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Volume III, Issue 3 (March 1998)
Dr. Vincent Dole Interview (Part II) - by Odus Green
The Naltrexone "Cure" - by Adam
Addicts vs Doctors: Another Version - by Howard Lotsof
LAAM - by Dr. Marc Shinderman
Another Naltrexone Experience - by Nancy (DONT Member)
Briefly Speaking - Short items - quotes, 'n stuff
Doctor's Column - Questions for Methadone Today's Medical Advisory Board
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Dr. Vincent Dole Interview (Part II)
by Odus Green
This is the second of a two-part interview with Dr. Vincent Dole, Father of Methadone
Maintenance. This material was gleaned from two seperate conversations we had over
a two day period in January. Dr. Dole is without doubt one of the most humble, self-effacing
men I have ever had the pleasure of meeting. I can only hope this interview can convey
the intelligence and dedication of this man. To this day, he is still very much involved
with Methadone and its application toward freeing drug addicts from their dilemma.
That dilemma being the black market which the government keeps strong and viable
simply by keeping drugs illegal and treatment all but unobtainable. The fact is,
even if one is able to get into a treatment program, the rules which govern dispensing
methadone are archaic and very constraining in their application. Hopefully, one
day methadone will be available through private physicians. Only then will many people
be able to lead full, normal lives. As it stands now, we will continue to be "punished"
as long as we remain in treatment.
Odus: How do you see "for-profit" clinics affecting Methadone treatment today.
Dr. Dole: I believe there is too much prejudice against "for-profit" clinics. While there is some foundation for prejudice against them, you must remember that any hospital or medical clinic is in business to make a profit. Now, to open a Methadone clinic strictly because you see a profit is doing nothing more than handing out medicine; that is obviously wrong and motivated by greed. Still, if you look at the history of practicing medicine, doctors have always had to make enough money to eat. I do not see making a profit as a bad thing, and I think it can be good, particularly if it breeds competition. You see, if money is being made, then others will want to enter the field, and this keeps any one person from having a monopoly, thus charging whatever he wants. Competition will ultimately keep the prices down to an affordable level. However, I do not at all like the idea of exploiting people to make money.
Odus: How do you feel about the licensing procedure for Methadone clinics?
Dr. Dole: Well, I do believe it helps keep out many doctors who would otherwise not be the best choice for the position. However, it also tends to facilitate the hiring of people with little scientific knowledge and they don't really care either. Some of the people who are lower on the scale tend to see themselves as simply "filling a slot" and only there to fulfill the rules. This is not the best environment in which to carry on treatment. In some states, the system is set up so that it is purely political in nature, and that is definitely detrimental to Methadone treatment. These politically based clinics are typically some of the worst around.
Odus: How do you see private physicians fitting into the scheme of things in the future?
Dr. Dole: I feel that this will go a long way toward addressing the size problem we are faced with now. Many clinics have way too many patients on their programs. There is no way one physician can handle 500 or 600 patients. Also, this translates into counselors having 50 or 60 patients. You can't assure proper treatment when it takes all your time simply to fill out paper work. With all the paperwork required, there is simply no time for counseling, and this is a sad situation.
Odus: Have you read the "Swiss Heroin Report" and if so, what did you think about that?
Dr. Dole: Well, yes, I did read it. The question, "What did I think" reminds me of the old question "How's your wife?" and the obvious answer is, "Compared to what?" My feeling is, the attitude with which the Swiss approached this is a pragmatic one. They left behind the presumptions and simply said, "Let's just see what we can do to help," and that in itself is a good thing. I feel that this alone makes it much more successful than a repressive study. Unfortunately, it is posed here in such a way as to say "Which drug is more successful, this drug or that drug?" My own experience is that heroin is not an ideal drug for maintenance simply because its period of action is just too short. Also, injection is not the ideal way to give a medicine which will be taken frequently.
Odus: What do you think about drug prohibition altogether?
