Methadone Today

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Volume I, Number 7 - 6 (August - June 1996)


What is the Purpose of Drug Laws? - by John Lystad
NOTICE - In Memory of Ira Sobel - by Beth Francisco
LAAM: The Real Deal - by Ira Sobel
Dangerous Prescedent - by Beth Francisco
Sad Tales From Nassau County Jail - by Donna Schoen (Reprinted from Methadone Awareness October 1995)
Why IV Users Deserve Clean Needles - Maia Szalavitz
Recovery and Harm Reduction - Beth Francisco
The Seven Day Issue: Sneak Attack!!! - Ira Sobel

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by John Lystad

My name is John, and I am currently in a methadone program since I have long past the stage where I could tolerate what I would have to do in order to support my habit of heroin. Here is a short essay on how I view restrictive drug laws.

Let us not forget that drug addicts are human beings and as such are guaranteed certain rights in the Constitution--the Bill of Rights. Is this not correct? Consider for a second that modern medical science has recently determined addiction to be genetic in nature and not a choice. Even without that, don't we have the right to the pursuit of happiness as long as we do not hurt other people at least in the physical sense? If so, why are we treated worse than violent offenders when it comes to punishments handed down by the courts? It seems absurd that a nation could actually release a murderer from prison so as to make room for a drug offender. As far as I can see, drug use in and of itself is a victimless crime if there is no legal or emotional stigma attached to it. When extreme artificial importance is attached to something such as the propaganda supporting the "drug war," a common result is fascination, neurosis, and irrational behavior. If an adult wishes to use a mind or body altering substance, it should be up to that individual.

No one owns your body except yourself so, therefore, shouldn't "you" be the deciding factor of what goes into it? If not, who is to decide and on what basis or whose consideration? It seems that for all my adult years, somebody or something has been preventing me from exercising my freedom of choice in a fundamental way. It has been decided for me one of the most basic of human rights--what I can or cannot put into my own body. Am I not smart enough or important enough to decide for myself what goes into my own body?

Why was "drug prohibition" started in the first place? When the Harrison Narcotic Act was passed, there was hardly any drug problem at all. Out of all the drugs available when they were legal, there was maybe one addict out of a thousand people, and anyone could just go to the corner store and buy drugs cheaply. Now, after over eighty years of this vicious drug war Puritanism, just look at the marvelous result. Drugs, having become profitable, are everywhere. Enough is enough; besides, I hardly think there is anyone on the face of the planet who is better qualified than me to decide what is right for me.

Since I was born, I have never seen a day when drugs have not been hunted down, demonized, condemned, scapegoated, and oh yes, widely used and hugely profitable. I do not advocate drug use but, at the same time, I do not condemn it. After all, "drug prohibition" causes the very thing it is supposed to suppress--large scale use. This widespread usage comes from the fact that if you know you have something that people will always want and have always wanted, then lo and behold it's suddenly made illegal, you can practically set your price, thus producing huge profits for any person willing to risk selling it.

Many people seem to think that addicts are involved in crime so much because they are high on drugs; nothing could be further from the truth. In reality, it's more like this: The addict wakes up in the morning with a terrible knowledge that he/she must come up with an almost unreal amount of money just to sustain their habit in order to be able to function for one more day. Since no honest job can afford them enough money to support their habit at prohibition prices, the addict must resort to crime if no other legal way exists for them to continually come up with exorbitant amounts of money.

In early addiction, many people, if employed, can afford a light indulgence on their salary alone. It is common, however, that as the addiction grows, the job will no longer support the growing appetite for the drug. This causes absenteeism because a person going through withdrawal is likely to miss work in order to come up with some quick money, legal or not, just to feel better. Of course, this costs the employer money and often leads to termination of the employee which in itself has a tendency in many people to increase their desire to use.

There is another problem with highly restrictive drug laws. They are terribly expensive to maintain. Who pays? We all do in our taxes that no longer go toward truly beneficial social programs that improve our quality of life so as to be able to pay $30,000 per inmate per year to keep drug offenders in overcrowded jails. Law enforcement and penal institution budgets must also be continually increased to keep up with the unnecessary but now abundant drug-related crime.
Our ill-conceived drug policy also takes an emotional toll. Who nowadays isn't worried about becoming the victim of crime? Could this lead to an automatic distrust of people unknown to us? What effect does this have? What parent isn't worried about their child becoming a casualty of drug-selling violence or peer pressure? Schools are infested with drug "entrepreneurs" marketing their product. Why? As long as drugs are illegal, they will be unnaturally profitable, and wherever there is a lucrative market for something, people will take advantage of it and cash in. So, ultimately, anti-drug laws produce more, not less drug consumption.

