Methadone Today

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Volume II, Number 5 - May 1997

See Doctor's Column: Here

Methadone--It Saved My Life - by Julian Robinson

Clinics in Italy - by Roberto Nardini

A Course in Methadone Maintenance - by Ken T.

Thanks From a Patient - by Dennis D.

Did You Know?

Briefly Speaking

Methadone--It Saved My Life
by Julian Robinson

I have been taking methadone for 13 years; my dose has always been, still is, and always shall be 100mgs. I have been in and out of literally every type of drug treatment available, as well as many other forms of therapy. Though I never had intended to remain in methadone maintenance, I must tell you, it no doubt saved my life.

For thirty plus years, I've had 7 habits, 5 institutionalizations, 8 overdoses requiring hospitalization, and all the aforementioned treatments; all I can say is that methadone, antidepressants, and the twelve steps (which I only began three months ago) have allowed me to feel strong, healthy and hopeful for the first time in my life.

The problem with chemotherapy for substance abuse/addiction is one of ignorance and very poor communication. The issue has nothing at all to do with whether or not a person takes drugs but, rather, what particular drugs said person takes.

I remember when I was detoxing from heroin addiction thirteen years ago. Some of the staff had spoken to me about trying methadone maintenance as treatment for my smack habit. My initial response is the same response lay people say to me upon learning that I'm on methadone: ". . .but you're taking a drug to not take drugs. You're still on drugs, so what's the difference?" As we all know all too well, there is a huge difference.

My problem was not with drugs; it had more to do with ‘EUPHORIA'. When the desire for euphoria affects all areas of your life in negative ways, you have a drug problem. Virtually everyone takes some form of drug for something or other, and many people have adjusted their lives to incorporate drugs or medicine for the remainder of their lives--hypertension, diabetes, many, many forms of mental health problems, such as depression, bi-polar disorder, schizophrenia, multiple personality disorder, anxiety, phobias, et al. I do not have enough space to list them all, but suffice it to say, it is not whether or not you are taking drugs but what drugs you are taking.

Since the age of 5, I have been severely depressed. In my teens (preteens, 10-12 years of age), I self medicated the depression and by age 27, I had a gagging smack habit and a love affair with mainlining speedballs. Once it was clearly understood what was wrong, I was given the proper medication by professionals--methadone, Prozac, and a mild tricyclic, and I've never felt better.

The other thing I have noticed is that there are too many people around proselytizing what treatment is right and what is wrong. Many of these people go to some college and get some degree--usually in social work and maybe a few courses here and there in psychology. Smugly, they expect to be referred to as professionals. HA!! Listen people, I have a Ph.D. in philosophy, with psychology as a minor, and I know shit!!

With all my life experience, all my schooling and all my independent study (which accounts for more reading than I have ever done in school), I can honestly say, "The more I learn and know, the more I realize how very little I really know!" But, I can tell you one thing for certain--there is no right or wrong treatment. Any treatment can work for any person. You have to check them out and see what you are most impressed with and comfortable with. But, even more important: If you are not committed to sobriety, moderation, complete abstinence forever et al, nothing will work. This I can safely tell you from personal experience and from observing others. Gotta Go. Love on ya.

P.S. If anybody feels like writing me, please do: 3487 Anchor Place, Oceanside, NY 11572.

P.P.S. I didn't know Ira Sobel, but from reading his editorials, I must tell you, we have lost a wonderful human being. All I can say is, "I hope one day we meet spiritually. Gonna miss ya buddy! We never met face to face, but I love ya." End

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Clinics in Italy
by Roberto Nardini

The Italian methadone situation is really complex; if you forgive my sluppy English, I will try to give you an idea what is going on here in Italy. In our Country, by law there must be a service for drug addiction every USL (Unit=E0 Sanitaria Locale). There are about 600 Ser.T. (Servizio Tossicodipendenze) nationwide. Each of them, by law must provide the most known modalities, methadone included. And for that purpose the USLs have been provided with funds.