Dr. Dole: Now, that is an open-ended question. By that I mean, you can't just give a "yes" or "no" answer to it. Certainly, prohibition as we've seen it has been unproductive. It has had the opposite effect from its intentions. The question is, "What can we do to ensure the rational use of dangerous drugs?" The forces of prejudice, ignorance, and demand are such that it cannot be "solved" by policy or law. Taken in context of time, it is obvious that these drugs have been used since their discovery and will continue to be used in the future by some people. What to do about that, I don't have the answer. There is no policy which can change anything overnight, which is what politicians will try to do. Actually, political expediency is sometimes hostile to common sense. All we can do is try to change the trend in which the country is heading.
Odus: From my reading, I understand you had many detractors during your years of research. Who were they, and why were they against your work?
Dr. Dole: Oh yes, there were many who didn't like what I was saying, especially the "Federal Bureau of Narcotics and Dangerous Drugs" (BNDD--this is the forerunner to today's DEA). They tried every way possible to discredit me. Luckily, I was sufficiently entrenched in the University system that they couldn't do anything. Their power was too weak to reach me there. Now, Dr. Nyswander actually did risk imprisonment in her work. She was simply a private practice doctor who risked her freedom many times to help addicted persons. In that position, she didn't have the protection I did being a University researcher. I will say there was a lot of drama between myself and Mr. Anslinger (Mr. Anslinger was the head of BNDD).
Odus: Anything you'd like to add for folks to know?
Dr. Dole: Just that you people who are involved in advocacy, keep up the work. I have seen changes come about because of people becoming involved. It is these who are the real heroes in all this. Without advocacy, changes will not come about within the present system.
This ends the interview. Again, I'd like to Thank Beth, Editor of Methadone Today, for making this possible. I hope everyone will take Dr. Dole's advice and become involved in advocacy at your own clinic. Even the little things will add up to a total advocacy movement. Let's not take the word of anyone and assume "It's in the regs." If you follow up on many of the more outrageous rules you encounter, you will find that the worst rules are instituted at the clinic level, not the federal or state level. The clinic is the easiest place to change these rules. All it takes is a bit of dedication and hard work. Together, we can change things folks. Some day, I want to be going to my own physician for my medicine, as I should have been doing for years now. Thanks to all. - Odus
Thanks again to Dr. Dole for consenting to this interview for Methadone Today's readers. Thanks to Odus for dropping everything to help me out, those on the methadone list who submitted questions, and the Drug Policy Foundation for making
it all possible. - Beth Francisco, Editor
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The Naltrexone "Cure"
I'm unfortunately already dependent on opiates but have fortunately received pharmaceutical
morphine the last 5 years - with one break; I tried the "Naltrexone Cure"
three years ago--you know, a procedure they carry out in private hospitals/clinics
in Spain, Israel, and probably other countries as well (I did it in Israel) where
they fill your body up first with naloxone (the drug they use for OD's) while you're
under prolonged anaesthesia, 8 hours in my case (I was using 100 mg methadone daily
at the time), whereafter you wake up in *heavy* withdrawal.
They tell you before the operation that as you wake up from the anesthesia, you will have gone through all the worst, and you'll then only experience a few remaining/residual withdrawal symptoms. I recall they had this thing for explaining the procedure in a very annoying manner; I actually get goosey all over thinking of their layman patronising explanation, going like this: "we are going to fill your body with a fluid that makes it possible to compress the whole process of withdrawal into 4-8 hours, and as the pains during this will be so bad, we'll put you to sleep during this, but when you wake up the worst is over, and you're almost fully recovered." Of course, shame on me that I didn't check out the medical facts behind the procedure before entering it, but now I, of course, know that what they say is completely impossible and, alas, just a way of selling their "cure." All this procedure is actually doing is filling your body up with a major dose of nalexone, and the instant withdrawal triggered by such a *continuing* excess dose naloxone would be impossible to endure if not under total anesthesia. This puts you into withdrawal big time, but it doesn't compress the duration of withdrawal at all as they had alleged. They even admitted this after the operation and said that was their method of talking people into it, as they then believe they have succeeded in their goal, which is that the patient now can't find relief in taking opiates as they've made him or her resistant.
AND this is where I really got mad and still am with the whole affair; they basically lied to trick me into a treatment program that anyway can be terminated by the patient him or herself after 3-4 days if he or she decides not to take the pill--in other words it's an antabuse approach more than a "cure."