If you're hip to hypocrisy, look at the U.S. as regards Columbia or Panama. America told Columbia to stop growing coca or suffer economic consequences while, at the very same time, the U.S. is their biggest customer for it, making it a most profitable crop. Second, think of the Noriega incident where America actually invaded another sovereign nation to kidnap its president, ostensibly because he didn't do what the U.S. told him to do regarding the coca trade. I say "ostensibly" because I believe the real reason America captured Panama's president and put him in prison is because he had somehow become a threat to some powerful people's business interests. I wonder how America would feel if Panama invaded America and took the president hostage? Not too good I would imagine.

Cocaine production will never decrease as long as there is a lucrative market for it, and as long as people keep making a big fuss about it, there will always be a lucrative market. This is simply an aspect of the law of supply and demand that holds true for all goods and services.

It's time America stopped confusing a medical problem with a criminal one. The damage already done is immeasurable. The dangers of holding on to our greed-inspired drug policies include the very real possibility of losing some of the most precious things that this country was founded on--Life, Liberty, and the pursuit of happiness, free from unreasonable intrusions into some of the most private aspects of our lives under the guise of law and order.

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by Beth Francisco

Ira Sobel died Sunday, July 7, 1996. He had been hospitalized the week prior for symptoms resulting from Hepatitis C. According to Joycelyn Woods, Executive Vice-President of NAMA, he checked himself out of the hospital against medical advice and started having chest pains a few days later. He called 911 but by the time they arrived, he was dead.

Hepatitis C is a disease of the liver, and it is common among addicts due to the sharing of needles and other infected paraphernalia. Active addicts and those who have not used in years are susceptible to this virus. Interferon is used to treat Hepatitis C, along with strict diet, good personal hygiene, and abstinence from alcohol.

Ira experienced a bout of Hepatitis C in March 1995. In his own words from an article he wrote:

I experienced severe pain in my legs and ankles. My legs swelled up and became bloated. I had water retention. I was unaware that this swelling to my legs is a tell-tale sign of something bad. I went to a liver specialist who took my blood, and he directed me to have a sonogram.

Signs of the Hepatitis C Virus (HCV) are:

Elevated liver enzymes
Blood transfusion history
Sex with an IV drug user
Intravenous use history
Swelling of hands or feet (Edema)
Scab-like lesions over arms and legs

Many of you have commented that you enjoyed reading Ira's articles. I still have some that he sent me to publish, so you will see his name in print periodically (In fact, the article by Ira "LAAM: The Real Deal" was written just before he died. He was having trouble faxing it to me, and he decided he was only going to try one last time--fortunately for us, it worked because he died soon after). Just out of the hospital, he was worrying about the newsletters for which he wrote. Ira made a great contribution to Methadone Today, and we will miss his enthusiasm for methadone advocacy. I know I will certainly miss his Sunday phone calls to find out how the newsletter was going. Ira was a great support to me and Methadone Today.

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LAAM: The Real Deal
by Ira Sobel (New York City)

I was recently informed by my counselor that my program will be offering Levomethadyl Acetate Hydrochloride (LAAM) in January 1997. Right up front I will say that LAAM is not a long-acting methadone!!! It is a different medication altogether. LAAM is growing due to its false claims made by the pharmaceutical company, Roxane. The company puts out a colorful brochure with claims that by switching to their drug, it "gives your patients time for a productive life." What hooey!!!

Believe me, it's all about diversion and how the DEA is going to deal with it. I will try to be objective but again, I say that we on methadone should know all about every change and proposal taking place in the methadone treatment field. In this case, LAAM is just another part of the big picture--just a tip of the iceberg. There are many new changes and proposals taking place in the methadone treatment field, such as:

1. The 7 Day a week, no take-home issue.

2. The conversion from one type of methadone to another type, such as the changeover from orange diskette to cherry methadose. There are at least 4 different types of methadone being dispensed in methadone programs in New York city.

