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Rehab Riviera: Drugs for drug addicts; solution or crutch?

The white pill looks like a baby aspirin. Brody Webster sticks it in his mouth and holds it there for 15 minutes, trying not to swallow. When the underside of his tongue finally goes numb, he knows he has taken the full dose.
Webster smiles. He repeats this ritual every day, with mathematical precision, for one reason: “I’m a really bad addict,” he said mischievously.
Brody Webster, 22, pops Zubsolv, a pill he dissolves beneath his tongue to curb his cravings for opioids. This has allowed him to hold an internship at Dr. Faried Banimahd’s office and think about the future, he says. (Photo by Mindy Schauer, Orange County Register/SCNG)Dr. Faried Banimahd has become a mentor and father figure for 22-year-old Brody Webster, giving him an internship at this Laguna Hills office and encouraging him to have a curiosity about the world. Webster is also one of Banimahd’s patients who takes Zubsolv for his opioid addiction. Webster has been sober for more than six months. (Photo by Mindy Schauer, Orange County Register/SCNG)Recovering addict Brody Webster, 22, takes a cigarette break across the street from Dr. Faried Banimahd’s office where he works as an intern. Webster’s “Blessed” neck tattoo, one of many all over his body, is to remind himself that, “The fact that I’m still standing, still breathing – I’m lucky to be alive. I’m not taking anything for granted.” (Photo by Mindy Schauer, Orange County Register/SCNG)Office manager Ramana Sheik and intern Brody Webster, 22, work together in Dr. Faried Banimahd’s Laguna Hills office. Banimahd treats drug addicts medicinally, including Webster who has been sober several months. (Photo by Mindy Schauer, Orange County Register/SCNG)Dr. Faried Banimahd provides meals for his office staff because “Feeding people not only addresses basic biological needs but it helps build trust, camaraderie and relationships,” he says. On this day his staff, Brody Webster and Janet Parra, enjoy a Persian spread. (Photo by Mindy Schauer, Orange County Register/SCNG)Brody Webster, 22, makes his bed in the morning before leaving his sober living home in Orange for his internship at Dr. Faried Banimahd’s Laguna Hills office. His life now has purpose he says. (Photo by Mindy Schauer, Orange County Register/SCNG)Working the appointment desk is one of 22-year-old Brody Webster’s responsibilities as an intern at Dr. Faried Banimahd’s office in Laguna Hills. The patients love him, Banimahd says. (Photo by Mindy Schauer, Orange County Register/SCNG)Patient Jerome Shirar updates Dr. Faried Banimahd on his progress during a recent office visit. Shirar is on a medication-assisted treatment plan. (Photo by Mindy Schauer, Orange County Register/SCNG)Dr. Faried Banimahd squeezes in time between seeing patients to help office manager Ramana Sheik with her biopsychology studies at his Laguna Hills office. “I just love you Dr. B,” Sheik says when he helps her figure out a problem while she prepares for a test. (Photo by Mindy Schauer, Orange County Register/SCNG)Brody Webster recently moved into a new sober living home in Santa Ana run by Dr. Faried Banimahd. Webster calls the newly updated home “the bomb” and proudly takes a visitor on tour. He plays with his new dog, a stray, he named “Lucifur”. (Photo by Mindy Schauer, Orange County Register/SCNG)Dr. Faried Banimahd, right, fills in for a co-worker during IOP or Intensive Outpatient Therapy for recovering drug addicts, who, like Webster, have been through the rehab system multiple times. Banimahd likes to “Have complete control of my patients from top to bottom” until they have the ability to be successfully plugged back into the community.” He tells the group, “You guys for some reason haven’t been given the tools to put one foot in front of the other.” (Photo by Mindy Schauer, Orange County Register/SCNG)Recovering addict Brody Webster, 22, takes part in his IOP group for recovering addicts who have been through the system multiple times. “You can die out there. If you’re not done you’re not done…It’s a pros and cons list. You know which side is going to come out winning,” he says. (Photo by Mindy Schauer, Orange County Register/SCNG)Brody Webster recently moved into a new sober living home in Santa Ana run by Dr. Faried Banimahd. (Photo by Mindy Schauer, Orange County Register/SCNG)Show Caption of Expand
That little pill doesn’t get him high. It contains buprenorphine, a medication that binds to opioid receptors and tricks the brain into thinking it’s had a fix, reducing an addict’s overwhelming physical cravings for opiates such as heroin and prescription painkillers.