So you would say, "Where is the problem?" Well, the problem is pretty Italian, in that what has been stated by law seldom gets done. People (doctors, nurses, social workers, psychologists) get paid anyway--there must be 22 operators every 150 patients, but patients seldom get real treatment. Why? First of all, the Italian information in this field has been monopolized by the religious organizations.

Many priests started treatment centers years ago and have conditioned the whole policy, getting most of the funds and achieving tremendous power. They show ads on TV, they publish in magazines and newspapers, just bombarding the public opinion with their awful propaganda. Thus, most addicts and their families don't ask for MMTP, and when they do, many doctors don't listen to them.

A great part of the public clinics are devoted to detoxification as main treatment or as previous practice before sending patients to a treatment center. There are clinics that provide MMTP, but only those who accepted the right protocols which we introduced in Italy years ago. Those clinics are growing in number and quality, and we really work hard on this project through meetings and conferences, disseminating materials and so on. After 1993, following a successful referendum promoted by ourselves along with some radicals, every doctor, even a G. P. out of the public clinics can, by law, provide a methadone treatment to an addict patient.

Coordination and cooperation with the local public clinic is recommended by the guidelines issued by the government (1994). Again, only on the law because most doctors don't even want to talk to an addict. By the way, we are the only non-public clinic in Italy providing MMTP and assistance to anyone who needs it. We often assist patients who are not able to get a treatment in their clinic. We write letters, we send faxes, etc. We are, for many inefficient services, a classic pain in the ass. We are a non profit association founded in 1978, just with the main purpose of helping this weak part of our society. It's a long, long story.

Whatever you get here in Italy, good or bad treatment, methadone or treatment center, is completely free. We also have referred many American traveling patients to the appropriate local services to be dosed as per the recommendations of their doctors. We haven't done much of this job since TRIP (organization which arranged dosing for traveling patients) no longer exists, but we are ready and perfectly organized to do it again. So, whoever plans to take a trip to Italy will be welcome, and we will be glad to refer him/her to the right service(s) accordingly with their particular schedule. Wherever you go in Italy, there are clinics in close proximity. The problem is whether those clinics respect and follow the directions from the original foreign clinic. Of course they should, but not always do they. Therefore, I suggest you get in touch with us before leaving, so that we can contact the Italian doctors and make sure they will dose properly any traveling person.

Foreigners, when they show up at the Italian clinic are supposed to present a letter signed by their doctor, stating the dose and the eventual take home privilege (which is not always respected here in Italy). We will be glad to previously announce the visit of any American friend to any Italian clinic, so that when they get here, everything is already settled. And, of course, this will be a free service.

If you have any questions, please don't hesitate to write to:

R. Nardini - Gruppo S.I.M.S.
Tel/fax +39 584 72600 Segreteria 24h

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Is A Course in Methadone Maintenance Feasible?
by Ken T.

What is methadone? What is methadone maintenance? Can the many truths really be told to our friends or families, or doctors even, about a treatment that almost no one understands--yet the use of which can save an addict's life? Many addicts' lives.

Imagine yourself a reporter interviewing the general public about methadone. You want to know what methadone maintenance means to them. You would certainly come across these and many other opinions:

"Oh, I don't know--never really thought about it much", or "It's trash, just a substitute for heroin--legal dope", or maybe "Methadone is fantastic; it has changed my life, helped me so much!"

Whatever the opinion, one thing is certain. As a result of methadone, many lives have been saved and transformed for the better. Over the years, it has touched thousands of lives. So, many of us profess to believe in our chosen treatment for our addictions.

The word "methadone" has been used, misused, and abused in the name of countless causes over the course of many years. But in spite of the successful use of methadone in treating narcotic addiction, it is an enigmatic source of treatment. It has been totally misunderstood since day one. Can the masses, in general, be educated as to the usefulness of methadone maintenance? The simple answer--yes! But how?