After the anesthesia, the patient is supposed to take a daily tablet of Naltrexone every day as it makes it impossible for the patient to get any effect from opiates and as such should stop any sudden craving. It is also "supposed" to diminish general craving. I hung in there for two months, which I'm pretty proud of as I was feeling incredibly sick the whole time with no improvement in sight--you know the kind of sickness/withdrawal where you're incapable of doing anything, not even read. Sleep was completely out of the question, so after two weeks with not one minute of sleep, I was close to going insane. I was really determined to quit, so I kept taking the naltrexone as they, of course, told me it soon would get better.
At this point, I had to begin to take benzos; even the doctor who was in personal charge of my case and who had denied me benzos so far was now more than willing to prescribe me 2 mg flunitrazepam straight off (aka Rohypnol in the US), as he was probably afraid of a suicide on his hands. So I began sleeping, and after one month in Israel, I went back to Europe still feeling very sick but now able to sleep. After two months, I was taking 8 mg of flunitrazepam daily, and as I had always hated benzos and saw no light at the end of the tunnel, I stopped taking the Naltrexone pills and went straight to my doctor to get a new methadone script after having done heroin only one time, as I knew I'd continue on opiates.
Summa Sumarum-- it took me more than a year to kick my benzo habit, and the operation and trip to Israel set me back about 8,000 U.S. dollars--not that the latter prosaic issue is so important, but the whole experience has made me very dubious towards alternative instant "cures" for opiate dependency--besides Ibogaine--about which I admitedly know little. I just heard there should be some other herbal cure offered in Korea, know about that?
Editor's Note: Heantos, to which Adam refers, means "heat of the sun." It is a Vietnamese herbal treatment--a mixture of 13 plants and herbs, and it is "supposed" to ease withdrawal and cure opiate addiction. Heantos was created in the 1980s by Dr. Tran Khuong Dan, a Vietnamese physician whose father and brother were addicted to opiates.
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Addicts vs Doctors: Another Version
by Howard Lotsof
It would be easy for me to write this report if it were a matter of another uncaring
doctor or nurse mistreating a methadone patient or police brutality demonstrated
towards heroin addicts. But, this is my own story. The story of a young heroin addict
in the 1960s who, in a study of exotic drugs, discovered Ibogaine, a substance that
is now an experimental anti-addictive medication for the elimination of narcotic
withdrawal and to interrupt drug craving behavior. I was 19 years old at the time
of my discovery and a new heroin addict. Heroin had not yet left its mark on me.
I had not lost my job, my home or my non-using friends. No one except my drug using
friends knew I was taking heroin, and I viewed its use as romantic and exciting as
do many young users.
My interests in drugs varied widely including that in hallucinogens, and one day I was offered a dose of Ibogaine, a substance found in the West African shrub, Tabernanthe iboga. I had no Idea what Ibogaine would do, and I certainly had no intent of stopping my heroin use. About thirty hours passed during which I was in a waking dream state for about 4 hours. My next memories until I fell asleep were vague. My last thought before finally falling asleep, exhausted, was that I would sleep for a week. I woke up 3 hours later completely refreshed but still had no idea what had happened to me.
My first perception upon waking was that I was surprised how refreshed I felt after only 3 hours sleep. I dressed and left my parents house when it hit me that I wasn't in narcotic withdrawal, and the next thought to pass through my mind was that my perception of heroin changed from a drug that gave me comfort to one that emulated death. My final thought was that I preferred life to death. In all, I provided doses of Ibogaine to 6 heroin addicts other than myself and to 14 non addicts. None of us who were addicted experienced withdrawal, and 5 out of 7 of us stayed off heroin for at least 6 months from that single dose of Ibogaine. None of us had the intention of stopping our heroin use. That was an effect of the Ibogaine.
