Delray Beach: Xanax, addiction and death
http://thecoastalstar.ning.com/profiles/blogs/delray-beach-xanax-addiction-and-death
Family members search for answers after suicide at beachside rehab house
Tod Abrams’ last act, in a life that included a once-thriving career as a Hollywood film executive and fathering a son whom he said he adored, was to tie a pair of bathrobe cords together, loop them around his neck and fix a knot below his left ear. Then he hanged himself from a metal rod in a closet.
“The anguish, anxiety and nightmares were unbearable,” the 52-year-old Abrams had written in a note to his family. Police found it on a dresser in his room on Aug. 30 last year, after he had been dead for a few hours. It was only a month after he had sought help with his addiction to Xanax, a sedative used to treat anxiety, at a $60,000-a-month residential facility run by Caron Treatment Centers in an upscale oceanside neighborhood in Delray Beach.
“I haven’t slept in 4 days and I’m probably beginning to hallucinate,” his note went on. “The people here were very kind but the program was too rigorous, too difficult. I’m too fatigued to proceed on. I don’t have the strength.”
With his death, Abrams joined the hundreds — perhaps thousands — of people suffering from substance use disorders who in recent years have succumbed to their disease in Florida. In Palm Beach County alone, at least 377 people died last year from drug overdoses, according to Pamela Cavender, the records custodian for the county’s medical examiner, citing statistics that are still being assembled. The problem, Cavender said, is “out of control.”
While the level of commitment to battling drug abuse varies widely, the success rate of treatment is exemplified not only by the almost ceaseless procession of deaths — whether by overdose, suicide or other means — but by the parade of addicts going in and out of rehabilitation centers and so-called sober homes in Delray Beach and other towns in South Florida.
Distraught addicts who announce their intention to kill themselves are routinely taken for evaluation to the South County Mental Health Center and other institutions under the terms of the Baker Act, which provides for involuntary commitment of people deemed a danger to themselves or others.
“Any time a kid says, ‘I’m going to kill myself,’ he gets Baker Acted,” said a Delray Beach firefighter-paramedic who asked not to be named and who has often transported such patients. “We’re doing 10 of those a week.”
In the wake of Abrams’ death, his younger sister, Jill, and other relatives have been left to wonder why no such action was taken in his case, especially since he took part in regular counseling sessions at the Caron facility and, according to his family, often discussed his state of mind with anyone who would listen. It remains unclear whether he actually brought up the subject of suicide while at Caron, and officials of its parent organization declined to comment on his time there.
Still, two days before her brother left for Delray Beach, Jill Abrams said, he told her he wanted to end it all. “ ‘The meds tell me to kill myself,’ ” she recalled him saying, and described him as “panicking and bouncing off the walls, crying hysterically.”
“We all knew as a family that my brother was suicidal,” she said, and asked why it might not have been equally apparent to the caregivers at Caron. “He was there to be weaned off drugs, but I assumed that in all these counseling sessions they were also going to deal with his suicidal feelings.”
Six months before he died, however, Abrams suggested in a blog that he had come to terms with ending his addiction to Xanax, which he said he had begun taking only to help him sleep.
“I am truly heartbroken today as I have to break up with the great love of my life,” he wrote. “I love Xanax. Of course my doctor never told me that Xanax is highly addictive.”
He wrote that, as with heroin, a Xanax addict cannot simply go “cold turkey”: suddenly and completely ceasing the use of a drug. Such a shock, he went on, would result in full “meltdown” and leave him “blubbering and incoherent.”
Abrams, who had held executive positions at New Line Cinema and Fine Line Features, founded Alternative Marketing Solutions, produced several independent films and accumulated considerable wealth, asked his blog readers to pray for him, “for I have lost the greatest love I have ever known and his name is Xanax, Xanax, Xanax.”
Before traveling last summer from his home in Los Angeles to Delray Beach, Abrams had tried to detoxify for eight days in Long Beach, Calif., but his effort foundered and he went back to taking the drug, according to a family member. After he had arrived at Caron’s residence at 1232 Seaspray Ave., the task was to wean him off his dependence on Xanax and transition him to lesser narcotics.
But things apparently began to go wrong very quickly. On Aug. 16, after having been there only two weeks, Abrams wrote in his journal that he had already attempted suicide and “was quite serious about killing myself.” He went on: “I planned to hang myself and nearly completed the task.”
