Julia M Aharonov, DO  
Female, 54
Pontiac, MI

Specialties: Addiction, Drug abuse and dependence

Interests: My family
Advanced Rapid Detox
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What Determines Long Term Success  of Detox Treatment

Mar 28, 2013 - 1 comments

rapid detox


Detox Success


Naltrexone therapy

There a probably a dozen of places around the country that claim to do rapid detox from opiates. Their protocols vary mostly based on their doctors’ experience and skill set.  These physicians don't share their protocols since they are all in competition with each other. The basic theory behind the process is the same. What varies from clinic to clinic is the physicians’ experience, ethics and care that they put into each and every one of their patients. Another thing that varies wildly is the sticker price.
Yes, a rapid detox clinic can be built on a grand scale, in a spa like facility, or use a hospital wing - both of which will add on thousands to the cost and may jeopardize the privacy by exposing the patients’ chart to the JCAHO inspectors. All of which does nothing to improve patient safety, outcome or long term success.
What does determine success is the careful screening of patients, both psychological and physical; using protocols that are individualized to each patient, which can only be done after years of experience; and unrestricted follow-up using long-term naltrexone therapy.
Naltrexone therapy has been shown in study after study to be effective in minimizing cravings for opiates and preventing relapse. In fact, the longer one stays on naltrexone therapy, the less likely they are to relapse.
By keeping in touch with patients and encouraging them to stay in touch with the clinic and continue the naltrexone therapy, the clinic can significantly improve the long term success of their rapid detox treatment.

Journey with MDS - another amazing testimonial

Dec 23, 2012 - 2 comments

  This is a testimonial that we just recently got via e-mail from a mother of a patient. It was so thoughtful and complete, I felt it would be only right that I share this with my readers here on MedHelp.  If it gives you some hope in this season of hope and giving, I will be glad:

  " Our Personal Journey With MDS
    In 2010 my daughter was first prescribed opiates to deal with chronic back pain. Due to her age, physicians in our state were very reluctant to deal with her. This seemed like the only form of relief at the time.. Two years later, we found ourselves in the middle of a critical drug addiction. I say "critical", because it had affected every aspect of her life in a negative way and had literally consumed her.

    We knew at that point that we needed a solution and that’s when our journey to find a rapid detox center began. After looking at many facilities and researching their practices, we choose MDS. I would like to share with you our experience with this facility, but mostly, with the wonderful people who form this very special place.

    Almost immediately we were embraced by every single person we met and made to feel at peace and ease with our choice. Ann, Dr George, Dr Julia, Shawn, Elaine and Sara are people who will forever be a part of our lives because that’s just how it is. They are caring, loving, professionals who understand the importance of what they do and are committed from the very beginning, continuing as long as you need them. Let me lead you through what we experienced and what you can expect from MDS and their staff…

    We were taken in within 48 hours after our call even though they don’t typically do this procedure on Fridays. Dr George explained to us his understanding of the importance of getting patients in when “they” were ready….before they changed their mind.. My daughter was the only patient they had that day and the full staff was there for her, and as it turns out, for me as well. They have only a 5 patient per week limit on their scheduled days so they can provide specialized care to each patient.

    On the day of the procedure, we went to the rapid detox center and met with Ann, Dr. George, Dr Julia (the board certified anesthesiologist), Shawn, (the paramedic) and Bonnie, the RN. We were shown the surgical procedure room and the recovery room. We were told what was going to happen and where and approximately how long it would take.

    They told us that the fee was all inclusive and that was true.. They furnished all the meds, hotel, transportation, etc.. We weren’t asked for an additional penny for anything. Some of the other places that we researched were not inclusive and the fees added up very quickly to, in some cases, more than twice as much as this facility charges..

    After the procedure, my daughter returned to the hotel accompanied by Shawn, and Elaine. These women stayed with us until way up into the morning hours when my daughter was resting peacefully. Doctor George came to visit us in the morning and checked her to make sure she was comfortable. More staff members stopped by to check on us throughout our stay and Dr George continued to visit us there daily. We were given the cell phone numbers of everyone we met and I can tell you from experience, they are always there to take your call, answer your questions, and do whatever needs to be done. This has continued since we have returned home. I have had to call the doctor on a couple of occasions and he has been truly awesome..
    If you find yourself in need of a program of this nature, and since you are reading this I must assume that you are, please do your homework and find out the following:

    *How much experience does the Doctor, Anesthesiologist, and Staff, have with this procedure?

    *How long have they been at the same location and with the same experienced doctors?

    Don’t just take their word for it, Google them.. nobody needs a traveling show to do this procedure.

    *Do they encourage you and a family member to meet with the staff/board certified anesthesiologist, and tour the surgical facility before the procedure?

    *Do they provide unlimited after-care?

    *How many patients do they manage at one time?

    *Is their price truly inclusive?