3. LAAM, marketed under the name ORLAAM, is being offered at more programs throughout the United States.

I have written articles relating to each new development. In the June 1996 issue of Methadone Today, I wrote "The Seven Day Issue: Sneak Attack!!!" concerning the DEA and their fight for all patients on methadone to report to the clinic 7 days a week with no take-homes. The basis for these proposals are directly linked to loitering and diversion. To stop diversion, the DEA wants to stop all take-homes.

The DEA has not been successful in busting cocaine cartels. The "War on Drugs" is a failure. So, the powers that be decided to go after people on methadone throughout the country. A Real Sneak Attack!!!

In October 1995, I wrote an article for Methadone Awareness called "Winds of Change" in which I depicted the different types of methadone being used in New York City. In that piece, I talked about the fears and crucial questions every person on methadone has about the possible changeover.

I spoke to many patients who expressed concern when they learned of changes and about the new types of methadone. For years it was felt that the orange diskette would be the only form of methadone dispensed to all people on methadone. Currently, there are at least four different types being used in New York City. They are: Orange diskette, Cherry Methadose, White Diskette, and Clear Liquid, made from powder. When a methadone program changes types of methadone, there is a transitional period whereby the patient's body must adjust to the new medication. So, it seems natural for the patients to have trepidation concerning the change from one type of methadone to another.

I see a similarity between the types of methadone development and now LAAM in that the critical questions and fears remain the same, such as, "Will I feel different or normal? Will I experience a feeling of sickness or anxiety? Will this new type of medication hold me?" That's the bottom line here. It all boils down to the fear of the unknown that makes patients fearful of any change. And that includes me.

Methadone vs. LAAM
The Food and Drug Administration (FDA) approved LAAM, which is the first alternative medication to treat opiate addiction in years. It is touted to be a synthetic opiod similar to methadone but, brothers and sisters, that is not the case. LAAM "is fundamentally a different medication because it produces a lower level of narcotic effects than perceived by the methadone patient." This quote was made by Walter Ling, at a symposium in New York City, co-sponsored by The National Institute on Drug Abuse (NIDA) to brief heroin treatment practitioners on the use of LAAM. Mr. Ling was the principal investigator on two LAAM studies.

LAAM was developed in 1948 as a pain killer. When LAAM was tested in 1952, it was found that the drug could prevent withdrawal symptoms for 72 hours. That is the major selling point to LAAM. The simple fact that the drug lasts up to 72 hours, compared to methadone which lasts from 24-36 hours, is LAAM's ace in the hole. LAAM has some similarities to methadone, but it is not methadone. Yes, LAAM is a synthetic narcotic and yes, it lasts up to 72 hours so patients can reduce the number of times they have to report to the clinic if they choose LAAM1

LAAM is fundamentally a different medication than methadone, and more and more clinic systems are making the switch to include this medication. Roxane, the pharmaceutical company that produces ORLAAM, puts out a pamphlet entitled, "Information for Patients and Family Members" to explain the changeover from methadone to LAAM. Peace.

1That is, unless they have earned once - or twice - per - week take home privileges. There are no LAAM take homes.

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Dangerous Precedent
by Beth Francisco

On March 29, 1996, President Clinton signed into effect Public Law 104-121. This law eliminates addicts from eligibility for Supplemental Security Income (SSI) and Social Security Disability (SSD). The new eligibility requirements are effective "immediately for any new or pending claim for SSI/SSDI benefits based on the disability determination for substance abusers where alcoholism and/or drug addiction is a contributing factor material to the eligibility determination" (AMTA News Report, May 1996). For those already receiving benefits, they will be terminated January 1, 1997 unless they reapply by July 29, 1996 and qualify under the redetermination for something other than alcohol or drug addiction.

This is a dangerous precedent. If drug and alcohol problems are not included in the definition of disability, this could affect Medicaid and insurance companies' funding of drug and alcohol treatment. It is very unfortunate that legislators voted this in and that our President allowed it.

