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Volume II, Issue 11 (November 1997)
Dear Doctor (Open Letter) - Magic
The Good News Is. . . .
The Bad News Is. . . .
A Warning About Alcohol - Lyle
Natural Opioids - by Roberto Nardini
Response to "Ignorance" - Aaron
Briefly Speaking - Short items about drugs in
Back Page - Philosophy of Methadone Maintenance: From A Counselor
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Dear Doctor (Open Letter)
I'd give anything to have a chance to do my life over. My greatest pain today,
with all that I have done to myself and with the images and thoughts (mind movies)
I am forced to live with forever, is the complete lack of understanding and compassion
for a human being who, for one reason or another, completely screwed-up their life.
Believe me, we as addicts have enough to deal with as it is. This stigma
we all live under is a plentiful hassle all unto itself. Just imagine, you enroll
in treatment, you're committed, asking for help; you clean yourself up and utilize
the tools of your treatment, all to have an irate neighbor (twice) filming you go
in and out of your methadone clinic, soon to be shown on cable access t.v. for all
to see. That's confidentiality? Not to mention the Portland police frequently parked
out front, checking plates, waiting and watching.
Methadone has not only
actually saved my life but has helped me to function very well. I have been clean
from illegal opiates for about 3 years except one time after a difficult, prolonged
death in my family--no excuse--I just didn't deal with it properly.
I have struck a compassionate chord in your soul? You see doctor, every time that
I inform someone in your profession, about my illness, a disease that was probably
inherited--at the very least, a learned behavior--not to mention the new studies
into the complex brain chemicals, leading to the conclusion of a dysfunction that
I may never be able to do anything about, I am met with suspicion and a general,
noticeable lack of care.
I really do understand the position this puts
an M.D. in. That is why I have never asked for a prescription for anything and have,
up until now, always informed my new M.D. of my addiction history. I always wanted
to be honest and up front, even going as far as telling this new doctor that I would
never put him in a bad position (i.e. asking for drugs). I just wanted care and
to be treated like any other patient. This is without a doubt a protection for me
first and at least, I thought, security for the new doctor.
Even the very
doctor who prescribes my methadone has said that he hates us. And in his own words,
he once leaned over the table to me and stated: You dope fiends and whores think
you have all the answers. This after asking him if he had any knowledge of some new
treatments that were going on in Europe.
I've come a very long way and have
demonstrated to myself, my two fantastic children, my great, beautifully understanding
wife of 14 years, and anyone with whom I come in contact, that I am an honest, trustworthy,
and genuinely good person--not a dope fiend.
Well Doctor, if I've still got
your attention and you still want me as a regular patient, I have one favor to ask
of you: Do you remember, a few months ago, I received a complete physical from you?
Well once a year, I am required by my clinic to obtain a physical exam. This is
mainly done by the clinic M.D.--this same doctor mentioned above gives us a 3-minute
exam (no kidding!) 3-5 minutes in & out to the tune of $75 which, of course,
our insurance won't cover, plus, a blood panel, which I have already had done. He
is also required to take our temperature and blood pressure; this has never been
performed--at least on me, it hasn't.
This year I got permission to see
you, doctor. Not only do I not want that other uncaring, "hates-us M.D."
to put his hands on me at all but, I got much more value from you with the unbiased,
real, complete physical that you gave me. Plus, my insurance covers me for one complete
exam a year. I pay $240.00 a month out of pocket for the equivalent of two 10 mg.
dolophine tablets a day, with basically no other therapy except one group meeting
for 1 & ½ hours once a month that I am required to attend. I have always paid
for my illness--never the state. Just like the N.A. meetings I attend outside of
the clinic, I take it upon myself to help myself.
As I said, most of us are
deeply ashamed of our condition at almost every level, no matter how well we are
doing. I just could not tell you, when I first met you. I just wanted care--not
more disappointment. For that, I am truly sorry, and I really hope that you do understand.
Here is the catch: My clinic needs (wants) acknowledgment from you stating that
you are aware of my being on methadone maintenance and that you were aware of this
when you did my exam. I asked the director why was this necessary, especially since
they have the paperwork from you that I gave them. Also, when in comparison to a
3-minute clinic exam, to your most thorough, complete physical, what could you have
possibly missed? This is just one, among the many hoops and road-blocks that they
always pull. Just when you think you have a handle on your life situation, they
change the rules, pulling the rug out from under you. No real thought in what the
outcome will be or how it will affect any of us--just implement new policy because
it sounds good to them and because they have every right to do so.
please remember, I will absolutely understand if this is not possible. Or, without
having to tell this little white lie, we can go the other way: I'll make an appointment
and you can re-examine me to meet this requirement. I have a real phobia about this,
doctor. Please help if you can.