    I would, without reservation, recommend this facility and this staff to anyone in need of this vital service. It’s alarming to me that as big as the addictions problem is, there are only about 6 facilities in this country that provide this service. Just as important as the treatment is the confidentiality.

    Your treatment at this facility will never become public information to any person or entity.. That’s so important, especially if you’re a professional. Just remember, there is good and bad in everything in this world. Our experience with MDS was remarkable….

    Thanks to MDS, my daughter has her life back and I have my daughter back… We love you guys..
    Good Luck to you in your journey, and may God have his hands on you and guide and protect you now and always….Amen "

    Blessed in West Virginia

How to choose your rapid drug detox center?

Jul 30, 2012 - 6 comments

Once you decided to get opiate free and you know that you need help to get there, how do you pick where to get that help? Well, I’m going to try to clear the muddy waters for you. Yes, I would love for everyone to come to my clinic, however that is not always reasonable or a viable option for all. But here are some things that every one of you should consider.

The Staff - that is probably the most important part of your procedure. Who is around you during your procedure and how they get you through it is vital to how you do during the process and in the long run. How well they prepare you, what expectations they give and what support you receive afterwards will determine your overall success or failure.

The Physicians - even though it is true that a Board Certified Anesthesiologist is a must, only a few of us actually know the process of rapid drug detox. Experience in this field is extremely important. They do not teach this in anesthesia residency or fellowship. There are clinics that just hire board certified Anesthesiologists or even CRNAs to do the procedure for them by following their "protocol". That is not good enough. The doctor needs to have done many, many procedures and understand the addiction physiology to do this right.  There should also be an Internist/Addictionologist who will take care of you prior to, during and after the procedure and is an integral part of your experience. S/he guides you though your follow up Naltrexone therapy and helps you through all the lumps and bumps on the road of recovery.

The Facility - should be equipped with the kind of state of art equipment you would see in any operating room.  Then following the procedure you should be in a room that has the same equipment as any hospital’s ICU or post anesthesia recovery unit (PACU). Does the rapid drug detox have to be done in a hospital? No, it does not, not at all.  It only increases your costs and decreases your privacy and confidentiality.  If the rapid detox clinic is a safe facility that is equipped with appropriate equipment and medications, and is staffed with experienced staff, they will be equipped to deal with any emergency, akin to any other free standing outpatient surgical center.  It is helpful if they are located close to a large medical center.

The Follow-up – if rapid drug detox is the best way for you to get opiate free, Naltrexone therapy is the lynchpin of staying opiate free. The best clinics include 2 month Naltrexone pellet into the cost of the procedure. To continue naltrexone therapy at home, Alkermes, the pharmaceutical company that produces Vivitrol (injectable naltrexone) to help those patient who have and are willing to use their Medical Insurance to fully cover these injections for as long as one year after  rapid detox procedure, ensuring sobriety.  For those patients who are willing to pay for injections out-of-pocket, Alkermes is willing to help with substantial discounts.
Please, be certain you are getting Vivitrol after an opiate detox procedure, and not a compounded generic substitute, as the dose and the delivery mode may not be accurate. Such generic substitutes have been known to be used by some detox clinics.

The Location - can play an important role in making your decision. You may choose to stay close to home to keep the costs down depending on where you live or go half way across the country to keep your confidentiality. You may choose a place that has cheaper tickets to fly into or you may just choose the best clinic there is. You may also choose a clinic by reading the testimonials. Some locations may just be cheaper because of simple matter of local economics or because the clinic is owned by doctors who run it, so they do not have to answer to a corporate entity. This brings me to the last point.

The Cost - is still important to most people, especially in this economic climate. Some centers attract patients with beautiful buildings and surroundings, promises of spa treatments or even scare them into doing it in some “hospital”. They can name amazing university credentials and whatnots, but the basic calculation should be: who are the staff and how are they treating you, do they care about you or your money? Do the doctors have appropriate experience? Are you getting appropriate Naltrexone follow-through treatment? Is the facility well equipped and close to a major medical center? Is location easily accessible? And is the cost reasonable for what you are getting?

Here are all the things you need to consider before you choose. I do hope I made it easier for you.

Opioids for Chronic Pain  (First Do No Harm)

Jul 26, 2012 - 19 comments



Chronic Pain

This is an extremely timely article that was just published mostly for general practitioners in the Annals of Family Medicine Magazine. I thought that it some numbers in it were both troubling and fascinating to want to share it with all of you. In a nut shell it says what I have been saying all along - doctors write too many opiate prescriptions for far many chronic pain patients.

Nearly 15,000 people die from  opiate prescription overdoses than both heroin and cocaine combined.

Opiate prescription has increased 6 fold from 1997 to 2007 and has been accelerating since.

There are better (in my opinion) treatments for chronic pain that are much safer than opioids,such as physical therapy, cognitive behavioral therapy, anti-depression medications, and treatment of underlying psychiatric illnesses such as depression and anxiety, dietary and life-style changes, etc.

High dose long term opiates have not been shown in multiple studies to improve long term pain scores of chronic pain patients - and that is the most important fact of the whole article.