It is very easy to attack addicts, the poor, women, and children. It is very easy to take away from the powerless in society, those who have no voice. This was the easy way out. Addicts have been so demonized that it is very easy to disallow benefits to them. It is the old adage--penny wise, pound foolish. Yes, it may look like a few dollars are being saved, but the fact of the matter is that for every $1 spent on drug and alcohol treatment, there is a $7 saving to society. For every $1 spent on methadone treatment, there is a saving of $12 to $14. Does it still look like the same good deal now?

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Reprinted from Methadone Awareness - October 1995
by Donna Schoen (Long Island, NY)

Several months ago, a friend called me up unusually upset. The father of her child (who was a patient at L.I.J. MMTP) called her from Nassau County Jail. Sick with the AIDS virus, the jail was refusing to medicate him with his methadone. Phone calls from his program were received by the jail, pleading with them to medicate this patient. After all, his body was going through hell from the withdrawal from the methadone and from being sick with the virus.

After 7 days of leaving Mr. J.B. sick, crying and begging like a dog, they finally gave him methadone - a blind 7-day detox. Whatever the blind dose was, it was inadequate. He still suffered. After the 7-day inadequate detox, he was given Clonadine - which is a blood pressure medication which is also inadequate in detoxing someone off of opiates.

Being a Patient Advocate, I was outraged at hearing this. I could feel his suffering. As chairperson of the Patient Committee at Long Island Jewish, and a member of NAMA, I started hearing more and more tales of the mistreatment of methadone maintenance patients at Nassau County Jail. I've heard at least 40 stories from people that I know were there.

I was at Rikers Island back in 1992, and I know they have the ‘KEEP Program' there. I believe Suffolk County also makes provisions for methadone patients. All I could think was "What's wrong with these people? How can they treat human beings like this?" They are treating us like dogs. They make us squirm and beg like dogs for our methadone. It is done on a case by case basis. If they decide to detox you, they will. Hard, fast and dangerously!!! And they leave you hanging for days while deciding this.

People have likened the doctor there to someone out of the Gestapo. The stories were outrageous. All I could think of is that something has to be done. Any of us living here in Nassau County could end up there and in the same situation as these people. I started asking people for their stories about their stays in the N.C. Jail. Aside from Mr. J.B.'s story (which I just gave), here are excerpts from some of the stories which I received:

Mr. R.C.
"I repeatedly informed the detectives and then the guards at NC Jail that I was on a Methadone Program and on a dosage of 100 mgs. I told them that a detox from such a high dose could be detrimental. The guards told me "That's your problem. It's not our fault that you're a drug addict." While in lock-up, I started having heart palpitations and was rushed to Nassau County Medical Center (NCMC), where I was medicated. But no one would tell me what amount was being administered."

(**What other person, asides from a desperate addict, would accept being given a medication and not knowing what dose they were receiving??!)

Mr. M.G.
"My fifth and most terrifying experience went like this: I came down to 40 mgs. in anticipation of spending 4 months in Nassau County Jail Hell. I received a 9-day detox. About 3 days after the end of my detox, I got really sick and was unable to stop vomiting. In the course of 1 month, I lost at least 40 pounds. I visited NCMC at least 2 times and was told it was a stomach virus. I was put on a liquid diet and I stayed in the shower all day and threw up all night. I told them I was sick and withdrawing, but none of the doctors at the jail wanted to hear that. To make a long story short, they gave me exploratory surgery, and I have the 12-inch scar to prove it. The only thing they found was a partial obstruction, which the surgeon said was formed from vomiting for such a long time. I wouldn't wish this treatment on an enemy! Nassau County needs a change! It's long overdue!"

(**Mr. M.G. had similar experiences with other detoxes at Nassau County Jail, but none as devastating as this one.)

Mr. B.D.
"I went to Nassau County Jail on A DWI in January 1992. I told the doctor that I was on methadone and was legally on a prescription for Xanax (see note below). I never saw an actual doctor, just a guy with a limp. They said, "Get this guy out of here." They sent me to NCMC. They chained me to a bed and let me withdraw. They gave me Ipecac syrup to induce vomiting. After 2 days, I was finally given methadone. They never gave me anything to detox me from the pills. I was chained to a bed for 21 days. Then I was returned to the jail. I hadn't slept in 44 days. After I got back to the jail, I had a seizure. Another inmate, (Mr. S.) Had full-blown AIDS. He was on 100 mgs. of methadone. The doctor told him that the methadone was killing him. They scared him into stopping the methadone. He ended up in unbearable pain, had dementia and was given dialysis. He died."