Times were changing. The enforcement arm of the FDA stopped our access to Ibogaine, and I moved to California from New York, got married, and after about a year moved back to New York where somewhere in 1968/69, I became re-addicted to heroin. There was no availability to Ibogaine, and when the first methadone programs began to expand and take in patients, it was like a Godsend. I hated being a heroin addict. Like most, I loved the effects of heroin, but it was no longer romantic. I was sick more than I was high. And, I did not want a life where one person would kill another for a few cents worth of heroin. I took to methadone like it was made for me. I tried heroin only once to test methadone's opioid-blocking effect and was convinced. I never used heroin again.
I stayed on the methadone program for 3 years. These were the Dole and Nyswander days. Drs. Dole and Nyswander were the developers of methadone maintenance. They cared for their patients, and that care showed in the results they were having that demonstrated methadone was a highly effective treatment for heroin addiction.
Problems in the methadone programs began when federal and state authorities started to place more and more restrictions on methadone patients. I could see the handwriting on the wall and realized that I did not want to switch from the pusher on the street to the pusher in Washington. Most methadone patients believed you could not get off methadone, but from my Ibogaine experience, I knew that addiction was reversible. Slowly, very slowly, milligram by milligram, I began to come down from 100 mgs a day. Eighteen months later, after a final month at 1-1/4 mg per day, I was off methadone. I coordinated my last dose with a month at a country house of a friend and had arranged a scholarship to New York University to study film and television in the fall.
Everything was going well. I finished school but realized that I was not going to make it in the film industry. For some years, I production managed the Rock Against Racism Concerts in Central Park, but after three years of having to fight with the City of New York for permits and cooperation to put on concerts that should have been welcomed, I decided I wanted to do something more permanent--something that would benefit people and not have to be fought for on a yearly basis. The answer to me was Ibogaine, the medication that allowed me to free myself of narcotic dependence.
After spending about a year in medical and scientific libraries reviewing Ibogaine, opiate and cocaine literature, I realized that I was not knowledgeable enough to write a scientific paper on the matter but that I did have the ability to write a patent that would allow the marketing of Ibogaine to treat addiction, and that is what I did.
The next step was to begin to get scientists to listen, and that was not easy. As a former addict, walking in and telling addiction specialists that I had discovered the breakthrough they had been looking for for decades was not the story they wanted to hear. Eventually, I brought my work to the National Institute on Drug Abuse (NIDA) sometime around 1984 and was told my information was interesting but they wanted to see animal verification of Ibogaine's effects before they would consider treating it seriously. My feelings at that time were, animals were animals, and people were people, and it could not be expected that animal effects would be similar to the effects of Ibogaine seen in myself and my friends in 1962. I was wrong. Animal research mimicked the effects of Ibogaine on humans.
Further human and animal research carried out in Holland and then animal research in the United States, showed that Ibogaine acted on animals and humans in a similar manner. Some people and some animals stopped self-administration of drugs from a single treatment of Ibogaine. Some animals and some people stopped after two treatments, some after three treatments, and some animals never stopped at all.
If we were going to get anywhere, we had to get FDA approval for human research in the United States. If we obtained approval, it would mean Ibogaine would be available to anyone who needed it. That was our plan. In 1991, I made the acquaintance of Deborah Mash, a molecular biologist and political powerhouse at the University of Miami. It was one of many strange Ibogaine meetings. She had heard of Ibogaine, and I had heard of her work with cocaethylene, a drug produced when alcohol and cocaine are taken together. I had just gotten her on the phone to talk about cocaethylene when she said, "What about Ibogaine?" I was stunned, as I had not mentioned it to her, but she had just returned from a scientific meeting where three other researchers presented on Ibogaine.
Our meeting eventually led to a contract between her employer, the University of Miami School of Medicine, and NDA, the company my friends and I had established to bring Ibogaine to the market. Deborah was one of the most dynamic scientific administrators I had ever met. Her husband, Joe Geller, was Chairman of the Dade Country Democratic Party, and they were Hillary/Bill Clinton Associates. Animal research with Ibogaine was going on in the United States and Europe, and Deborah and I working together along with Act-Up and other activist groups were able to convince the FDA to allow human experimentation.
The work was proceeding, but the fulfillment of the contractual obligations by the University were not. We were not receiving reports, copies of government communications, and research data as called for. Deborah had a hot temper, and I figured the best approach was to let her keep working rather than immediately demanding the data, but there were increasing clues that we were in for trouble.