After cycling through more 12-step programs than he cares to count — at a cost of hundreds of thousands of dollars over several years — Webster believes the $5 pill is a big reason why he’s been clean for nearly eight months. It’s part of why he can show up at Dr. Faried Banimahd’s office for his internship – dressed in crisp navy blue scrubs and bright red sneakers – not just on time, but early.
It’s also a reason why the 22-year-old finally has hope for a productive, opiate-free life.
“Every place I went was the same; the traditional, generic, 12-step, one-size-fits-all bull—-. They keep you sober while you’re in. But 30 days later you’re out, and then what? You’re right back where you left off,” he said.
“This is a different concept, a different view,” Webster added. “The medication gets rid of the cravings. Without it, I don’t know what I’d do or where I’d be.”
Medication, however, is only part of it.
Webster also attends intensive outpatient therapy sessions, where he wrestles with the root causes of his behavior. His internship allows him face-time with his doctor — who has become a father-figure in his life — several times a week. He sleeps in a sober living home where, he says, the house manager is like his big brother. He’s starting to work on his GED, to look for a part-time job, to think about a career in nursing. He got his driver’s license, saved enough money to buy a car, and has a sense of purpose that is entirely new to him.
“I’m doing great,” he said.
Victory? Not in the dogma of traditional addiction treatment, honed for decades by the tenets of Alcoholics Anonymous which asserts that total abstinence is the only road to recovery.
Despite widely accepted scientific evidence that medication-assisted treatment excels at keeping addicts alive — and a new federal push to greatly expand its use in response to the opioid epidemic — abstinence-only remains a bedrock of America’s addiction treatment industry. That’s particularly true in California, where the “non-medical social model” is so ubiquitous it’s known elsewhere as “the California model.”
Buprenorphine is an opioid itself, critics of medication-assisted treatment say. Webster isn’t clean, they might argue; he has simply replaced one drug with another.
Some adherents of 12-step style recovery shared a message on Facebook about Suboxone, a brand-name of buprenophine: “This isn’t recovery — it’s government drug dealing.” It was shared more than 100,000 times.
Doctors specializing in addiction medicine increasingly see such messaging as dangerous propaganda.
“There are people in the 12-step community who tell their own, ‘You have a sponsor, don’t listen to your doctor. Don’t take that medication. Don’t take anything,’ ” said Dr. Joe Desanto, whose own addiction to prescription opiates six years ago nearly cost him his medical license. “It’s horrible.”
Many doctors say the widespread resistance to — and sometimes the rejection of — addiction-treatment medicine is a key reason why there are more treatment centers and more money being spent on addiction, even as there is less success in getting people sober.
Simply put, addiction treatment in America isn’t working, said Walter Ling, professor of psychiatry and founding director of the Integrated Substance Abuse Programs at UCLA.
“The difference between getting off drugs and staying off drugs is the difference between a wedding and a happy marriage,” Ling said. “The wedding is a big deal, but it has nothing to do with a happy marriage. Right now, our entire treatment system is targeted to the wedding.”
California has nearly 2,000 non-medical addiction treatment facilities that rely heavily on the “social model” of peer support. It has just nine chemical-dependency hospitals, according to state data.
Ling’s research showed the effectiveness of buprenorphine implants at managing addiction, and finds the term “medication-assisted treatment” laughable.
