here. I am not writing this blog to sell anything so my intent is to tell about my experience with this process. So, I will be as honest as I can possibly be and tell the events that followed as accurately as I possibly can. Naturally, I was under light anesthesia for the procedure. However, I did awake in a very nice recovery area, surrounded by the staff members who were there for my every need. Honestly, my first two hours seemed like something had gone terribly wrong. I recall a horrible case of restless legs, arms, body, and was unable to be still in the bed. The knowing staff did everything possible to alleviate these symptoms but this was just part of the process I was to endure. I lay there and recalled reading a testimonial of someone who had said they had had 8 hours of restless leg after their procedure so I kept thinking, “OK, I can do anything for just 8 hours”, over and over. Thank God, this was over in about 2 hours and I’ve only gotten better since that time.
As to their word, Mallory and Katie both returned to the hotel with my son and me. They assisted me to the bed where I slept for hours. I had fits of sneezing (3-4 big sneezes which I was told are part of the withdrawals) but, other than that, I did not have a single problem. They remained with my son and offered him support for several hours and I will never forget their kindness. I knew they had lives and families to get to but their dedication to what they are doing was insurmountable. I will never forget them for the comfort they provided my son who feared that he would not know what to do to care for his mother.

The next day, and for the next two days, just as we were told, Dr. George came by to check on me each morning, followed shortly by a visit from Asher. We had their personal phone numbers and there was never a time that we called that they didn’t promptly answer with words of wisdom and comfort. I am still astounded by Asher’s understanding of the addiction process and he offered a great deal of comfort to my son. Although I was feeling better by the hour (exactly as Asher told me I would), it was very nice to see their faces and hear how well I was doing.

I was given an array of medications with explicit instructions (to my son) to help me through any imaginable problem that may arise. I did take medication to help with a little restlessness for the first few nights, but at this point have stopped all the meds. I have them available if I need them but it feels so wonderful to “feel” again, I’m hesitant to take anything and am beginning to feel human again. My son and I left on Saturday morning as scheduled. I did not want to get out of bed because, as Newton’s law suggests, “ An object at rest stays at rest and an object in motion stays in motion” (more or less). So, I knew that the only way I was going to get moving was to get up and get moving. My son packed our bags and we headed to the airport.

At this point, I am 5 days post procedure. I awoke at 5 am (haven’t done that in years) and am dressed and ready to go. I ate breakfast (oh, one thing I did forget to mention was that I had zero appetite for the first 4 days but it is gradually returning and food tastes good again), and am now ready to go out and do errands. I am fortunate that I have a few more days off work because I still feel a little weak and am working through that on a daily basis by getting up and moving. My body is alive again and I spent last evening laughing, literally belly laughing, with another of my sons – something I haven’t done in a very long time. Happily, just as Dr. George also wisely suggested, my libido has returned with a vengeance and I’m 54 years old! YAY!

I had the wonderful privilege of meeting another patient who underwent the same rapid detox procedure on the same day and he came and visited my son and me on the 3rd day after our procedure. He also did extremely well and I was a little envious that he was up and around before me, which gave me that much more incentive to get up and get moving. He was a great guy, someone I would never have met under any other circumstances. He had been on what he described as massive doses of opiates, too numerous to count, and was a little surprised that a drug like Tramadol could have grabbed me like it did. What I want to say to anyone who still suffers, is that it does not matter what form of opiate you are having a problem with. Opiates are insidious, extremely addicting, and in too many cases in our world today, lethal. If you are like me and cannot stop, please understand that you are not weak, immoral, or lack motivation. Opiates have a physical mechanism that allows them to attach to brain receptors. You face one of a few options. One is that of placing yourself in a room without access out for up to 2 months to go through the withdrawal process. But, if you are like me, once the withdrawals get too bad, you’ll be out of that room in a flash trying to find something to make you feel “normal” again, and the addiction continues to rage. Next, you can continue to try to wean off the medications. The problem with that is that the brain receptors do not easily let go of the opiates and I was never able to get past the lower dosages. You can also continue to use, destroy your life and those around you and end up either in jail or, worse, in the cemetery. Or, you can make the call to Ann at MDS and find your angels like I found mine.

I will continue to add to this as time goes on. Like I said, I still feel a little weak, but not much and this is only day 5. I’m going shopping and plan to clean house later – if I choose to.  You see, today I have choices that I didn’t have a week ago and I am grateful to God for this opportunity. I plan to seek out a meeting of some sort this evening – oh, and I went to church right by myself yesterday! I’m going to do every single thing Dr. George tells me I should do. He has answered every phone call I’ve made to him and I have every reason to believe he will be there as time goes on. I have a Naltrexone implant but am taking Naltrexone by mouth for a few days until that kicks in. I’m not messing with this addiction – hopefully, ever again. Not sure if I’ll be able to return for new implants every few months, but that is certainly an option.  If not the implant, I will take the Naltrexone pills again for as long as I need. Asher made a little funny on his last visit to me; he said, “yeah, this is your chance at a drug-free life – unless you have a few thousand dollars you wanna throw around again”! I have decided that I don’t want to go that route again and, for that reason, am extremely grateful to the caring staff at MDS for giving me my life back and will follow every bit of advice they give me.

I am filled with gratitude today and apologize for the length of this blog. But then again, it’s my blog so I guess it can be as long as I want. My goal was to share my complete experience with the wonderful people at MDS and my prayers for those of you who still suffer with this disease. If you are waiting for the right time, maybe it is now. Ann is the angel of mercy you will speak to and I believe you will never turn back!

Tramadol: Misuse, Abuse and Addiction

Sep 11, 2011 - 67 comments
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tramadol

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Addiction

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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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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.