Expert advice on Narconon

1998
By Folke Sjoqvist
Translated by Catarina Pamnell

Translation of the expert advice on Narconon given to the Swedish National Board of Health and Welfare, who are responsible for medical practices including drug abuse treatments in this country. This was mentioned in recent Swedish TV programs on Narconon.

My apologies beforehand for any translational mistakes - I just got hold of this copy and wanted to get it out ASAP. If anything doesn't make sense, please tell me.

Original page numbers in (brackets), my comments in [square brackets].

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961126 Socialstyrelsen [The National Board of Health and Welfare] Halso- och sjukvardsgruppen [Health Care and Medical Services] Allmanna enheten [General Division] Att. Byradir [Director] Bengt Wennermark 106 30 Stockholm

Diary number 00-10129/95, 960209 regarding Narconon's treatment program

In my capacity of scientific advisor to Socialstyrelsen [National Board of Health and Welfare] I have been asked to make a statement regarding the detoxification program for drug addicts by the use of, among other things, vitamins and sauna that is practised within Narconon. I have been asked to answer as many as possible of the following subproblems:

1. Can this method of detoxification be considered to conform to scientific standards and medical experience? ["vetenskap och beprovad erfarenhet"]

2. Could this method risk the health of the client?

3. Could this method lead to permanent damage?

4. Should this program be prohibited?

5. May medical doctors prescribe the stated doses of vitamins; if so, on what indications?

The cover letter is supplemented by documents from Livsmedelsverket [National Food Administration], that describe the treatment program, especially the vitamin program, and a publication titled "Narconon - the detoxification program for a new life". In this publication the detoxification program is popularly described and illustrated by drawings. It is claimed that by a combination of sauna and vitamins one can expel drug residues and residues of other addictive substances (such as bensodiazepines) from the fat depositories of the body. It is further claimed that tens of thousands of people have successfully completed the detoxification program.

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The publication is accompanied by statements from anonymous persons, but scientific data is completely lacking. Some quotes from a number of unsubstantiated statements about this program (appendix 1):

"LSD may stick in the tissues of the body, primarily in fat tissue, and may remain there for years after the person stopped taking it. It can become reactivated years later and cause unpredictable trips, just as if he had taken more LSD" (pp. 12-13)

"Further research has now revealed that other drugs - heroine, cocaine, "angel dust", mescaline, marijuana, to mention a few - can also stick in the body" (p. 14)

"Two to three years after my announcement of the discovery that drug residues may stick in the body, medical experts who were doing autopsies confirmed this" (p. 20)

This implicates that the author, i.e. L Ron Hubbard, made this discovery which is incorrect. It is, of course, absurd to believe that at an autopsy one would be able to discover microgram quantities of drug residues.

"Drugs are basically poisons. Drug residues that have been stored in tissues take their toll. They burn up the body's reserves of vitamins and minerals and can cause nutrient deficiencies" (p.21)

The program is described in the following manner: "A well-planned personal schedule will be worked out for you, which you shall adhere to every day. It includes: Exercise and sauna (most people will get the best result from a combination of jogging and sauna, five hours a day, of which the greater part is spent in the sauna)" (p. 40)

"Another remarkable factor: Due to the large amounts of niacin taken and due to the heat of the sauna, the program might result in the elimination of effects of radiation" [no page number given]

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"While on the program, I got all the various symptoms of radiation sickness - vomiting, flushed and tingling skin. When I continued the program all this ceased and has not since returned. Now I feel much more alert - (W.M.)" (pp. 64-65)

"During the Vietnam war I was exposed to deadly gases and poisons, especially 'agent orange' and some kind of nerve gas. These poisons were dulling my perceptions and I could not think clearly and logically. Ever since then I considered my environment to be dangerous. During the program I was brought out of this condition and these poisons and gases were completely flushed out. I feel healthy and in control of my body. Now life is definitely worth living and creating. I can say that there is hope for the Vietnam veterans - W.B." (p. 71)

"I have suffered from a skin fungus disease for about 18 years, that disappeared when I did the program. All my most important senses - sight, taste, smell etc. - also seemed to improve - PG" (p. 73)

From these quotes it is quite clear that the ambition of Narconon is not limited to the treatment of drug abuse, but that they aim for more universal effects. As for the rest, the quotes speak for themselves.

