Robert Komarenski is a convicted pedophile who says he wants to escape his dark urges. But since his release from a state psychiatric hospital last month, he has been unable to obtain the drugs he says curb his destructive desires.
Jobless, he has been turned down for the medication by the government-funded clinics he visited. Wandering the streets of the San Fernando Valley for weeks, unable to afford the expensive prescription drugs, Komarenski worried that he would lose control and commit another crime.
Komarenski's unusual case has revealed a flaw in California's efforts to control would-be child molesters, psychiatrists say: Many released sex offenders have nowhere to turn to obtain the effective but expensive drugs.
Thousands of sex offenders are paroled in California each year; there are 20,000 registered in Los Angeles County. Beginning in 2002, some child molesters will be required to submit to testosterone-reducing drugs while on parole under a state law that is the first of its kind in the nation.
The drugs are said to reduce recidivism, and will eventually be provided free to paroled child molesters who qualify. In the meantime, people who want to submit to the drug regimen face huge challenges, both because of the costs and because many mental health professionals are not familiar with the medications.
It was only after repeated inquiries from The Times that officials pledged to continue Komarenski's drug treatment. He received his first shot at a county mental health clinic Wednesday.
"The drugs are accessible in the sense that they're sold in pharmacies and, theoretically, if you have the money and a prescription, a person could have access to them," said Dr. Gabrielle Paladino, a staff psychiatrist at Atascadero State Hospital, which houses the state's sexually violent predators.
"The problem is that you don't have a lot of doctors out there that treat sex offenders. Your average psychiatrist in the field wouldn't prescribe it in his lifetime."
The drug treatment is still highly specialized because it is generally seen as punishment, not therapy, according to Dr. Fred Berlin, founder of the Sexual Disorders Clinic at Johns Hopkins University in Baltimore.
"We still don't have a general acceptance that this is as much a mental health matter as a criminal justice matter," Berlin said. "It doesn't make sense, particularly if someone doesn't have money, that they should have to commit a crime to get this medication."
Ironically, committing a new crime would practically guarantee access to the drugs--after a long prison term. Starting in 2002, California law will require many repeat child molesters to be "chemically castrated" upon parole.
So-called chemical castration is a reversible drug therapy involving regular doses of antiandrogens: drugs that stop the body's production of testosterone, the hormone primarily responsible for the male sex drive. By reducing sexual desire, psychiatrists say, the drugs quiet the sexual fantasies and urges that plague many sexual deviants, particularly child molesters.
They do not eliminate a person's sexual attraction to children, experts caution, but they can help such a person keep from acting on those deviant tendencies.
Both of the drugs used for this purpose in the United States are manufactured and marketed for other uses: Depo Provera for birth control and Lupron for treatment of prostate cancer, experts said. Both are expensive, with monthly dosages running as much as $100 for Depo Provera and nearly $600 for Lupron.
They are not widely prescribed or widely understood in the psychiatric community.
Only California's maximum security psychiatric hospitals routinely treat mentally disordered sex offenders with testosterone-reducing drugs, authorities said. Patients at Atascadero who agree to a conditional release program can continue the drugs through a special program outside hospital walls, said Paladino, a staff psychiatrist, and the state Department of Mental Health.
The drugs are not offered to convicted sex offenders in California prisons, nor are they offered to parolees, according to the Department of Corrections. Because the chemical castration law is not retroactive, the first felon who may be forced to take the drug would be released in 2002.
"We just follow the law," said Terry Thornton, a Department of Corrections spokeswoman. "If someone wanted it, they'd have to do it on their own."
Obstacles to Treatment
It is difficult to know how many offenders want the treatment. Corrections officials say no one has ever requested it, but Berlin of Johns Hopkins said it is foolhardy to expect someone to tell jailers they are considering committing a crime. "Most people aren't going to put themselves at risk of going to jail to get treatment," Berlin said. State and local mental health officials said there is no public treatment center in California set up to provide the specialized drug therapy to sexual deviants in the community.