Volume II, Number 4 - April 1997 (This is another 6-page special issue--the
print version has more information than the online version due to my lack of knowledge
of formatting online in chart form - Editor)
Doctor's Column can be seen: Here
Methadone in Australia - Dr. Andrew Byrne
Big Differences: Methadone Clinics in England - John
Check Out Your HMO Before Signing Up
Rights Advisor/DONT Meeting - Beth Francisco, Editor
Did You Know?
METHADONE IN AUSTRALIA
by Andrew Byrne
As in America, the history of methadone treatment in Australia is long and bumpy.
It was first used in 1969 in Sydney within a couple of years of the introduction
of recreational heroin to our country by servicemen on leave from the Vietnam war.
With the help of a couple of devoted people and a few hundred initial patients, the
word slowly spread that methadone had advantages for addicts as well as society generally.
It was used in a haphazard manner in some states during the 1970s (but that is better
than no methadone in the other states!).
In 1985 there was a Special Premiers'
(= State Governors) Conference to discuss a strategy for the looming HIV epidemic.
Already Australia had initial cases, and people were dying. Methadone treatment was
recommended as a way of reducing needle sharing. Hence, a vast expansion of the numbers
in treatment commenced in different ways in the various states.
Wales used generalist doctors like myself to prescribe methadone, whereas previously
only psychiatrists were permitted to do so. Other states mostly used large centralized
clinics, most of which have since closed down. For the past ten years, methadone
has been available from a variety of sources in New South Wales (population 5.5 million;
capital, Sydney)--private and public hospitals, local community pharmacies, traditional
clinics, most prisons, (some) emergency rooms and even (exceptionally) doctors' offices.
All Australian methadone for addiction treatment is given as a foul-tasting
liquid which is paid for directly by the federal government. Note this is the drug
itself, which costs about 50 cents per dose (average 65mg). The dispensing, however,
costs from $3 to $7 daily, depending on the setting (pharmacies the cheapest and
private clinics the most expensive).
If patients are hospitalized for any
reason, the Health Department requires that they be given their normal dose by the
hospital on telephone confirmation of the last dose from the patient's normal dispensary.
This usually works well, although a few hospital staff members are still methadone
We now have strict rules (which are usually adhered to) that
if methadone patients are taken into police custody, they must be permitted their
medication within 24 hours, even if that means the police taking the patient to their
clinic. Usually, in practice, it is simpler since they are released sooner, or else
there is an obliging clinic nearby with a reciprocal arrangement to dose the patient
on receipt of a confirmatory fax. All prisons are now obliged to maintain patients
on methadone on the inside if they were on treatment on the outside.
and prison officers were initially resistant to these moves, but they have since
mostly come on side for the simple reason that it is humane and very practical. Patients
who are given their normal daily medicine are cooperative and appreciative, whereas
those denied treatment can understandably become rather stroppy (angry). These innovations
have been successful in New South Wales but, like condoms in prisons, the policies
have yet to be used widely in other states or territories.
All things considered,
the story has been quite the reverse of what I read of the American experience of
methadone treatment delivery. We still have some waiting lists, it can be quite expensive
and take-home doses can be hard to obtain. But generally, most Australian addicts
who want to get methadone can access it one way or another.
We still have
a large heroin problem, and overdose deaths are increasing. But, we now have over
35,000 patients who have been on methadone (15,000 currently). They all used to be
unstable heroin users but most now lead relatively normal lives. Indeed, amongst
them are physicians, nurses, legal workers, airline staff and others from virtually
every walk of life.
Our most notable achievement has been the very low rate
of HIV amongst drug users. With needle exchanges widely available, methadone treatment,
as well as education campaigns, the incidence of HIV has remained less than 2%. In
spite of this good fortune, we have over 90% positive for hepatitis C.
are lessons for Australia in the US experience, but the reverse may also be true.
In a future paper, I will outline the nuts and bolts of what treatment entails in
this country. I would also like to address the brave new world of methadone maintenance
alternatives, buprenorphine, Kapanol, Pallium and even heroin itself. While we have
limited experience, these drugs are being used in various parts of the world. Results
are awaited with interest.