Although the FDA gave the University permission to proceed to the next step of research, they stopped work on Ibogaine and informed us their obligations to finish the study had been completed. We disagreed and back and forth letters of demands and refusals for information went on through 1995 until May 1997 when Deborah Mash filed a complaint against me in Federal Court in Miami stating in simple terms that I had stolen an invention of hers. This was untrue. The invention was for a new patent I had filed for the use of betacarbolines in combination with noribogaine. An example of a betacarboline would be harmaline, a substance that is one of the ingredients in Yage or Ayahuasca used in the Sainte Daime Church.
Noribogaine is a metabolite of ibogaine. A metabolite is a drug that is created by the body when you take another drug. For instance when you take Ibogaine, noribogaine is created. When you take heroin, the body changes it to morphine. During her research, Deborah found that noribogaine was created when you took Ibogaine, and as this was reported to be her discovery, we applied for a patent for noribogaine alone to treat chemical dependence.
The contract between the University of Miami and NDA called for all inventions relating to the work to be the property of NDA, and that is why the patent application for noribogaine was assigned to NDA. The Patent Office was resistant to awarding the noribogaine patent and rejected it three times. Shortly thereafter, Deborah filed charges against me in Federal Court stating that the Betacarboline in combination with noribogaine patent was hers and that I had failed to properly fight for her noribogaine patent with the intent of depriving the University of the small percentage of profits that they were to receive if noribogaine was ever commercialized. The reality was that Deborah, either out of ignorance or purpose, never overcame the Patent Office objections to the noribogaine patent and further, she had never supplied me with any information indicating the combined used of betacarbolines and noribogaine to treat addiction.
The reason she filed the legal complaint against me became apparent two days after I received the court papers. I discovered that in breach of the contract, after the University stopped the FDA approved Ibogaine studies that would have benefited tens to hundreds of thousands of heroin, cocaine, alcohol and methadone users, Deborah developed and patented a series of new drugs, Bioactive Tricyclic Ibogaine Analogs, to compete with Ibogaine. These drugs, by the Agreement between the University of Miami and NDA, should have been the property of NDA. Instead, Deborah and her associates wrongfully assigned them to the University of Miami and the University of Minnesota.
What really got me mad was being called a thief of her property. Though I had been driven into poverty by actions she had taken to destroy myself and NDA, I borrowed money and began to fight back in Federal Court in Miami, and NDA filed charges against the University of Miami in New York State Supreme Court as the University was the party with whom NDA had contracted, not Deborah. The University had cost us millions of dollars in development by stopping the FDA study. We filed our complaint against the University for breach of contact, fraud, and for not controlling their employee, Deborah Mash, among other charges. Soon, I found myself fighting four law firms and a well-connected political machine whose purpose was to destroy my reputation and take what I had worked 17 years to create: a highly effective treatment for addiction. My intention was to make it available in a way in which it would be there for anyone who needed it through private and/or social medical insurance. How this will all end, I cannot say, but take this from me: Just because you have been a heroin addict or are a methadone patient doesn't mean that you can never again be a creative, productive person or should not fight back even if you're attacked by those who have enough money to sink a battleship.
My message to you is to believe in yourself. Fight for your rights, and don't let anyone put you down for being who you are. Keep the faith and wish me luck. I feel like I am in three biblical scenarios at once: David and Goliath, Daniel in the Lions' Den, and Job.
For those of you who have access to the internet, Ibogaine information can be obtained at:
http://www.Ibogaine.org or http://www.Ibogaine.desk.nl
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by Dr. Marc Shinderman
LAAM is an addition to options for addicts. Period. LAAM is better for whomever
likes it better than methadone. MOST patients do NOT prefer it, but some do. You
only know if you try it. Half of my patients that choose to try it go back to methadone
ultimately. Other clinics have better things to say about it, but my guess is that
it has to do with differences in take home or methadone dose options in those clinics
compared with ours (they cannot get take homes with methadone, or cannot get a dose
of it that stops their drug craving is what I mean). Doses of LAAM which are acceptable
to the clinic sometimes stop craving in patients who can not be stabilized on a 100
mg dose, which is the maximum given in some treatment settings.