Contacts with Narconon

In the early stages of my inquiry, I was contacted by the chairman for Narconon Europe, Bosse Persson, Eslov, who later sent documentation and certificates ["intyg" - written and signed statements] regarding the treatment program of Narconon. I have also during spring of '96 been contacted by Hakan Larsson, Narconon, who via my secretary tried to gain access to my office room, in order to find out what basic information Socialstyrelsen had supplied me with in this matter.

I have gone through the material I received from Narconon. It consists of four American certificates regarding the treatment program, two Swedish doctor's certificates regarding the absence of side effects, and finally a file of

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off-print and congress material, especially regarding the part of the treatment program that concerns exposure to environmental toxins.

The four American certificates were written by Shelley L Beckman, PhD, Megan Shields, MD, Forest Tennant, MD and Alfonso Poredes, MD. Shelley Beckman lack medical education and the main sphere of interest of Megan Shields is chlorated pesticides. Forest Tennant, on the other hand, has extensive scientific merits in the field of addiction medicine, with 166 publications on the abuse of alcohol, cocaine, opiates, anabolic steroides, etc. and he has among other things administrated drug abuse issues in the field of sports. However, he has among all of his publications not one that concerns the evaluation of Narconon's treatment program. The main point of his certificate is: "Narconon may have its faults but it has attempted to use nutritional supplementation, exercises, saunas and simple educational courses to better the alcoholic and addict" (appendix 2). Like Shelley Beckman he states that drugs are excreted in sweat, but this is pharmacologically self-evident and has no quantitative importance (see below).

Two Swedish physicians, medical doctors Tom Norman and Ture Alander have at the request of Narconon certified that the treatment has not resulted in any side effects (appendix 2). They do not state what side effects have been screened for, nor how this was done.

The file of documentation I received from Bo Persson conforms mostly to "International Conference on Human Detoxification", Dec 1-2, 1995 in Los Angeles. Much of the material concerns aspects of environmental toxicology (such as how PCB, PBB and chlorated pesticides are affected by the Hubbard treatment). Narconon claim their treatment program is effective also for detoxification from these substances, but I judge this question to lie outside of my mandate. If an evaluation of this aspect of the treatment program is desired, I would like to refer it to a suitable unit of environmental medicine. To do such an evaluation it would be necessary to, among other things, review what methods of analysis were used for these substances.

Apart from the material on environmental toxicology, the file contains an overview of the scientific literature that supports Ron Hubbard's detoxification method (appendix 3).

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Here one finds correct references to the well-known fact that psycotropic substances, both on acute and repeated intake will accumulate in fat. Thus there is a reference to the classic publication in 1957 by Nobel Prize laurate Julius Axelrod, who showed that LSD accumulates in fat tissue.

Then follows a discussion from a theoretical point of view on how to reduce the amount of "bioaccumulated" products in the body. There is no mention of the vital fact that fat soluble drugs must first be redistributed from tissues to the bloodstream and then metabolized (broken down) before they can be excreted, and that there are presently no known methods for speeding up these processes. (One exception is the administration for several days to weeks of certain other drugs, e.g. phenobarbital and rifampicin who speed up the metabolism of certain drugs.) The important biological function of drug metabolism processes is to transform fat soluble drugs to water soluble products. This is achieved by, among other things, a series of oxidations, so called hydroxylations, followed by conjugation with endogenous substances, for example glucaronic acid and sulphate. In this way, e.g. psychoactive drugs can be transformed into a number of metabolic products that eventually reach a high enough level of water solubility to be spontaneously excreted and in high concentrations via the urine.

About thirty years ago it was believed, even within established medicine, that by enforced excretion methods, for example enforced diuresis, it would be possible to remove substances affecting the central nervous system, such as barbiturates. In the middle of the 1960s, considerable effort was taken to remove this obsolete treatment method from Swedish medical care. The only possibility to noticably affect the excretion of such drugs by enforced diuresis is to heavily manipulate the pH of the urine, which in itself may cause side effects. This method is effective only for a small number of drugs, and that is when the so called pKa-value (acid-base properties) of the drug is close to the physiological pH (see for example my chapter on interactions in FASS [the Swedish standard medical drug encyclopaedia] ).

Then the detoxification program of Ron Hubbard is described, which has been designed to mobilize and speed up the elimination of foreign substances stored in fat. It is claimed that the program is well founded in medical literature. There is however no scientific reference given for this statement.

