Methadone Today

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Volume II, Issue 10 (October 1997)

The History of Methadone and How the USA Grabbed the Glory - Judith Ostergard (AMMO)
Researcher, Andrew Preston

The Good News Is. . . .

The Bad News Is. . . .

Methadone Treatment in Jail - "A Decade Into It" - Judith Ostergard

Ignorance - by Beth Francisco

Response to "Diversion" (Odus Green) - By Nancy Rose - Secretary of DONT

Briefly Speaking - Short items about drugs in history

Back Page - Philosophy of Methadone Maintenance: From A Counselor Manual

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The History of Methadone and How the USA Grabbed the Glory
Judith Ostergard (AMMO)
Researcher, Andrew Preston

Methadone's prehistory began with its chemical ancestor pethidine. Created in 1937 by two German scientists, Max Eisleb and Gustav Schaumann, pethidine still soothes the labor pains of thousands of mothers-to-be in Europe.

Its creators worked for the German chemical conglomerate, I.G. Farbenindustrie, in the same labs which turned out the process of changing opium into heroin. The company's factory was at Hochst-am-Main, so pethidine was given the serial number Hochst 8909. Later it was christened Dolantin.

Practically since addiction was recognized, the Holy Grail of drug chemists has been the search for the "non addictive" analgesic--a drug which kills pain without being so good that people won't want to stop taking it. They thought pethadine was it, but as with heroin before and Temgestic since, pain and pleasure proved difficult to disintangle and the search continued.

Eisleb and Schaumann's colleagues, Drs. Max Bockmuhl and Gustav Ehrhart, continued juggling the atomic constituents of Dolantin hoping to create a painkiller sufficiently unlike morphine to sidestep tough curbs on opiate precribing. Among their 300 creations in 1938, the atoms of carbon, hydrogen, nitrogen, oxygen and chlorine fell into the concellation we know as Methadone. Max and Gustav labeled their creation Hochst-10820, and later the company dubbed it Palamidon.

It was not an instant hit. The agreement that ended the war forced Germany to hand over its industry, with all its patents and trade names, to the allies. The Hochst factory fell to U.S. victors, and the U.S. sent a team of four men to investigate the plant's war-time work.

In 1945, the U.S. Department of Commerce put out its first publication documenting the effects of Methadone. It pointed out that though chemically different, the drug closely mimicked morphine's pain-killing properties.

U.S.A. Grabs the Glory

Hochst's cache of chemical creations was raided by U.S. victors and the recipes broadcast free to chemical companies around the world, giving methadone and other products an economic head start in the drug market. Recipients were free to choose their their own brand (or trade) names.

For Methadone, the U.S. company, Eli-Lilly, chose Dolophine, the name widely held to have been derived from Adolf Hitler's Christian name. It is most unlikely that Eli's name makers were closet Nazis commemorating the Fuhrer. Probably the name was welded from the French words, "douleur" (pain) and "fin" (end).
Methadone remained a little-used option in medicine's analgesic armory until 1964. U.S. Drs. Marie Nyswander and Vincent Dole decided they would try a new role for the drug. What they sought was an was an opiate-type drug which worked when taken by mouth and which didn't need ever-increasing doses to stay effective. Their initial trials with Methadone soon gave it a new lease on life, and the rest is history. END

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I wanted to comment on the article in last month's newsletter, by Nancy R. Here in La Crosse, WI, we have no problem in getting our doses promptly if a patient should become incarcerated at the County Jail. The reason is that the director of the methadone clinic in our city is also the jail doctor. He is a very understanding man when it comes to most issues involving opiate addiction. He also heads the chemical dependancy program at the hospital where the clinic is located. He sends the doses down via the jail nurse or, if need be, will personally bring them to the jail.

The only problem is, if the reason for a patient's incarceration is a drug or alcohol offense, most likely that patient will find him/herself quickly terminated from the methadone program. That means a quick detox and, in some cases, I've heard painful. They (meaning the nurse and other counselors) can make the detox as fast as they want to.

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Patients are supposed to be protected from job discrimination when they are legally medicated with methadone. Although the Americans with Disabilities Act (ADA) prohibits denying employment to methadone patients because of the medication they are taking, some methadone patients are denied employment and/or are fired for this sin! If this happens to you, don't stand for it. File a complaint with the Equal Employment Opportunities Commission (EEOC).