“What is the medication assisting?” Ling said. “It is the treatment.”

Faith, not science
Risky substance use and addiction are America’s largest preventable and most costly health problems, said the National Center on Addiction and Substance Abuse at Columbia University. Addiction drives crime and lost productivity, accounts for one-third of hospital inpatient costs, and in 2015 drained an estimated $468 billion a year from government coffers.
The AA approach has been America’s go-to response to the problem for the better part of a century, and it remains the most widely-used tool for fighting substance abuse. Last year, “twelve-step facilitation” was used in 73 percent of addiction treatment facilities, according to the National Survey of Substance Abuse Treatment Services, done annually by SAMHSA.
Conversely, just 21 percent of addiction treatment centers used extended-release injectable naltrexone, while 27 percent used buprenorphine, according to SAMHSA.
The famous 12-step program favored by the American recovery industry was founded in 1935 by two alcoholics when abstinence was the only option. It involves admitting that one is powerless over the drug of choice; that life has become unmanageable; that a greater power can restore sanity; and then turning one’s life and will over to God, however one understands God.
The strength of AA, supporters argue, is in the powerful bond forged between people supporting one another through the battle for sobriety. They learn, by seeing others, that recovery is indeed possible, adherents say. Millions of people say they owe their sobriety — and their lives — to AA and similar 12-step programs.
Still, numerous studies show that about 90 percent of those seeking recovery through abstinence alone fail. And some experts decry AA as faith, not science.
“As a treatment, AA is essentially useless,” said psychologist and author Stanton Peele. “They’ve convinced everybody in America they are the best and only way on the basis of no evidence whatsoever.”
Banimahd, Webster’s doctor, doesn’t go that far. He believes social support and and fellowship can certainly help addicts who are getting treatment. But, he said, such help should not be confused with treatment itself.
Some of the resistance to medication-assisted treatment springs from a feeling that sinners should suffer, he said.  But he also believes that much resistance comes from the powerful, non-medical, $30-plus billion addiction treatment industry itself.
“Medication-assisted treatment cuts into their profits and hurts their voodoo,” Banimahd said. “They don’t really want to stop addiction. There’s too much money in it. This industry is full of idiocy and greed, voodoo and magic.”
Slicing the recovery pie
Banimahd’s practice in Laguna Hills is affiliated with The Coleman Institute, which uses medically-assisted detox to remove drugs from the body, followed by naltrexone therapy — via implants in the belly — to keep cravings at bay.
Desanto, in Costa Mesa, partners with BioCorRx, an Anaheim company working on FDA approval for naltrexone implants.
Naltrexone is like buprenorphine, except that it blocks opioids entirely and can be used to treat alcoholism as well as opiate addiction. Banimahd and Desanto are addiction medicine specialists — pioneers in a land that may seem new and uncharted, but is not. Like methadone, the medications they use have been around for decades and are safely used in Europe and elsewhere to manage drug addiction.
In the U.S., where some 60,000 deaths are expected from drug overdoses this year, data suggest that many people still haven’t heard of these drugs, and that some who have are hesitant to use them:
• While $36 billion was spent on addiction treatment in 2015, just 5 percent of it — $1.8 billion — paid for medication-assisted treatment, according to market analysis by Open Minds, a financial adviser for health and human service investors.
• 85 percent of all U.S. counties have no addiction treatment facilities that provide medication-assisted therapy for people diagnosed with an opioid-use disorder, says the newly-released President’s Commission on Combating Drug and Addiction and the Opioid Crisis.
• Opioid treatment programs were available in only 9 percent of all U.S. treatment facilities in 2016, according to the Substance Abuse and Mental Health Services Administration.
Yet the evidence for medication-assisted success is overwhelming. Myriad studies have found that it can slash the death rate among addicts by half or more.
Long-acting injections and implants — which deliver a constant stream of opioid-blocking medication for weeks or months at a time, thus eliminating the daily decision addicts must make to take a pill — also show promise.