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The components of the program are described as exercise, sauna, vitamin supplements, replacement of fluid lost during sweating, regular diet, good sleep, etc. It is said that a number of studies show that exercise, apart from improving circulation in tissues, will also mobilize fat from tissue depositories and that this mobilization of fat depositories is followed by a mobilization of the toxins stored in fat tissue. Here some references are given to animal studies that solely deal with DDT or PCB.

Regarding the sauna, it is pointed out that mobilizing chemicals from fat tissue is not desirable unless the elimination is simultaneously increased. The purpose of the sauna is to increase "heat stress" to increase circulation in tissues, and to increase elimination of various compounds through sweat and sebaceous glands. In this context it is stated that methadone, amphetamines, morphine, etc. has been shown to occur in human sweat. However, this is self-evident, since all compounds present in the blood stream can be detected in other body fluids including sweat. The news is that during the last twenty years, the methods for analyzing drugs have developed such a sensibility that it is now possible to detect even very low concentrations (thousands of a microgram) of foreign substances in body fluids such as sweat, saliva and also hair and nails (see for example P Kintz, Drug testing in addicts; A comparison between urine, sweat and hair. Therapeutic Drug Monitoring 15, 450, 1996). These concentrations are however often very low compared to the total amount of the drug in the body. For most psychotropic substances, the amount in the total blood volume is negligible or very small in comparison to the total amount in the body. The relationship between the concentration in the rest of the body, and the concentration in plasma is given by the so called distribution volume. This is for most psychoactive drugs and abused substances in the magnitude of several liters per kilogram, which means that the average concentration in tissues is several times that of the blood. Consequently, it is impossible to expel such substances from the body by trying to influence the fraction that is present in the blood volume, for example by dialysis and enforced diuresis. The retransportation of the substances from tissues to blood is the speed limiting factor. In some extreme cases, such as the malaria drug chloroquine, the distribution volume is 100 L/kg, that is the concentration in tissues is 100 times higher than the blood concentration. Chloroquine in tissues is slowly distributed to the blood, and may therefore with sensitive methods be detected in urine for up to one year after the termination of treatment.

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Then, however, blood concentrations are "homeopatic", that is so low that they lack pharmaceutical importance.

This part of the documentation does not contain any quantitative discussions about how large are the amounts of various drugs that can be excreted in sweat. To make such estimates would require full metabolic studies and every drug has to be studied separately, as their pharmaco- kinetic properties such as distribution volume, half-life, metabolism, etc. vary. It is thus impossible to generalize.

Regarding the vitamin treatment, it is said that niacin initially will reduce the mobilization of fatty acids, and then increase it. It is claimed that this mobilization of free fatty acids is accompanied by a simultaneous mobilization of chemicals stored in fat. Again there are references made to animal studies regarding environmental toxins. Regarding vitamin supplementation, it is claimed that this part of the treatment program among other things aims at restoring the vitamins lost through sweating (no figures given). Another aim is to compensate for vitamin deficiency that has arisen in connection to various types of drug abuse. Yet another aim seems to be the prevention of vitamin deficiency, as this is said to prolong the metabolism of drugs. This is also an unsubstantiated claim from the point of view of human pharmacology, just like the claim that vitamin supplementation could benefit the metabolism of various chemicals.

In the part about results of the treatment program, it is claimed that it will reduce the levels of various fat stored chemicals. There are again references to works on environmental toxins in Vietnam veterans, but no reference to drug abuse substances.

Here is also an unpublished article by Megan Shields, Shelley Beckman, Forest Tennant and Michael Wistner: "Reduction of Drug Residues: Applications in drug rehabilitation", presented on the 23rd annual meeting of American Public Health Association (appendix 4). 249 clients with drug abuse problems have been asked to estimate their own symptoms before and after the Hubbard treatment, and on 8 clients the concentrations of drug abuse substanses have been measured in urine and sweat, before and during the treatment.

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The first part of the study may be disregarded, since it is totally uncontrolled and open to various forms of bias. The observations on the 8 drug addicts concern determination of drug metabolites. It is not clear what method of analysis has been used. There are mentions of both "fluorescent immunoassay" and "polarized fluorescent immunoassay". Probably this refers to fluorescence polarization immunoassay (FPIA), that is Abbot's method which is used in Sweden for screening. It is semi-quantitative and unspecific, that is it measures the sum of active substance and inactive metabolites. Four addicts had smoked cocaine, three used amphetamine and diazepam frequently, and one used both cocaine and heroine. Here drug metabolites were detected in sweat and urine in seven of the eight clients. In five, a quantitatively unimportant increase of the drug metabolite concentration in sweat and urine was shown after the start of the detoxification program. The graphs shown in this unpublished work are also to be found, but with totally incorrect scales, in the magazine "Narconon-Nytt" [Narconon News] number 3, 1995, that has also been sent to me (appendix 5). There, the drug concentration is given in the unit microgram/milliliter, while the unit in the original publication is nanogram/milliliter, that is 1000 times less. The Narconon article is obviously unreasonable, since it would mean that one of the patients, if he urinated one liter per day, would excrete one gram of opiates per day for more than one week!