(**Xanax is one of the most dangerous detoxes. Anyone that is detoxing is vomiting enough on their own without being given something to induce vomiting. Inducing vomiting on a person that is detoxing is cruel and dangerous. This could cause the person to dehydrate, among other things.)

Something must be done. Although the right thing would be to maintain meth patients on their present dose (like diabetics are), the least that could be done is for the jail to institute a "KEEP" program. None of these people deserve to be treated like this. This is the 1990's - not the Dark Ages! Methadone has been used successfully for 30 years. We should not be thrown in a cell like animals, left without our medication and sick like dogs. Do these people have any compassion? I guess not. Something has to change.

Note from the editors of Methadone Today:
Although these stories happened in Nassau County Jail, any city, Anywhere, USA could be substituted. It is a sad fact that this is what we have come to because addicts have been so demonized that people don't care what happens to them. If an animal was treated the way these people were treated, there would be animal rights activists knocking down doors and screaming for resignations. But, these are "just" addicts, and "they" didn't go to jail to be fed their drugs. That's the mentality of this country when discussing drugs, I'm sad to say. Something certainly does have to change, and that "something" is people's attitudes about a medical problem that has been made a criminal "justice" problem.

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Why IV Users Deserve Clean Needles
by Maia Szalavitz

They hadn't seen such a crowd on Delancey Street in years. Two weeks ago, ACT UP and Jon Parker's National AIDS Brigade, incensed by the mayor's decision to close the city's needle exchange program, came to hand out syringes and bleach. The Guardian Angels came to stage a counter-protest. When the cops moved in, the shouting reached a feverish pitch. As the TV cameras focused on activists being handcuffed, a few addicts took advantage of the confusion, grabbed some bleach, and fled down a side street.

Opponents of safe drug-use programs have long argued that distributing needles and bleach only encourages addiction. They maintain that people who use drugs are seeking death and won't take steps to protect themselves from AIDS. They say that addicts like to share needles. They are wrong on all three counts.

I first shot drugs in 1986. A friend gave me my wings. I heard ringing emptiness in my head and wanted the sensation to last forever. My friend had injected me with his own works. As I went on to shoot heroin, I continued to share--but only when there weren't enough needles to go around. When sociologists first saw needle sharing, they labeled it a "sub-cultural ritual." The myth was that sharing was somehow part of the high--like passing a joint. But no one asked addicts why they share. The media was all too willing to point out negative attributes of drug users, but when it came to needles we were suddenly supposed to be generous.

In fact, I never saw needle sharing as a ritual and never heard of anyone who has. Needles are not meant to be reused. The second user gets a duller point. When you shoot someone else's blood, you might get a highly unpleasant reaction--called a "bonecrusher" on the street.

The only person I've known who was eager to share was notorious for it--because no one else liked to do it. He was the poorest of the crowd of junkies I knew. He injected other people's blood because he thought there might be dope left in it (He later died of a cocaine overdose, leaving behind a pregnant, HIV-positive girlfriend).

A second myth is that addicts don't care enough about life to protect themselves from AIDS. While I was doing heroin, I didn't want to die; I wanted to live without pain. I told myself heroin was keeping me from suicide. AIDS did not offer such promise--only slow, painful, almost certain death.

Two months after I started shooting up, a counselor from San Francisco showed me how I could protect myself by cleaning my works. From that time until I got straight, I was never without a bottle of Clorox. I cleaned my works compulsively, just as I used them.

My experience is hardly unique. In San Francisco, before 1986, only 12 per cent of drug users surveyed said they cleaned their needles. But three years later, after a massive street education campaign, the portion had jumped to almost 80 per cent. Infection rates among IV users in San Francisco haven't risen above 15 per cent since the campaign got underway.

Some needle exchange opponents look at these figures and say bleach alone might do the trick. But with bleach, needle sharing still occurs, and with it the chance that HIV might be transmitted. San Francisco's success isn't just due to bleach; though needles are illegal there too, the city quietly tolerates an informal exchange program.