There are advantages and disadvantages with LAAM due to regulatory problems as compared with methadone. Once these regulatory problems are ironed out, we may get a better idea of the maximum value of the drug. I am specifically talking about the regulations which now prohibit take home doses of LAAM. This makes it less desirable to many patients who now come to the clinic one or two days a week or who must travel frequently.
There are advantages and disadvantages between medications due to pharmacological (pharmacokinetic) and side effect profile differences . For instance, those who benefit from split dosing or flexible timing of drug effect based on employment (or other physical and mental) demands, pain management or other situations where pulsed medication doses are required, may prefer to have a shorter-acting medication like methadone under their control.
The DEA thinks that any drug which cannot be diverted and lets you have minimal contact with the patient is better. In that regard, LAAM is better. Methadone is preferable for some patients with hepatitis. Due to the long action and unpredictable sedation with LAAM, mild overdose is more likely, and the treatment of serious overdose is more complicated than with methadone. In terms of cost and inconvenience, difficulties with induction, medicating after missed days, around holidays, during vacations, and compulsory monthly pregnancy testing, methadone has some big advantages, currently. Regulation changes could diminish some of those problems by allowing take homes and travel bottles. Hydromorphone implants (Dilaudid) are better still in some folks' opinion for those who do not mind getting subcutaneous implants every so often. (See your local oncologist, until it becomes legal for maintenance.)
On site heroin maintenance is best for a small percentage of addicts (if you can move to Switzerland and fail methadone treatment a few times). Codeine phosphate works for many patients in Germany, and buprenorphine has its proponents (mainly those with uncomplicated opiate addiction and lower levels of opiod tolerance). Different opiates might be a perfect fit for maintenance in a given patient or in a certain stage of treatment in the same patient. Not only are all addicts not created equal, but their ability to benefit from one opiate or another may change during the course of their lives.
It is clear that we all need more options, both in drug choice and the structure of treatment settings to get the best results for many patients who are not well served by the current offerings. Consensus is, however, methadone in MMT best meets the needs of most patients most of the time.
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Another Naltrexone Experience
by Nancy R. (DONT member)
Several DONT members asked around (in person and on the Internet for anyone who
has gone through a "rapid detox procedure" to let us know how it worked
for them. There were quite a few responses, but only one man responded who said he
had positive results with it.
Richard said he had the procedure done inpatient in a hospital in Miami. He had been on methadone for 11 years, taking between 70 and 110 mg daily. At the time of undergoing "rapid detox," he was at 70 mg. He told us he was under anesthesia for twelve hours! He took Naltrexone for only 30 days afterward (that is all he said he needed). Also, on the first evening of the procedure, he was given a Valium. Richard reported that he had mild discomfort but nothing unbearable. He was able to sleep just fine. When he called us at DONT in December 1997, he reported he had not relapsed since the procedure.
Richard also stated that he had tried withdrawing from Methadone in various ways over the past 11 years: He had tried inpatient 30 days in a hospital (couldn't sleep well for over six weeks), he had cold-turkeyed in jail (absolute hell), and he had tried slow detoxing over a long period of time outpatient through his clinic. Out of all the methods mentioned, Richard claims the rapid detox worked best for him.
Richard's success with the naltrexone detox seems to be a rare outcome of the procedure. From the responses we received, numerous doctor's reports, and the various literature on this procedure, it seems that it has the best chance of working for someone like a professional (who is extremely motivated and has a good support system) and for addicts with a short history of using opiates, i.e. a few years or less.
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More than 10 million marijuana arrests since 1965. . . Another every 54
seconds! - Your tax dollars at work.
Travel to exotic places, Lie to Congress with impunity, Good Pay and FREE DRUGS, Contact CIA for details.
"God grant me the ingenuity to escape the things I can not change, the money and will to change the things I can, and good lawyers to know the difference."
"I have sworn upon the altar of God, eternal hostility against every form of tyranny over the mind of man." - Thomas Jefferson
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