Methadone Today

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Volume II, Issue 11 (November 1997)

Dear Doctor (Open Letter) - Magic

The Good News Is. . . .

The Bad News Is. . . .

A Warning About Alcohol - Lyle

Natural Opioids - by Roberto Nardini

Response to "Ignorance" - Aaron

Briefly Speaking - Short items about drugs in history

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

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Dear Doctor (Open Letter)

I'd give anything to have a chance to do my life over. My greatest pain today, with all that I have done to myself and with the images and thoughts (mind movies) I am forced to live with forever, is the complete lack of understanding and compassion for a human being who, for one reason or another, completely screwed-up their life.

Believe me, we as addicts have enough to deal with as it is. This stigma we all live under is a plentiful hassle all unto itself. Just imagine, you enroll in treatment, you're committed, asking for help; you clean yourself up and utilize the tools of your treatment, all to have an irate neighbor (twice) filming you go in and out of your methadone clinic, soon to be shown on cable access t.v. for all to see. That's confidentiality? Not to mention the Portland police frequently parked out front, checking plates, waiting and watching.

Methadone has not only actually saved my life but has helped me to function very well. I have been clean from illegal opiates for about 3 years except one time after a difficult, prolonged death in my family--no excuse--I just didn't deal with it properly.
Hopefully, I have struck a compassionate chord in your soul? You see doctor, every time that I inform someone in your profession, about my illness, a disease that was probably inherited--at the very least, a learned behavior--not to mention the new studies into the complex brain chemicals, leading to the conclusion of a dysfunction that I may never be able to do anything about, I am met with suspicion and a general, noticeable lack of care.

I really do understand the position this puts an M.D. in. That is why I have never asked for a prescription for anything and have, up until now, always informed my new M.D. of my addiction history. I always wanted to be honest and up front, even going as far as telling this new doctor that I would never put him in a bad position (i.e. asking for drugs). I just wanted care and to be treated like any other patient. This is without a doubt a protection for me first and at least, I thought, security for the new doctor.

Even the very doctor who prescribes my methadone has said that he hates us. And in his own words, he once leaned over the table to me and stated: You dope fiends and whores think you have all the answers. This after asking him if he had any knowledge of some new treatments that were going on in Europe.

I've come a very long way and have demonstrated to myself, my two fantastic children, my great, beautifully understanding wife of 14 years, and anyone with whom I come in contact, that I am an honest, trustworthy, and genuinely good person--not a dope fiend.

Well Doctor, if I've still got your attention and you still want me as a regular patient, I have one favor to ask of you: Do you remember, a few months ago, I received a complete physical from you? Well once a year, I am required by my clinic to obtain a physical exam. This is mainly done by the clinic M.D.--this same doctor mentioned above gives us a 3-minute exam (no kidding!) 3-5 minutes in & out to the tune of $75 which, of course, our insurance won't cover, plus, a blood panel, which I have already had done. He is also required to take our temperature and blood pressure; this has never been performed--at least on me, it hasn't.

This year I got permission to see you, doctor. Not only do I not want that other uncaring, "hates-us M.D." to put his hands on me at all but, I got much more value from you with the unbiased, real, complete physical that you gave me. Plus, my insurance covers me for one complete exam a year. I pay $240.00 a month out of pocket for the equivalent of two 10 mg. dolophine tablets a day, with basically no other therapy except one group meeting for 1 & hours once a month that I am required to attend. I have always paid for my illness--never the state. Just like the N.A. meetings I attend outside of the clinic, I take it upon myself to help myself.

As I said, most of us are deeply ashamed of our condition at almost every level, no matter how well we are doing. I just could not tell you, when I first met you. I just wanted care--not more disappointment. For that, I am truly sorry, and I really hope that you do understand.

Here is the catch: My clinic needs (wants) acknowledgment from you stating that you are aware of my being on methadone maintenance and that you were aware of this when you did my exam. I asked the director why was this necessary, especially since they have the paperwork from you that I gave them. Also, when in comparison to a 3-minute clinic exam, to your most thorough, complete physical, what could you have possibly missed? This is just one, among the many hoops and road-blocks that they always pull. Just when you think you have a handle on your life situation, they change the rules, pulling the rug out from under you. No real thought in what the outcome will be or how it will affect any of us--just implement new policy because it sounds good to them and because they have every right to do so.