Please read this short abstract if you want more details and are not afraid of medical lingo.

From Annals of Family Medicine
Opioids for Chronic Pain
First Do No Harm

Roger A. Rosenblatt, MD, MPH; Mary Catlin, BSN, MPH

Authors and Disclosures

Posted: 07/24/2012; Ann Fam Med. 2012;10(4):300-301. © 2012 Annals of Family Medicine, Inc.

Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium.
Attributed to Thomas Sydenham, circa 1680

Overdose deaths from prescription painkillers have skyrocketed in the past decade. Every year, nearly 15,000 people die from overdoses involving these drugs—more than those who die from heroin and cocaine combined.
National Center for Injury Prevention and Control

Opioids are a large family of biologically active peptides that bind to and activate receptors in humans and can reduce pain and induce euphoria. Humans have a voracious appetite for opioids to the extent that our own brains produce them (eg, endorphins), and many people avidly consume those that are produced by plants or synthesized by factories in our environment. Opioids have shaped the course of human history and are arguably one of the most powerful, ubiquitous, useful, and deadly substances in our medical armamentarium.

Our society is agonizingly ambivalent about what role opioids should play in our lives. There is no question that opioids are effective analgesics in the treatment of pain caused by acute injury or surgery, and they are invaluable in the palliative care of patients with cancer and other lethal diseases. But we have criminalized the nonmedical use of opioids and deploy vast armies of combatants in the (largely ineffective) war on such drugs as heroin and opium. The greatest medical and recreational use of opioids in the United States falls between these two extremes and is fostered by the prescription of opioid medications for chronic noncancer pain.

What should be our policy that determines how and when to use opioids for our patients with chronic noncancer pain? The 2 articles in this issue of the Annals discussing opioid use and misuse illustrate the complexity of this question. In Grattan et al's study of patients on long-term opioid therapy for chronic pain at 2 of the largest health plans in the country, patients with no history of a substance use disorder were much more likely to "misuse" opioids if they were depressed. The misuse that patients admitted to during a telephone interview was using their prescribed opioids to treat stress or insomnia rather than pain itself or using more opioids than had been prescribed. Perhaps most interesting is that misuse was common even in patients without depression, occurring in more than one-third of patients.

Patients with severe depression as measured on the 9-item Patient Health Questionnaire were even more likely to misuse opioids than were patients with no or moderate depression. Although this self-report of opioid misuse is already surprisingly high, it may well be even more common than reported in this study. Given that patients are more likely to deny overuse when questioned, and that those patients who didn't respond to the interview may represent a group who are less compliant with instructions, it is reasonable to surmise that opioid misuse probably occurs very frequently in any population using them for prolonged periods of time.

Zweifler focuses his discussion on the most difficult issue that clinicians wrestle with as they try to help patients with chronic non-cancer pain: pain is impossible to measure. Pain is a normal (and protective) physiological response to the physical and emotional vicissitudes of life itself, and anyone who lives long enough will have chronic pain as an obligate consequence of aging. Zweifler cuts this clinical Gordian knot by recommending a strict standard for initiating opioid therapy for chronic disease: "objective evidence of severe disease." Although this dictum has the virtue of brevity, it fails the test of clinical utility. Chronic pain is predominantly a condition that is experienced in the central nervous system, and the event that first triggered the pain may no longer exist or may be impossible to determine. A guideline that requires definitive objective confirmation of severe disease—especially in an era where magnetic resonance screening can show clinically irrelevant anomalies in a large proportion of patients—is likely to lead to as many false-negative and false-positive diagnoses as the much-maligned visual analog pain scale that is currently in widespread use.

So what is the clinician to do? This is what we know about the use of opioids for chronic non-cancer pain:

    The volume of prescribed opioids has increased 600% from 1997 to 2007.
    During roughly the same period, the number of unintentional lethal overdoses involving prescription opioids increased more than 350%, from approximately 4,000 in 1999 to more than 14,000 in 2007.
    Risk of overdose or death increases with higher doses of opioids, especially in patients who concurrently use other respiratory depressants such as benzodiazepines.
    There are treatments for chronic pain that are much safer than opioids, including, but not limited to, physical therapy, cognitive behavioral therapy, low-dose tricyclic medications, and treatment of co-occurring psychiatric illnesses.
    High doses of opioids do not reliably decrease patients' report of the magnitude of chronic pain, nor do they improve patients' overall health and function.

Thus it is reasonable to conclude that opioids for chronic non-cancer pain are not appropriate therapy for most patients in primary care settings. When other interventions fail or are inadequate, cautious evidence-based consideration of low-dose opioids as an adjunct to other therapies may be considered. Entering into chronic opioid therapy requires a long-term commitment by clinician and patient alike to use this powerful, precious, and dangerous medication with care and diligence. As clinicians and as patients, we need to develop a generous measure of respect for the power of opioids to do harm as well as provide relief from pain.