Methadone patients have also had probation officers violate their probation because they are on methadone. Other patients are told to detox or they will be violated. Don't let this happen to you.

We must not accept these decisions from non-medical personnel, and we must not accept being denied employment simply because we are taking this life-saving medication. We must not accept injustices of any kind.

If any of these things happen to you, your counselor or program should help you. If not, contact your patient advocacy group. If you do not know who that is, contact Methadone Today, P.O. Box 164, Davison, MI 48423-0164; call (810) 658-9064 or (810) 756-5938), and we will put you in touch with an advocate in your area. If there is no advocacy group in your area, we will do what we can to steer you to the right agencies for help with the problem.

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Methadone Treatment in Jail - "A Decade Into It"
Judith Ostergard
Advocates of Methadone Maintenance of Omaha (AMMO)

The Key Extended Entry Program (KEEP) was started almost one decade ago at New York City's "Rikers' Island Facility" and is the nation's only in-jail Methadone Maintenance Program.

The prison runs the program to help prisoners who are addicted to narcotics in the United States. About 3,000 persons ingest methadone daily at Rikers. KEEP is funded by the New York State Office of Alcohol and Substance Abuse Center (ASAC) and operated by Montefiore Medical Center. KEEP is run through a grant from the National Institute of Drug Abuse (NIDA). The research focuses on outcomes for KEEP. Participants who had not been enrolled in a community methadone program will get their chance to clean up. At the time of their arrest, any one prisoner with obvious drug problems are turned over to KEEP. KEEP is successful in routing out untreated narcotic users into treatment after release from Riker's Island In an interview sample, 85% of KEEP methadone participants who were not in treatment at arrest applied for Community Methadone Treatment once released.

Cartoon by Ken Thompson - Roseville

KEEP is the only outreach effort in New York City which has been shown by controlled evaluation to increase community drug participation. As good as the numbers look, the KEEP program has had to fight each year for fiscal survival and has received little recognition from state and municipal agencies covered with public health.

Why KEEP remains so marginally supported despite its potential for even greater contributions to public health is exactly what a "NIMBY" refers to--not in my back yard. Efforts against AIDS, Hepatitis C, B, A, etc. are questions to ponder. Charles La Porte and Richard Marx were instrumental in conceptualizing and implementing KEEP while both were working at the Division of Substance Abuse (DSA) in New York City.

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Response to "About Diversion" (by Odus Green)
Nancy Rose (Secretary of DONT)

I felt it was important to respond to last month's article, titled "About Diversion", by Odus Green (Vol. II, No. IX, Sept. 1997). I agree with much of his article, but another side must be given lest the article needlessly worry many patients.

In his article, Mr. Green writes that he believes that the "predominant means of illegal mass distribution of [methadone] is. . .by the very agencies that are charged with its proper dispersal." He goes on to say, ". . . a nurse could easily steal enough of the drug. . . .an underpaid LPN who makes up 250 doses a day and who wants to make a little side money [could]. . . .If s/he takes just 5 mgs. from each [patient's] dose,. . . she has 1250 mgs. To [sell] to the street each day." He also explains that the majority of patients need their entire dose and can ill afford (physically) to sell any of their take-home bottles. Not only do they face withdrawal, but they are selling clean, unadulterated medicine to do what?. . . .buy a street drug that is cut with who-knows-what?

I must respond! I agree that most patients need their dose and do NOT sell their methadone. But, most nurses are dedicated professionals who word hard and are honest. Besides, every milligram of methadone dispensed must be accounted for. Clinics are heavily regulated by the state, the feds, the DEA, etc. They have inspections on a regular basis.
I tend to think it would be extremely difficult for a nurse to steal methadone without being caught. Plus, the nurse would have to find "buyers", then risk getting caught, being fired, ruining his or her career and reputation, and being charged with a crime, risking his or her very freedom! Do you really think there are that many nurses willing to risk everything for some extra money?

On the other hand, I like Mr. Green's suggestion about abolishing the present clinic system and having methadone patients treated by a private physician and picking up their prescription methadone at a pharmacy like any other medicine. But, Mr. Green offers this partially as a solution to the problem of methadone being stolen by clinic staff. Couldn't pharmacy staff also conceivably steal in this manner?