A recent study found that nearly 86 percent of those who used the buprenorphine implant refrained from using opioids each month over a six-month window. In Russia, more than half of heroin-addicted patients who got a naltrexone implant were abstinent over a six-month clinical trial.
But skepticism runs deep.
Medication-assisted treatment suffers from the same fatal flaw as AA, in psychologist Peele’s opinion. “It has the same assumption: ‘You can’t possibly control this on your own, so don’t even think you can,’ “ Peele said. “It’s no advance whatsoever to me.”
Deadly neglect
Treatment grew up around AA in America because addiction was long viewed as a moral, not a medical, problem, experts said.
That “neglect,” as  the National Center on Addiction and Substance Abuse at Columbia University calls it, allowed a system of addiction care to flourish completely cut off from the medical system. The resulting problems are many, according to Rand, Pew, CASA Columbia, and others:
• American addiction treatment is based on an erroneous “acute-care” model, meaning that after a few weeks or months of treatment, addicts are cured. But experts now say addiction is a chronic, long-term problem that should be managed the way diabetes, high blood pressure and depression are managed.
• There are no national standards of addiction care. Patients face a patchwork of treatment programs with vastly different approaches, many offering unproven therapies and little medical supervision.
• There is no outcome data reflecting the quality of treatment providers that could help patients make informed decisions, and no agreement within the industry on how to define success.
It’s not surprising, then, that addicts leaving social treatment return to drug use half the time or more, according to the U.S. Surgeon General’s most recent probe. Or that, on average, it takes 8 or 9 years to achieve sustained recovery.
“Thirty days of treatment is not sufficient to change behavior for the rest of your life,” said Martin Y. Iguchi, a senior behavioral scientist and professor at Pardee RAND Graduate School in Santa Monica.
Desanto, the doctor working with BioCorRx, was once a believer in the AA approach. He was kick-boxing several years ago when he pulled his hamstring clear off the bone. The agony led him to use Vicodin and Percocet.
“It took away the pain; all the pain,” he said. “In the brain, in the heart, in the body. That’s what we’re up against.”
The physician was forced to face his addiction in 2011, after he wrote prescriptions for oxycodone for two patients — one with kidney stones and the other with lower back pain — then swapped their narcotics for over-the-counter acetaminophen. After one of those patients discovered the switch, Desanto admitted he had a problem he couldn’t control. His medical license was temporarily suspended.
That’s when he vowed to get sober. He went deep into the 12 steps. His medical license was reinstated after 60 days and he was allowed to practice again. Desanto succeeded through grit and total abstinence, and felt strongly that other addicts had to succeed that way, too.
But Desanto said he has kept an open mind about addiction treatment, and that in the years since his own recovery he’s seen mounting evidence that supports medication-assisted treatment.
“It’s hard to argue with,” said Desanto, who hosts the Radio Recovery Show on KOCI. “You put a patient on buprenorphine and naltrexone and it reduces the risk of overdose and death. It reduces craving. Removes the obsession.
“Over the past few years, my approach has changed 180 degrees,” he said. “Medicine is saving lives.”
Day at the office
Hovering above the collar of Webster’s navy blue scrubs is the word “Blessed,” which is tattooed across his neck in large cursive letters.
He sips a Red Bull, phone cradled under his ear, as he calls Banimahd’s patients to remind them of that day’s appointment times.
Between tasks, Webster works on an urgent project. An acquaintance from his darker days is in a bad way with “meth sores.” The stimulant can make users feel like bugs are crawling on their skin, so they obsessively dig after insects that aren’t there. His friend, a young woman, said she’d come to see the doctor that afternoon.
Webster dials her number to remind her. A man answers. She won’t be coming, the man says.
Webster stands up. “She needs help, man. I promise, I’m not going to steal your girl. I promise I’ll… make sure she’s OK.”