The following day, his caretakers diagnosed him with bipolar disorder and schizophrenia and put him on Zyprexa, an antipsychotic medication. According to his medical records, Abrams also had been prescribed Zofran, to combat toxic side effects that were making him vomit; Inderal, which is used to treat tremors, chest pain and high blood pressure; and Xopenex, which addresses lung problems such as asthma and chronic obstructive pulmonary disease.
Paradoxically, his sister said, Abrams appears to have been on more medications at the end of his month at Caron than when he arrived.
Abrams’ relatives and friends remain perplexed as to whether his caretakers were fully aware of the depth of his despair.
Did no one at Caron — which claims on its website to have attendants on duty around the clock — learn that Abrams continued to have severe anxiety and insomnia, and that when he did manage to sleep he had raging nightmares?
Two days before he died, Abrams was reported to have been vomiting profusely. Why was he not taken to an emergency room, especially since he was so ill that someone at Caron canceled a visit by Abrams’ father?
Why was he allowed to have belts, the kind of item often used in suicides?
Why would a rehab facility take Abrams and a few other patients out to see a violent film like Straight Outta Compton on what turned out to be Abrams’ penultimate night alive?
After Abrams’ death, his toxicology report showed a significant amount of caffeine in his system. Why was he allowed to consume coffee or caffeinated drinks, especially since the mix of caffeine and powerful drugs might have been contributing to his chronic sleeplessness?
Those questions and others were posed to Karen Pasternack, a spokeswoman for Caron, which sent two grief counselors to the home of Abrams’ mother after his death.
In an email message to The Coastal Star, Pasternack declined to address any issues related to Abrams or his care.
“The law and Caron’s own high ethical standards forbid our employees from discussing even the smallest of details about any patient, including confirming the identity of current or former patients,” wrote Pasternack, who said she represented the views of Bradley F. Sorte, the executive director of Caron’s facilities in Delray and Boca Raton, which are licensed by Florida’s Department of Children and Families to provide rehabilitation services.
“We will never violate federal or state laws or breach our patients’ sacred trust,” she went on. “We can proudly state that many Caron alumni, who have returned to their communities in Florida, Pennsylvania and elsewhere, know firsthand the strength of our programs. Caron fully complies with the law and adheres to the highest medical and psychological best practices with a focused commitment to transforming the lives of individuals and families impacted by addiction.”
Some years before Abrams’ death, a doctor in Beverly Hills, Calif., began prescribing a daily dose of Xanax to help fight his insomnia, according to Jill Abrams, who spoke from her home in Los Angeles. She said her brother was not told that the drug could have a permanent and negative effect on the chemistry of his brain.
When she spoke with her brother by phone about halfway through his stay in Delray Beach, he told her he “wanted to run away” from the residence, and that he had been going for 10-mile walks on the beach almost every day.
“That was not a good thing, because he was already so thin,” Jill Abrams said of her 5-foot, 8-inch-tall brother, who weighed 127 pounds when he died. “I can’t understand why he had such freedom. I thought it was a lock-down facility. In the rehab places in California, the patients don’t walk off on their own. They really watch them.”
In any case, she said, the death of her brother has left her not only deeply saddened but remorseful. “I feel incredible guilt,” she said, “for not hospitalizing him here in Los Angeles when he told me he was suicidal.”
In a blog, Jill Abrams wrote about the drug that bore perhaps more direct responsibility for her brother’s demise. “I am left feeling that we need to understand why this insidious drug is as prevalently over-prescribed as it is,” she wrote. “In rehab, Tod began working on his ideas for a foundation to educate and lobby for more transparency with prescription drugs like Xanax. Let my brother’s unexpected death put a spotlight on this dire epidemic in America.”
After Tod Abrams’ suicide, criticism of his treatment at Caron prompted a defense of the company by John Lehman, president of the Florida Association of Recovery Residences, which seeks to improve industry standards.
“I remain confident that this particular organization strives to serve their clients with the highest level of professionalism,” he wrote in an email, referring to Caron. “In point of fact, were the remainder of the Florida provider group as committed to delivery of quality services, there would be significantly less demand for oversight.”
Lehman — who dismissed as “absurd” the persistent allegations from Delray Beach residents that recovering and relapsed addicts had committed crimes and caused other problems in their neighborhoods — extended his condolences to the Abrams family.
“As is evidenced by this tragic story, a highly accomplished, creative and well-respected artist lost his battle to an insidious brain disease that robbed him of hope,” Lehman said. “May he rest in peace.”
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