We, as addicts, are equally misjudged, but we need to educate people and proceed slowly to your friends, family, and on through your doctor. Many people have never even met someone on methadone--not that they knew of anyway! A high percentage (90%) of the time, when I talk to a doctor, dentist, attorney, a nurse, or even a friend who doesn't know I'm on methadone, I am met with questions and much curiosity. Most are very receptive and ask questions such as: Does methadone really work? How long have you been on it? How does someone get into a clinic? Most are well-intentioned questions or comments, and I have discovered that most are very curious about the "demon-drug" methadone. The fears and concerns that people may have had about an addict quickly disappear! The wild-eyed, crazed, methadone-drinking moron image just as quickly fades away. Most are gracious listeners and so thankful for enlightening them that they become apologetic for their former beliefs. It is a wonderful feeling to be able to see the negative stereotypes and images of a methadone patient disappear within a smile!

But, on the other hand, I've been told that any connections to methadone, even in a subtle manner, would be "political suicide." "Not worth the trouble", and "Is of no interest to me." Please, don't let the attitude of the ignorant few deter you in any way. The ignorant will always be out there and set in their ignorant ways, ready to pounce upon anyone whom they see as "different" from themselves.

Don't give up hope, for hope is eternal!

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Thanks From a Patient
by Dennis D.

I would like to commend your organization (DONT) and NAMA in attempting to enlighten both the treatment community and the general public on the truth about MMT by taking a proactive role in dispelling the myths, ignorance, and stigma associated with the most effective treatment modality available for opiate addiction.

I have suffered from and struggled with opiate addiction for over 20 years. During this time I have gone through the gamut of traditional abstinence-oriented treatment programs, group and individual therapy, and 12-Step fellowships in an attempt to stop using opiates and have failed each time. This treatment failure was not from a lack of wanting to stop nor from not "working the program." I desperately wanted to stop but simply couldn't despite the threat of severe consequences if I resumed active addiction. The reason was simple: I could not live a single day where I was not besieged with constant dysphoria and depression despite over 3 years of continuous abstinence from all mood-altering substances. These manifestations could not be relieved to any noticeable extent no matter what Step I worked, how many meetings I attended, what antidepressant I was on, or how often I confided in my sponsor and therapists. There was only one thing that would end this torment. My body was screaming for the substance that would return it to stability. I eventually gave up. It had the better of me.

After much research of the literature and talking with fellow narcotic addicts, I am convinced that opiate addiction is a psychological manifestation of a physiological abnormality. There is only one form of treatment that addresses this: Methadone maintenance. It has been proven that psychotherapy alone as a treatment for depression is almost universally unsuccessful. Only when appropriate pharmacological intervention is introduced does significant progress ensue. This also appears to be true for narcotic addiction.

After having attempted abstinence-only treatment numerous times only to eventually relapse, I have enrolled in a MMT program for the first time. What a long, drawn-out process this is! I applied over a month ago, and I finally have a meeting with the board of directors next week to determine my eligibility even though I successfully met all acceptance criteria. This is madness! What is the suffering addict, who desperately seeks help, to do during the interim? A week seems unbearable, let alone a month. I had to begin treatment in an intensive outpatient/detox program while I wait to be accepted (I pray!).

The reason it's taking so long to get into this program is twofold:

(1) As you mentioned, I must "prove" that I'm a narcotic addict who has had a several year history of opiate addiction. This does not seem to be too difficult to ascertain to me, but I guess they want to be careful. Again, too much governmental red tape.

(2) The intake process consists of first completing some general paperwork. This is followed by an assessment meeting with one of the counselors 1 to 2 weeks later, depending upon their schedule. If you still meet the requirements of the program, you then meet with the intake panel for final disposition. Again this can take 1-2 weeks following the assessment interview. After having successfully completed this, then you meet with the physician who will usually begin treatment that day. The major hassle in all of this is that intakes are only done on certain days of the week, and the number of open slots depends upon the number of applicants at the time. As it is, the MD is only available on certain days, and the intake panel only meets once or twice a month, etc.