In cities where needle exchange is openly permitted--Seattle, Portland, Tacoma, Sydney, Hong Kong, Paris, London, Glasgow, Liverpool, and Amsterdam--HIV infection rates have stabilized at low levels. In Edinburgh, after a police crackdown on syringes in 1987, infection rates abruptly jumped 10 per cent; six months after needle exchange was instituted, no further increase was seen.
Meanwhile, according to a 1988 New York County Lawyers Association study, in nine states where needles are illegal the rate of infected IV users is six times higher than in states where needles can be bought over the counter. The state with the highest rate of all is New York, where as many as 150,000 addicts are believed to be infected and each day risk spreading the virus to other addicts, to their spouses, to their unborn children.

Opponents of needle exchange are blinded by a third myth: that distributing needles encourages drug abuse. But there has been no increase in cities where needles are exchanged. In fact, in some of these cities, drug abuse has declined.

Some opponents, particularly in minority communities, believe that the government purposefully tolerates drug dealing and mistake the effort to save lives through needle distribution as a form of genocide. They believe the only way to stop AIDS among users is drug treatment. But those in the minority community who work with addicts daily, like Yolanda Serrano of the Association for Drug Abuse, Prevention, and Treatment, are vocal advocates of needle exchange. They understand that even in the best rehab programs only a very small fraction stay clean for life.

On my last day using drugs, I weighed only 80 pounds. I had pulled out large clumps of my hair and I was an etiolated grayish-green. I was 23 and looked twice my age. I looked like an AIDS patient in the final stages. I found myself begging a friend for his heroin--pleading, groveling, humiliated. Suddenly I had a moment of clarity. I saw that I was near death.

This moment can't be artificially induced. Being around others who are recovering helps, but the desire to quit must come up from within. And once it's there, the sight of a needle isn't going to remove it. That's why the Pavlovian argument against needle exchange fails. The sight of a needle is no more likely to make a recovering addict shoot up than the sight of a spoon.

And needle exchange can be a bridge to treatment. When I went with Jon Parker's brigade to the streets of Bushwick, where I used to cop dope, within minutes addicts surrounded him, as if drawn magnetically. They didn't just take the needles and run. They listened so they could learn how to stay safe. And they asked about getting clean.

When you give addicts needles, you're giving them the right message--that someone cares enough to want them to stay free of AIDS even if they continue to use drugs. Dead addicts don't recover.

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Recovery and Harm Reduction
by Beth Francisco

Since the beginning of the so-called "Drug War" and "zero tolerance," our government has been waging war on the citizens of this country without regard for the realities of life. It is unrealistic to demand zero tolerance, especially when we know that addiction is a disease and genetically passed on from one generation to the next. However, the Drug Enforcement Agency has become a bloated, powerful bureaucracy that does not intend to give up its power without a fierce fight. This also applies to some other agencies who wield their power and will not let go. This in the face of interfering with harm reduction policies and treatment of addiction in any other way than total abstinence. Recovery and success do not have to mean total abstinence and, in fact, to wait for total abstinence to deem an addict successful dooms most to total failure. Addiction is a medical problem and belongs with the medical profession--not the criminal justice system.

I found a newsgroup on the Internet devoted to harm reduction, and several disturbing items were emailed to me. The first was an article concerning a needle exchange project in New Jersey. Two volunteers doing needle exchange work were arrested by the Middlesex County Prosecutor's Office. This is absolutely intolerable in this day of AIDS. In a perfect world, no one would be addicted, and no one would be using IV drugs, but this is not a perfect world. To arrest people devoted to harm reduction is imposing death sentences on addicts who are PEOPLE who happen to have a disease. For anyone interested in contacting the DA who ordered the arrest, his name is Robert Gluck, P.O. Box 71, New Brunswick, NJ 08903.

Another item from the San Francisco Chronicle, April 19 (UPI) concerned "Illegal Mexican black tar heroin contaminated with an aggressive flesh-eating bacteria [which] killed two addicts and sickened another 15." One of the ways health officials got the word out to addicts was through the needle exchange program. Of course, this happened in San Francisco and the needle exchange activists who were arrested were in New Jersey, but how many addicts contracted AIDS through needle sharing while these activists were in jail? One is too many!