One last thing, thank you so very much for
taking your valuable time to read all this. I also promise you, if you decide to
keep me as a patient, I will never ask for any kind of medicine that might put you
in a bad position. Thank you once again, Respectfully, M.
sure that you do not know this, but you already have a patient who is on methadone
right now. He won't tell you for the same reason that I was afraid.
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THE GOOD NEWS IS.
. . .
"Doctors everywhere should be allowed to prescribe methadone to help fight
heroin addiction more widely," Barry McCaffrey, National Drug Control Policy
Director said. He criticized current policy which requires addicts to go to clinics
``If we do this thing correctly, if we allow the dose rates
to be prescribed by doctors and not by policy, if we allow it to be decentralized
so that physicians who are trained and monitored are allowed to dispense the drug
instead of necessarily having it only in some centralized locations. . .we're going
to make a big difference,'' he said at the NIDA Heroin Conference, September 29-30,
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THE BAD NEWS IS. ..
Mike H., one of our fellow methadone patients who wrote "Faith in Recovery"
for the March 1997 issue of Methadone Today, died last week of a massive coronary.
Mike had been decreasing his dose steadily over the last several months and was
down to a very few milligrams.
We were told he was being pressured to detox
the rest of the way from his medication (not by the clinic), and he just quit taking
it. We were also told that the shock from the sudden withdrawal and damage to his
heart from prior drug use was probably a contributing factor to the cause of death.
We will miss Mike.
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A Warning About
I was talking to my counselor one day about the use of alcohol while on methadone
maintenance. She told me that if the dosing nurse suspects you are under the influence
of alcohol, you may have to take a breathalyser test. Depending upon your BAL (blood
alcohol level), the nurse may refuse to dose you!
I know that many of us
DO have problems with alcohol, and we may be better off to completely avoid it.
But those of us who enjoy a beer during Saturday afternoon football should be aware
that a drink before going to the clinic could cause you to have a serious problem
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Response to "Ignorance"
This article is in part a response to Beth Francisco's article, "Ignorance."
When I think about the general public's attitude toward methadone and methadone
patients, I often will get very angry. Like the taxi driver in Beth's article, many
people know little or nothing about methadone and have no intention of learning about
addicts and their "legal heroin."
While some people are simply
close-minded and choose to remain ignorant, others are left in the dark or are mislead
by the media. Articles in previous Methadone Todays have covered the local news'
misrepresentation of methadone and methadone patients as, "junkies lining up
to get their free fix. . . ." In other cases, television routinely either ignores
or demonizes methadone patients.
Many television specials on drugs ignore
the very existence of methadone. M-TV did a special on drugs that seemed to me (at
the time) to be relatively balanced (I watched this special before I was a methadone
patient). The special focused on users (former and current) and dealers. When it
got to the subject of heroin, Kurt Loder (the host) introduced us to two registered
addicts in the UK on heroin maintenance. One of the addicts explained how she quickly
got hooked on heroin and explained that the government heroin did not get her high
and barely kept her from getting sick. While the special gave the viewer a glimpse
of the country's "harm reduction" policies, it made no mention of methadone
in the UK or the US.
Another television special, "Dying in Vein",
aired on VH-1 in response to the recent surge in heroin use. "Dying in Vein"
profiled several users, including a famous model, the singer of Sublime (who had
recently died of a heroin overdose), and the singer of Three Dog Night. Not once
was methadone even mentioned.
Finally, heroin was the subject of one of those
"news magazines" that featured an interview with Steven Tyler of Aerosmith.
They told about the recent resurgence in heroin use and how its increased purity
allows the user to snort instead of shoot it. Tyler and other former users tried
to convey the power of the addiction and the intensity of the cravings an addict
experiences. Yet methadone maintenance, the most effective treatment, was never
One would think that in the age of AIDS, an effective treatment
for heroin would be at least mentioned on television or radio specials. Alas, even
a radio advertisement by the Michigan Department of Health did not bring up this
taboo treatment. The advertisement told those in high-risk groups (people having
unprotected sex or using drugs) to get tested for AIDS and if it came back positive,
"treatments are available. . . ." If it came back negative? Just Say
No: "If you take drugs, stop!" Of course, it did not say (if you are going
to continue to use drugs) to stop sharing needles or to clean needles before using
them. No mention of methadone or drug treatment whatsoever. . . .For most heroin
addicts, to just quit cold turkey is about as easy as it would be for the DEA to
stop the flow of cocaine and heroin into this country. . . .