In closing, please remember, I will absolutely understand if this is not possible. Or, without having to tell this little white lie, we can go the other way: I'll make an appointment and you can re-examine me to meet this requirement. I have a real phobia about this, doctor. Please help if you can.

One last thing, thank you so very much for taking your valuable time to read all this. I also promise you, if you decide to keep me as a patient, I will never ask for any kind of medicine that might put you in a bad position. Thank you once again, Respectfully, M.

P.S. I'm sure that you do not know this, but you already have a patient who is on methadone right now. He won't tell you for the same reason that I was afraid.

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"Doctors everywhere should be allowed to prescribe methadone to help fight heroin addiction more widely," Barry McCaffrey, National Drug Control Policy Director said. He criticized current policy which requires addicts to go to clinics for treatment.

``If we do this thing correctly, if we allow the dose rates to be prescribed by doctors and not by policy, if we allow it to be decentralized so that physicians who are trained and monitored are allowed to dispense the drug instead of necessarily having it only in some centralized locations. . .we're going to make a big difference,'' he said at the NIDA Heroin Conference, September 29-30, 1997.

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Mike H., one of our fellow methadone patients who wrote "Faith in Recovery" for the March 1997 issue of Methadone Today, died last week of a massive coronary. Mike had been decreasing his dose steadily over the last several months and was down to a very few milligrams.

We were told he was being pressured to detox the rest of the way from his medication (not by the clinic), and he just quit taking it. We were also told that the shock from the sudden withdrawal and damage to his heart from prior drug use was probably a contributing factor to the cause of death. We will miss Mike.

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A Warning About Alcohol
by Lyle

I was talking to my counselor one day about the use of alcohol while on methadone maintenance. She told me that if the dosing nurse suspects you are under the influence of alcohol, you may have to take a breathalyser test. Depending upon your BAL (blood alcohol level), the nurse may refuse to dose you!

I know that many of us DO have problems with alcohol, and we may be better off to completely avoid it. But those of us who enjoy a beer during Saturday afternoon football should be aware that a drink before going to the clinic could cause you to have a serious problem getting dosed.

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Response to "Ignorance"
by Aaron

This article is in part a response to Beth Francisco's article, "Ignorance." When I think about the general public's attitude toward methadone and methadone patients, I often will get very angry. Like the taxi driver in Beth's article, many people know little or nothing about methadone and have no intention of learning about addicts and their "legal heroin."

While some people are simply close-minded and choose to remain ignorant, others are left in the dark or are mislead by the media. Articles in previous Methadone Todays have covered the local news' misrepresentation of methadone and methadone patients as, "junkies lining up to get their free fix. . . ." In other cases, television routinely either ignores or demonizes methadone patients.

Many television specials on drugs ignore the very existence of methadone. M-TV did a special on drugs that seemed to me (at the time) to be relatively balanced (I watched this special before I was a methadone patient). The special focused on users (former and current) and dealers. When it got to the subject of heroin, Kurt Loder (the host) introduced us to two registered addicts in the UK on heroin maintenance. One of the addicts explained how she quickly got hooked on heroin and explained that the government heroin did not get her high and barely kept her from getting sick. While the special gave the viewer a glimpse of the country's "harm reduction" policies, it made no mention of methadone in the UK or the US.

Another television special, "Dying in Vein", aired on VH-1 in response to the recent surge in heroin use. "Dying in Vein" profiled several users, including a famous model, the singer of Sublime (who had recently died of a heroin overdose), and the singer of Three Dog Night. Not once was methadone even mentioned.

Finally, heroin was the subject of one of those "news magazines" that featured an interview with Steven Tyler of Aerosmith. They told about the recent resurgence in heroin use and how its increased purity allows the user to snort instead of shoot it. Tyler and other former users tried to convey the power of the addiction and the intensity of the cravings an addict experiences. Yet methadone maintenance, the most effective treatment, was never even mentioned.

One would think that in the age of AIDS, an effective treatment for heroin would be at least mentioned on television or radio specials. Alas, even a radio advertisement by the Michigan Department of Health did not bring up this taboo treatment. The advertisement told those in high-risk groups (people having unprotected sex or using drugs) to get tested for AIDS and if it came back positive, "treatments are available. . . ." If it came back negative? Just Say No: "If you take drugs, stop!" Of course, it did not say (if you are going to continue to use drugs) to stop sharing needles or to clean needles before using them. No mention of methadone or drug treatment whatsoever. . . .For most heroin addicts, to just quit cold turkey is about as easy as it would be for the DEA to stop the flow of cocaine and heroin into this country. . . .