Probably none of us knew John Szyler, but we all probably know someone like him. He was an addict, the founder of the Chicago Recovery Alliance, and his definition of recovery was "any positive change." John died Saturday, May 4th with three bags of heroin at his side--one was used. It is unknown whether he overdosed, had "an allergic reaction, poison or whatever--John had little control over the chemical composition of the drug [or] its contaminates." Because addicts cannot go to their doctors and because doctors usually want nothing to do with addiction because they will have the Drug Enforcement Agency breathing down their necks, addicts do not know what they are getting when they buy a drug. Sad--this person was described as "a man who loved life and lived it to the fullest. He was an example to all around him by his kindness and advocacy for people with HIV and for drug users. He will be severely missed by all who knew him." I did not know John, and you probably don't either, but he most likely did not have to die. Had he been able to go to a physician for his addiction, he would probably be alive today to continue to be an example for his kindness. Hey, everybody out there with all this power over life and death, we are people--we are addicts, yes, but we are people, and we do not deserve a death sentence.

We, in methadone treatment, are in a different phase of recovery. Most of us are not using street drugs anymore, but we are still treated like criminals. We are looked down upon. We are treated not as people with a medical problem, but we are treated like a person with a moral deficiency. We do not deserve that kind of treatment; we need to be treated as any other person who has a medical problem, and it is about time for a wake-up call for our politicians. We no longer (if we ever did) have a "war on drugs." What we have is a "war on addicts" in this country. We have totally impossible laws regarding drug possession--on one hand, we have the Supreme Court saying that addiction is not a crime, but just possessing the materials needed to relieve the addiction is a crime. What's goin' on here? It is time we found out which politicians are for us, which are against us and force them to take a stand one way or the other. Addicts are people, not criminals.

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The Seven Day Issue: Sneak Attack!!!
by Ira Sobel (New York City)

The issue at hand is in black and white. The DEA wants all people on methadone to report to the clinic 7 days a week. The charge: DIVERSION OF METHADONE. That's every day, brothers and sisters. It won't matter if you are working and haven't had a dirty urine in years. The DEA doesn't discriminate. It will be across the board and that, unfortunately, means all of us. I have to admit that if these proposals go through, we on methadone will suffer.

The basis for these proposals are directly linked to loitering and diversion. That's the bottom line. The DEA does not care to talk about "good" patients or "good programs!!!" No, all they see is diversion. In their eyes, every person on methadone diverts their take-home medication. Anyone who has read one of my articles on the concept of methaphobia will understand when I say that the DEA is one of the biggest methaphobic organizations in the USA today. That's fact!!!

The DEA is getting their noses into the wrong arena. Every person on methadone is in recovery. Statistics will reveal that the DEA should stick to busting cocaine cartels and stay out of the mental health and addictions field. In truth, the DEA has not been successful in bringing international drug dealing operations to their knees. The so-called "war on drugs" is a failure.

So the powers that be decided to go after people in methadone programs throughout the United States. A real sneak attack. It doesn't matter to them that methadone is a treatment modality. So, they employed the same surveillance techniques and undercover operations they regularly utilize in order to catch cocaine barons. So, to the DEA, each person on methadone is a criminal.

The DEA is fervent in their aim to have every person on methadone report to their clinics 7 days a week. There are thousands of people on methadone who have matured out of committing felony crimes and drug-related activities. Methadone has been the key factor in helping thousands upon thousands of recovering people to change from their previous life of failure and defeat into the new life of integrity and victory. The DEA sees diversion, and all I see is that hidden population of methadone patients who have stopped committing crimes, are gainfully employed, own businesses, are going to school, getting job training, are raising children, and haven't had a dirty urine in years. The last contact with the "old life" is coming to the clinic. Sometimes the program is located in the same neighborhoods where they used to buy and use drugs. So, they fight for phase changes. These people have simply beat drugs and have been assimilated into the mainstream, the work force, the straight world.

Loitering is one of the most negative behaviors to affect methadone treatment. The central problem is that some non-working patients have too much time on their hands. If these patients had a structured schedule, whether inside their methadone programs or referred out to other agencies, programs, services, and schools, then the authorities and people who live in the community would begin to see less loitering and patients hanging out near the clinics.

