Setbacks plague drug addiction remedy

No-shows, dropouts weren't counted
Alliance press releases, some of which were reviewed or written by Hythiam, repeatedly stated that 98 percent of the urinalysis screens taken from the subjects were negative. That statistic, it turned out, did not count subjects who failed to show for required tests or dropped out of the program before completing it.

The auditors also were troubled by the changing number of subjects cited in the press releases.  The auditors said they eventually discovered that “drug free,” by the Alliance’s definition, did not mean that the subject had not returned to using meth or cocaine — and some had indeed relapsed — only  that they had not tested positive in the 60 days prior to the end of the program.

Pierce County Alliance administrators say they were blindsided by the audit and the freezing of funding for the program and were not given adequate time to explain their position. They argue that relapse is common in drug treatment and that the relatively few failures in the pilot program did not indicate that that Prometa was not effective.

“There were some who did well with Prometa, though they had some positive (urinalysis) after receiving treatment,” said James Boyle, the Alliance deputy director. “The auditors view those folks as not being successful. What we were trying to explain to them was that not every person who enters chemical dependency treatment will be drug free from Day One. … It’s a process over time.”

The program in Pierce County is not the only one to encounter problems. A program announced by Fulton County, Ga., in mid-2007 and hailed in Hythiam press releases was halted without explanation after a handful of treatments. The state of Idaho tentatively budgeted for a pilot program in its drug courts in early 2007, but abandoned the idea after drug court officials opposed it, citing the lack of scientific evidence.

Adding to the controversy over Prometa was report by the Tacoma News Tribune newspaper shortly before the suspension of the Pierce County program that Terree Schmidt-Whelan, the executive director of the Pierce County Alliance, another administrator of the nonprofit and key county and state officials who had heartily endorsed the program all had purchased stock in Hythiam.

‘I did believe we had found magic’
The only one who apparently violated a law in doing so was state Rep. Dennis Flannigan, who failed to file a public disclosure statement of his $28,000 stock purchase. He said a legislative attorney had approved the purchase and acknowledged no wrongdoing other than poor record keeping.

"I had no interest in promoting anything that didn’t work," said Flannigan, who has extensive experience in drug treatment. "I did believe we had found magic."

Schmidt-Whelan and John Neiswender, the Alliance’s chief financial officer, both of whom purchased Hythiam stock, did not respond to calls seeking comment. Boyle, the Alliance’s deputy director, said the nonprofit has no policy against such purchases.

Pierce County Executive John Ladenburg, who asked the County Council to fund the Prometa pilot program and also bought stock in the company, also did not respond to calls seeking comment.

The use of public funds for the program was controversial from the start because the drug combination reached the market without review or approval by the FDA and because Prometa had not been subjected to double-blind, placebo-controlled studies  –  the gold standard of scientific testing.

In the absence of such review, Hythiam relied on testimonials from recovered addicts and drug treatment practitioners to market Prometa.

The Alliance’s Schmidt-Whelan was among the early converts.  In an interview with msnbc.com for the February 2007 article, she described the results of the first Prometa test as “phenomenal.”

Boyle, her deputy, said he remains convinced that the drug combination will eventually be shown to be effective.

“It’s one of the most encouraging things I’ve ever seen and I’ve been working in chemical dependency and criminal justice in this county since 1968,” he said.

A popular option for private patients
Such endorsements have made Prometa an increasingly popular option for those seeking private treatment for drug addiction. Hythiam  says that about 2,500 private patients has been treated with Prometa at the four rehabilitation centers it operates or by about 70 other doctors licensed to administer the treatment. The company does not release data from private treatment facilities.

But Hythiam has aggressively sought to make Prometa  available as an option to the more than 2,000 drug courts in the country that offer treatment to offenders as a means of keeping them out of jail or providing a path for them to regain custody of children.

The company has made inroads in the public sector by signing on some influential players to advocate for Prometa. It appointed Andrea Grubb Barthwell, a former deputy director at the Office of National Drug Control Policy at the White House, and retired Judge Karen Freeman-Wilson, former CEO of the nonprofit National Association of Drug Court Professionals (NADCP), which represents about 20,000 drug court workers across the country, to serve on its Board of Directors. The company also hired the NADCP’s former membership coordinator, Arlandis Rush.

While still with the NADCP, Freeman-Wilson and Rush helped Prometa get its first day in drug court — a pilot program involving 30 people in Gary, Ind., that started in November 2005 and was deemed a big success.

Judge Deidre Monroe, who ran the city’s drug court, said the treatment combined with drug court was about twice as successful as drug court alone in getting people to quit drugs.

But the trial was far from conclusive, since people who complete drug court-ordered treatments typically leave the system at that point, leaving their ultimate outcomes unknown.

Msnbc.com ran into that obstacle in trying to find out how a young woman who underwent the Prometa treatment last year was faring. The Pierce County Alliance made Suzanne Younker available for interviews for msnbc.com’s article in February 2007, at which time she was entering her sixth month of sobriety, in an effort to regain custody of her infant son. But Younker did not answer calls from msnbc.com over the past month.

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