What makes me the most frustrated about these specials and advertisements is that even the ones that promote a sympathetic attitude toward addicts do not inform them of all the available treatments. Furthermore, any good special on drugs and drug addiction should discuss the success rates of different rehabilitation programs. Any good special on heroin would at least note the higher long-term success rate of methadone maintenance over abstinence-oriented programs.

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Natural Opioids
by Roberto Nardini

Since addiction is a big problem, we have submitted to the appealing offer of fellows who declare to be in a position to cure it, and to do it fast. Those individuals, most of the time, have earned a lot of money and sent to death thousands of innocent people whose despair was so great that they could have accepted any promise.

At the recent methadone conference in Chicago (April 1997), Avram Goldstein, the one who discovered the endorphins in 1975, has declared that the addiction is a TOTALLY PHYSICAL problem, and that the discomfort due to the lack of balance among the neurons, which is the only element that triggers the relapse, may last for months--in many cases, for years and for ever.

The addiction, as a relapsing disease, has never been considered to be due to the evident, early symptoms of a fast (always barbarian, anesthesia or not) or even slow withdrawal, but to the permanent PHYSICAL discomfort which follows them.

This discomfort can be avoided restoring the missing balance, and that can be done only through the administration af a long lasting and stable opioid, so that it can work exactly as the missing endorphins. Complying with this strategy, most addicts can become normal and functioning people, and in these conditions some, not all of them, can likely in the future try to function with no substitution. That's what we know from the scientific world at the present. Do addicts deserve some scientific research? Or are they are condemned to follow ideological and fake opinions?

We all, who have never been addicted to opiates, need a bunch of natural opioids in our system, and what is incredible, we want people who don't produce anymore opioids, to function without them. Isn't that awful?

The natural opioids we produce are crucial for our functioning. They are not named "methadone" but they work in a similar way. No one could have a normal life without them. Why do we keep pushing people who don't produce anymore "methadones" to get rid of them? Why do we want them rapidly cured and for ever? Why do we want them to risk their lives? Why do we allow dishonest people to solicit their hopes and expectations? Why?

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Briefly Speaking

1914 - The Harrison Narcotic Act is enacted, controlling the sale of opium and opium derivatives, and cocaine (Szasz, 1975, Ceremonial Chemistry, New York: Doubleday/Anchor).

1919 - The Eighteenth Amendment (Prohibition) is added to the U.S. Constitution.

1920 - The U.S. Department of Agriculture publishes a pamphlet urging Americans to grow cannabis (marijuana) as a profitable undertaking (Musto, "An historical perspective on legal and medical responses to substance abuse", Villanova Law Review, 18:808-817 [May], 1973, p. 816).

1921 - The U.S. Treasury Department issues regulations outlining the treatment of addiction permitted under the Harrison Act. In Syracuse, New York, the narcotics clinic doctor report curing 90 percent of their addicts (Lindesmith, The Addict and the Law, p. 141).

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Despite its well-documented success in treating chronic narcotic addiction for more than 25 years, methadone maintenance treatment has barely survived years of inadequate funding and negative public perception. Unfortunately, the biochemical and psychological underpinnings of narcotic addition continue to be misunderstood, and replacement medications are still viewed with suspicion.

Dr. Vincent Dole has described the function of methadone maintenance as follows:

The treatment is corrective, normalizing neurological and endocrinologic processes in patients whose endogenous ligand-receptor function has been deranged by long-term use of powerful narcotic drugs. Why some persons who are exposed to narcotics are more susceptible than others to this derangement and whether long-term addicts can recover normal function without maintenance therapy are questions for the future. At present, the most that can be said is that there seems to be a specific neurological basis for the compulsive use of heroin by addicts and that methadone taken in optimal doses can correct the disorder ("Implications of methadone maintenance for theories of narcotic addiction", Journal of the American Medical Association; 260:3025, 1988).

Source: U.S. Department of Health and Human Services (DHHS), Treatment Improvement Protocol (TIP) Series 1, State Methadone Treatment Guidelines (Parinno, Mark W., Ch. 1, p. 1). Ordering Information: 1-(800) SAY NO TO; Ask for TIP 1 or SMA93-1991.

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