No, I think the system should be changed for no other reason than that methadone patients, having the disease of addiction, should be treated like any other patient on any other medication. Private physicians prescribe and pharmacies distribute opiates and narcotic medicines. Cancer patients certainly are allowed to pick up their Dilaudid prescriptions, and other patients pick up opiate pain medications at their pharmacy. Methadone patients should not be treated any differently than any other patient with a disease.

Methadone Today is open, of course, to opinions of all patients, staff, or other persons interested in methadone treatment and/or advocacy. Articles such as Mr. Green's may reflect the fears of some patients, which becomes understandable when we realize that, as patients, we have faced much prejudice, ignorance, and rudeness over the years. Clinic staff, rather than react angrily to articles such as Mr. Green's, should perhaps consider why some patients feel this way.

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by Beth Francisco

The only word that comes to me is "ignorance." "Methadone makes your hair fall out, and it gets in your bones." Ignorance. I don't mean that in a derogatory way, but ignorance causes many of the problems we face as methadone patients.

An incident occurred when I was passing out Methadone Today. A taxi driver, an elderly lady, dropped a patient off at the clinic. I walked over and offered her a newsletter to read while she waited. She asked me what it was, and I told her. She said, "I don't need that. I ain't no alcoholic or no dopehead."

"You don't have to be an addict to read our newsletter. It's merely a source of information about methadone," I told her.

"Well, I don't want it!" she replied almost angrily, as though I was trying to give her something that might be catching. Ignorance.

Then we have those people who say, "When are you going to get off that shit?" Ignorance. Of course, these are the people who never saw me in the deepest stages of my addiction. They never felt the pain I felt when I would wake up in the morning and hate to hear the birds singing because I knew I had not saved anything from the night before so I could get well. I did not have the luxury of pressing the "snooze" button on the alarm clock; in those days, there was no "real" alarm clock--only the one in my head. That same clock in my head dictated every waking moment of my day.

Get up. Get up and get yourself around so you can get well enough to think about how you are going to keep yourself functioning today. God, I promise, this will be the last day. Just please get me well enough today so I can think how to quit. But, please, God, just let me find something today. Desperation. Can't call a doctor--they think I'm weak and that all it takes is will power. Ignorance.

Thank you, Drs. Dole and Nyswander, for methadone.

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Briefly Speaking

1885 - The Report of the Royal Commission on Opium concludes that opium is more like the Westerner's liquor than a substance to be feared and abhorred (Musto, The American Disease, p. 29).

1903 - The composition of Coca-Cola is changed, caffeine replacing the cocaine it contained until this time (Musto, The American Disease, p.43).

1910 - Dr. Hamilton Wright, considered by some the father of U.S. anti-narcotics laws, reports that American contractors give cocaine to their Negro employees to get more work out of them (Musto, The American Disease, p. 180).

1912 - The first international Opium convention meets at the Hague and recommends various measures for the international control of the trade in opium (Szasz, 1975, Ceremonial Chemistry).

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The initial goal of methadone maintenance is to free the addict from the periodic withdrawal that prompts regular use of illicit opiates. A patient who is thus freed from withdrawal symptoms will, it is hoped, be able to stop this illicit drug use and dissociate from people and places that involve drug use and crime, deal with his or her problems, establish a new lifestyle, and enjoy a higher quality of life.

The counselor should provide support and direction to any patient who is interested in tapering off methadone, but it is not realistic or therapeutically beneficial to routinely promote the goal of detoxification from methadone. To do so can suggest that what the patient is doing to deal with his or her heroin addiction is, at best, only temporarily acceptable. The focus upon getting off methadone maintenance implicitly conveys a negative attitude about the treatment. The patient who is not ready or able to withdraw from methadone is then left with the choice of being in a "bad" treatment or of returning to heroin use.

Source: U.S. Department of Health and Human Services (DHHS), Technical Assistance Publication (TAP) Series 7, Treatment of Opiate Addiction With Methadone: A Counselor Manual, (Ch. 3, p. 15). Ordering Information: 1-(800) SAY NO TO; Ask for Tap 7 or SMA94-2061

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