What makes me
the most frustrated about these specials and advertisements is that even the ones
that promote a sympathetic attitude toward addicts do not inform them of all the
available treatments. Furthermore, any good special on drugs and drug addiction
should discuss the success rates of different rehabilitation programs. Any good
special on heroin would at least note the higher long-term success rate of methadone
maintenance over abstinence-oriented programs.
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Since addiction is a big problem, we have submitted to the appealing offer of
fellows who declare to be in a position to cure it, and to do it fast. Those individuals,
most of the time, have earned a lot of money and sent to death thousands of innocent
people whose despair was so great that they could have accepted any promise.
At the recent methadone conference in Chicago (April 1997), Avram Goldstein, the
one who discovered the endorphins in 1975, has declared that the addiction is a TOTALLY
PHYSICAL problem, and that the discomfort due to the lack of balance among the neurons,
which is the only element that triggers the relapse, may last for months--in many
cases, for years and for ever.
The addiction, as a relapsing disease, has
never been considered to be due to the evident, early symptoms of a fast (always
barbarian, anesthesia or not) or even slow withdrawal, but to the permanent PHYSICAL
discomfort which follows them.
This discomfort can be avoided restoring the
missing balance, and that can be done only through the administration af a long lasting
and stable opioid, so that it can work exactly as the missing endorphins. Complying
with this strategy, most addicts can become normal and functioning people, and in
these conditions some, not all of them, can likely in the future try to function
with no substitution. That's what we know from the scientific world at the present.
Do addicts deserve some scientific research? Or are they are condemned to follow
ideological and fake opinions?
We all, who have never been addicted to opiates,
need a bunch of natural opioids in our system, and what is incredible, we want people
who don't produce anymore opioids, to function without them. Isn't that awful?
The natural opioids we produce are crucial for our functioning. They are not named
"methadone" but they work in a similar way. No one could have a normal
life without them. Why do we keep pushing people who don't produce anymore "methadones"
to get rid of them? Why do we want them rapidly cured and for ever? Why do we want
them to risk their lives? Why do we allow dishonest people to solicit their hopes
and expectations? Why?
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1914 - The Harrison Narcotic Act is enacted, controlling the sale of opium
and opium derivatives, and cocaine (Szasz, 1975, Ceremonial Chemistry, New York:
1919 - The Eighteenth Amendment (Prohibition) is
added to the U.S. Constitution.
1920 - The U.S. Department of Agriculture
publishes a pamphlet urging Americans to grow cannabis (marijuana) as a profitable
undertaking (Musto, "An historical perspective on legal and medical responses
to substance abuse", Villanova Law Review, 18:808-817 [May], 1973, p. 816).
- The U.S. Treasury Department issues regulations outlining the treatment of addiction
permitted under the Harrison Act. In Syracuse, New York, the narcotics clinic doctor
report curing 90 percent of their addicts (Lindesmith, The Addict and the Law, p.
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Despite its well-documented success in treating chronic narcotic addiction for
more than 25 years, methadone maintenance treatment has barely survived years of
inadequate funding and negative public perception. Unfortunately, the biochemical
and psychological underpinnings of narcotic addition continue to be misunderstood,
and replacement medications are still viewed with suspicion.
Dole has described the function of methadone maintenance as follows:
treatment is corrective, normalizing neurological and endocrinologic processes in
patients whose endogenous ligand-receptor function has been deranged by long-term
use of powerful narcotic drugs. Why some persons who are exposed to narcotics are
more susceptible than others to this derangement and whether long-term addicts can
recover normal function without maintenance therapy are questions for the future.
At present, the most that can be said is that there seems to be a specific neurological
basis for the compulsive use of heroin by addicts and that methadone taken in optimal
doses can correct the disorder ("Implications of methadone maintenance for theories
of narcotic addiction", Journal of the American Medical Association; 260:3025,
Source: U.S. Department of Health and Human Services (DHHS), Treatment
Improvement Protocol (TIP) Series 1, State Methadone Treatment Guidelines (Parinno,
Mark W., Ch. 1, p. 1). Ordering Information: 1-(800) SAY NO TO; Ask for TIP 1 or
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