MMT is the only treatment modality that makes sense to me. Its neuropharmacological approach to treatment is sound--unlike much of the current psycho babble and inner-child nonsense that is so pervasive in the treatment community today. I simply cannot comprehend the attitudes of treatment professionals and government policy makers alike who scoff at and dismiss MMT only to praise abstinence-only programs despite the fact that MMT is substantially more effective and less costly than abstinence programs will ever be. During my numerous attempts at recovery, at no time was MMT discussed as a potential option. This is truly a disservice to the thousands who needlessly suffer relapse after relapse in abstinence programs and eventually lose hope. When will they ever learn? If methadone was not a controlled substance, I wonder if this disparity in philosophies would exist? If the medical and treatment community truly believes that narcotic addiction is a disease process, why don't they finally treat it as one and end this inane prejudice and narrow-mindedness? Perhaps this may be one positive outcome of the HIV epidemic. It is sad to think that it takes this kind of motivation to grease the wheels of policy reform in this day and age of supposed enlightenment.

Thank you again for your interest, support and helping to break the barriers to responsible and ethical MMT. I look forward to becoming a member of NAMA and participating in this crucial endeavor.

My only hope is that this program treats us with some amount of dignity and truly views narcotic addiction as a disease entity, rather than just giving lip service to it. We are not bad people. We are simply sick, with an incurrable disease, trying one day at a time to get well. If methadone helps to facilitate this, I cannot ask for more! Thanks again for your interest and support.

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Did You Know?

The goal of methadone maintenance treatment (MMT) is to reduce illegal heroin use and the crime, death, disease, and other negative consequences associated with addiction. Methadone can be used to [withdraw] heroin addicts, but most heroin addicts who [withdraw]--using methadone or any other method--return to heroin use. Therefore, the goal of methadone maintenance treatment is to reduce and even eliminate heroin use among addicts by stabilizing them on methadone for as long as necessary to help them keep their lives together and avoid returning to previous patterns of drug use. The benefits of methadone maintenance treatment have been established by hundreds of scientific studies, and there are almost no negative health consequences of long-term methadone treatment, even when it continues for twenty or thirty years.

Methadone is cost effective. MMT, which costs on average about $4,000 per patient per year, reduces the criminal behavior associated with illegal drug use, promotes health, and improves social productivity, all of which serve to reduce the societal costs of drug addiction. Incarceration, by comparison, costs $20,000 to $40,000 per year. Residential drug treatment programs cost $13-20,000/year. Furthermore, given that only 5-10 percent of the cost of MMT actually pays for the medication itself, methadone could be prescribed and delivered even less expensively, through physicians in general medical practice, low-service clinics, and pharmacies.

Source: The Lindesmith Center, "Methadone Maintenance Treatment" A Project of the Open Society Institute

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Briefly Speaking

1650 - The use of tobacco is prohibited in Bavaria, Saxony, and In Zurich, but the prohibitions are ineffective [emphasis mine]. Sultan Murad IV of the Ottoman Empire decrees the death penalty for smoking tobacco: "Wherever the Sultan went on his travels or on a military expedition his halting-places were always distinguished by a terrible rise in executions. Even on the battlefield he was fond of surprising men in the act of smoking, when he would punish them by beheading, hanging, quartering or crushing their hands and feet. . . .Nevertheless, in spite of all the horrors and persecution. . .the passion for smoking still persisted" (Brecher et al, Licit and Illicit Drugs, p. 212).

Hmmm! Sound familiar? It should--just substitute a little--ergo, drug policy USA today--INEFFECTIVE!!!
Why? It's not a criminal justice (?) problem. Duh!

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