There’s more back-and-forth, and eventually, agreement. She’ll be in at 2:30.
Webster understands the reluctance. What gets glossed over by outsiders — what’s behind much of addiction, in Webster’s view — is that drugs can make a person feel “awesome.”
“Meth is intense,” Webster said. “The euphoria; you feel like God. The exhale is you, the inhale is Zeus.”
Webster grew up in West Seattle with no dad in his life. He said he started using weed and alcohol at 14. He had run-ins with the law; lost friends to overdoses; came close to death himself. Still, in his telling, there was an outlaw romance to it all.
“I’ve come to terms with it,” Webster said. “That was synthetic happiness. I want legitimate happiness.”
“I kept forgetting that I had been given so much,” Webster said, referring to the tattoo on his neck.
“I wanted to get where, every time I look in the mirror, I’m reminded of all the opportunity that’s been given to me, of all the things people have done for me. I’m lucky to be alive. I’m not taking anything for granted.”
Dr. B, as Webster calls Banimahd, is one of those blessings. “If he told me to wear a blindfold and follow him across a narrow bridge, I’d do it,” Webster said.
And that’s very nearly what Banimahd asks his patients to do.
“Everything you believe in is bull—-,” Banimahd tells a patient. “Any question you have, come to me. I drive the bus. I will eventually give you the wheel.”
Banimahd, 47, has health issues, though not connected to illegal drugs. He walks with a cane, and can tire easily. He smokes, though he knows it will kill him. He also is well-aware that he can come across as arrogant, and doesn’t much care.
He went to medical school at UC Irvine, is certified by the American Board of Emergency Medicine, and worked the ER at Kern Medical Center, where he clashed with co-workers, according to a lawsuit he filed against the center. But the number of drug overdoses he saw there was astounding, he said, and he became skilled at reversing them.
Banimahd returned to UCI on a fellowship in 2014 and became an assistant clinical professor of emergency medicine. He started working more with addiction patients. This year, he took over the medical practice of Gregory Van Dyke, a physician who has been disciplined for furnishing dangerous drugs to patients without examination and now stands accused of gross negligence by the California Medical Board. (The office phone still rings regularly with patients requesting phone refills on their prescriptions. “Sorry,” Webster says curtly. “Doctor doesn’t do that. If you’d like to come in for an appoint… ” But often, Webster said, the line goes dead before he can finish.)
A thick and slightly redundantly titled tome —  “American Society of Addiction Medicine Handbook of Addiction Medicine” — consumes a corner of the desk in Banimahd’s office. Across some neat piles of paperwork sits a patient who has been on Suboxone maintenance for two years, a time span that might shock supporters of abstinence-only treatment.
The man was addicted to pain pills. He didn’t have the time or inclination to go to a residential rehab — “I have a business to run,” he said. He’s found that medically-assisted treatment allows him to keep working, care for his family and live a normal life.
“I don’t feel high,” he said. “I feel better.”
Another patient, who has been sober and on medication for several months, expressed a desire to quit the medication as soon as possible. Banimahd frowned.
“There’s no good data telling me when it’s time,” Banimahd said. “A lot of people say ‘get off, get off, get off as quickly as possible.’ But do you say that to a diabetic about his insulin? Do you say that to someone who needs medication for high blood pressure? Of course not.
“Right now, I wouldn’t even think about (letting you) off,” Banimahd said to the patient. “I don’t know of any significant side effects. This isn’t going to kill you. Give it a couple of months. Let your brain heal. The medication buys you time to heal.”
Outside Banimahd’s closed door, Webster watched the clock. His drug-addicted friend failed to show for her 2:30 appointment. He called her back, but she said she couldn’t find a ride. He offered to send an Uber. She found another excuse and never came in.
“You are always holding your breath,” Banimahd said, referencing the struggle for sobriety.
“With medication, though, you hold your breath less.”
Source: Oc Register

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