People in programs have a lot of talent that just needs encouragement and support. If there were programs like day care from 9 to 5, patients could be transformed into productive members of society. Methadone programs should adopt a plan to give patients realistic goals to strive for. It would enable us on methadone to excel at something constructive. This is very important because anyone on methadone knows first hand the slurs, chides, and put downs made by family, law enforcement groups, and people in general who know nothing of the reality of methadone maintenance. With a new component, patients everywhere would get a boost in the self-esteem department!

Since I walk by many programs here in New York City, it's simple to tell whether the program has a loitering problem or not. In its place could be a combination of program security, outreach workers, counselors, and other staff members. I would love to see a counselor motioning with his arms to the patients outside to come on in because we have so many new activities! "Welcome, welcome!" I would love to see that. The sooner the welcome, the better!

I believe that together we can change people's attitudes about methadone treatment by reducing loitering and diversion and finding new interests for the patients by: 1) Running programs/classes inside the clinic, 2) Having GED classes so that patients can get their high school diploma, 3) Indoctrinating more methadone awareness meetings at every clinic, 4) Setting up a patient committee to address the loitering issue and other aspects of the program, and 5) Dosing patients at a dose high enough to eliminate the need for diversion (as evidenced by scientific instead of criminal justice guidelines). This would entail a holistic approach for the good of the program, the patients themselves, and the community at large.

I think that a patient committee could be set up with eight patients, two staff members, and the doctor of the clinic. This group can help patients with problems, institute more services at the clinic, and run methadone awareness meetings. I also feel that having GED classes would help those who had problems in schools or are self conscious about their shortcomings with reading and comprehension.

To require attendance at the clinic 7 days a week will hurt all patients in the program, but it will be the "good patients" who have successfully demonstrated their progress in the program who will suffer the most. They are invariably on a one or two-day-a-week pickup schedule and have been for years because of their courageous fight to beat drugs and advance themselves in the workplace.

Patients who work full time will be forced to report to the clinic daily, before work. This proposal is really unfair because the DEA doesn't want to know that many patients are working today due to being on methadone which has allowed them to stop drug use. Methadone treatment works. When a patient hasn't had a dirty urine for a specified amount of time, that patient gets a supervised urine, and then the phase change goes through. This translates into coming to the clinic less frequently. These are the patients (and there are many) who work towards progressing in the program. And by working, we patients are beating the odds that are against us. That is why everyone on methadone, who is employed or who is otherwise using their time constructively, is a winner.

Most clinics close before 5:00 p.m., so if we cannot come on a certain day due to our jobs, we will suffer the consequences--NO MEDICATION! So, the person is stuck. Which is more important: The job or the methadone? For most, there will be no job without the methadone. This is a crucial point. Many people have made the wrong choice and are now back on drugs. The DEA doesn't want to know what a relapse is or if the person has bounced back and is making strides in methadone treatment.

There are some providers and owners of methadone programs who are more interested in policing their programs and making money off patients than finding new ways to improve treatment and make services available for you and me (State and Federal agency regulations have to share in the blame--timewise, she sheer enormity of the tons of paperwork that has to be dealt with excludes this. Paperwork is more important than the patient's life). Loitering will cease when methadone programs start adopting goals for us to strive for, and this will only be accomplished when medical treatment is turned back to medicine. Despite the odds against us, the majority of patients, like myself, do not loiter and/or divert. We are in recovery, and there are hundreds of people who go to 12-step and other self-help groups.


In this case, that means the DEA. Diversion is ruining everything for everybody. We patients who report to the clinic one or two days a week are the ones who will get burned the most, and anyone working toward that goal will lose all initiative to do well. The DEA is pushing for this change in policy which will affect the entire methadone system in the United States of America. We must be aware of these proposals, and we as patients must be united in order to change policy. Methadone advocates are increasing. The National Alliance of Methadone Advocates (NAMA) is expanding day by day. New chapters are forming. In essence, these are exciting times for everyone on methadone. We have a sole purpose: PATIENTS' RIGHTS. That is for you in Marysville, California; you in Milwaukee; you in Gary, Indiana; and you in Detroit, Michigan.

We are all brothers and sisters living on the same spirit! We will make our stand together. I declare, "All patients on methadone throughout the USA must unite to fight against the oppressors, the persecutors, the enemies, the methaphobics, the DEA." - Peace.

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