The correct graphs (appendix 4) show, for both cocaine metabolites and bensodiazepine metabolites, that the concentrations in sweat lie below or on the same level as those for urine.

Starting from these graphs, it is possible to calculate the excretion of drugs through sweat and urine, and for the sake of simplicity we will assume 1 liter of urine and 1 liter of sweat per 24 hrs.

Client 1 then excretes a total of about 3.7 mg cocain metabolites, probably [bensoylekgonin] during days 7-47. According to Martindale a "normal dose" of cocaine is 8-16 mg per 24 hrs.

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Client 2 has during day 2 the concentration 1000 ng/ml in both sweat and urine. During days 11-14 the total amount excreted is approx. 0.06 mg cocaine metabolites.

Client 8 has taken bensodiazepines which makes a statement more difficult, since one does not know what bensodiazepine the person took. The analysis is calibrated with nordiazepam, but all bensodiazepin metabolites have a lower cross reactivity. The person excretes the equivalent of 3.4 mg nordiazepam during days 1-13. All observations, however, fall below the Abbott recommended cut-off level of 200 ng/ml. That limit should be adequate for oxazepam and diazepam abuse, which is the most common in the US.

Client 9 excretes the equivalent of 1.3 mg of nordiazepam in urine only during days 1-7, and 2.3 mg in both sweat and uring during days 7-16.

From these calculations it is clear that it is impossible to noticably influence the body concentrations of these drug abuse substances through enforced sweating (sauna). The speed limiting steps of elimination of these substances are the redistribution from tissues to blood, and the metabolism in the liver to inactive metabolites. To speed up the excretion of inactive metabolites of for example cocaine and diazepam is of no pharmaceutical importance, since they do not affect the body anyway.

The vitamin and mineral components of the treatment program

The subproblem of the vitamin and mineral components of the treatment program lie within the field of competence of Livsmedelsverket [National Food Administration]. Therefore, I have turned to them for their point of view on the doses used of vitamins and minerals. A statement has been given on 960625 by toxikologiska enheten [Department of Toxicology], Ulla Beckman Sundh and Helena Hallstrom (appendix 6). From this it is clear that side effects might be caused by several of the components, if doses are given according to the treatment program.

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I find it out of the question that vitamins and minerals could have any pharmacological effect on storage and excretion of drug abuse substances. They [vitamins etc.] are distributed, bound and eliminated from the body in totally different ways from drug abuse substances. Interactions between them are not known. Probably the vitamin part of the program is built on analogies with for example alcohol abuse, where vitamin deficiencies may occur.

International search for documentation on the treatment program

I have, with the help of lakemedelsinformationscentralen [the information central on pharmaceutics] of Huddinge hospital, made an international literature search in order to find documentation on the treatment program. The search covered the last 30 years, and it includes the experts referred to by Narconon (see p. 4). No documentation apart from that sent to me by Narconon has been found.

I have also consulted the National Institute on Drug Abuse, Maryland, USA (Dr Peter J. Delany) by phone, and got the answer: "In response to your request for information about the Narconon program. We know of no peer reviewed scientific literature to support this program."

Summary

As evident from this compilation, there is no documentation to show that the Hubbard method of detoxification from drug abuse conforms to scientific standards and medical experience [vetenskap och beprovad erfarenhet]. On the contrary, one may from a pharmacological point of view strongly question the idea of using enforced sweating to expel drugs from the body. The risks and side effects of the treatment method have also not been evaluated in a serious way. Methods that have not been evaluated and/or rest on incorrect theories should not be used in Swedish medical care. Medical doctors are to prescribe vitamins in the doses recommended by Livsmedelsverket [National Food Administration], and only on the indications approved by Livsmedelsverket and as stated in FASS.

[signed] Folke Sjoqvist
Professor, Scientific Advisor
in Clinical Pharmacology