Written by Dr. Andrew Byrne, General Practice
Physician in Sydney, Australia. Dr. Byrne has also written 2 books on the subject:
"Methadone in the Treatment of Narcotic Addiction" and "Addict in
the Family". $US14 and $9 respectively, including postage. Contact Tel: (612)
9319 5524 Fax: (612) 9318 0631 E-mail: email@example.com
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Big Differences--Methadone Clinics
by John Lystad (a longtime methadone patient)
I recently had the good fortune to visit England. Since I am on methadone maintenance,
and the FDA refused to allow me any take home methadone, it was necessary for me
to dose at a London clinic during my stay.
For an American in my situation,
this proved easier said than done. First off, dosing status must be arranged by the
clinic, not the guest, and apparently my clinic had a rather difficult time doing
whatever had to be done in order for me to guest dose in London. I received no word
on my guest-dosing status for months.
This was an extremely stressful time
for me because I had planned, saved, and dreamed about this trip for a long time.
If I were denied access to methadone, it would mean horrible withdrawals, or possibly
worse. Actually, it probably would have meant that all of my dreams, planning, and
the non-refundable airline ticket I purchased all went for nothing because I would
be too scared to go. But, just days before my flight, confirmation of dosing status
was granted, and a London clinic address was given to me.
ENGLISH METHADONE CLINICS FREE! OFFER HOPE AND DIGNITY TO PATIENTS
There are some major differences between methadone clinics in England compared
with those in the US. One big difference is that no one in England can be refused
treatment because of inability to pay; they are free to everyone including non-citizens.
Imagine that! The doctors there focus more on harm reduction and medicine rather
than making a profit. There was no bullet-proof glass, no mandatory drug testing
(except for gaining initial admittance to the program), no strong boxes were necessary,
they do not picture I.D. you every single visit (no matter how well they know you)
like they do in America (Editor's note: This is a clinic, not a government, regulation).
Counseling sessions are available but not required. I also could not help but notice
that there was no "You got a problem with that?" attitude from anyone in
the whole place.
As an American, I was pleased to be given the dignity of
take home medication. Everyone gets take home medication in English clinics, even
me. Here, in my own country, I am denied take home medication.
It was also
nice to see truly helpful and useful information available and distributed--things
like where to find shelter, a hot meal, a shower, clothes, medical attention, etc.,
as well as guides on transportation, nutrition, parenting, medical emergencies and
health bulletins. They made me feel like a regular person, not a morally deficient
inconvenience and of no consequence.
In many ways, the British treat methadone
patients with far more dignity and concern than the US does. The British medical
community does not punish methadone patients because of the nature of their illness,
and doctors are given much more freedom to treat patients as individuals. Under English
law, doctors are allowed a wider range of possible treatments in order to better
address the differing needs of their patients. This is tremendously beneficial because
what works for one person may not be effective for another.
will sometimes prescribe an addict's drug or drugs of choice when the life of the
patient is clearly in danger from use of impure street drugs. The people who are
maintained on pharmaceutically pure, abusable drugs are prescribed those drugs because
it was determined to be the most effective way of reducing the harm of addiction
and improving the quality of life for those people. These therapies mean nothing
less than survival for some people in the throes of addiction.
does not allow an addict dignity, equal medical treatment or rights, and it has not
been effective in curbing drug use, the English approach has proved promising. After
years of medically-supervised drug maintenance, many addicts have actually gotten
over the "thrill" of using drugs and gradually began to see it as more
of a waste of time. A good portion of the people who are prescribed their drugs of
choice quit using on their own after a time. It is through the purity of their prescribed
drugs and the hygienic, medically-informed conditions that legal drug maintenance
allows them that many patients survive the most self-destructive years of their addictions.
Unlike America, England never really had a "War on Drugs" (which actually
translates into a "War on Personal Rights", or more basically, a "War
on People"). America has had the same old tired anti-drug campaign for almost
a hundred years now. Most Americans have been spoon-fed anti-drug ads, commercials,
political campaigns, TV shows, etc. since birth, thus hating and blaming drugs and
drugs users comes easy. Heck, it's almost politically correct; it's certainly common,
and there are more drugs and drug money around than ever.
not warped the English sense of objectivity about drugs as much as it has here in
America--that's why the English are more tolerant, realistic, less hysterical and
more effective in dealing with the matter. It is interesting that in a country where
many abusable drugs can prescribed legally to maintain addicts that the addiction
level is among the lowest in the world, and the recovery rate is one of the highest.
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One advantage of being online is the wealth of information available about methadone
from all countries. The Swiss Methadone Report: Narcotic Substitution in the Treatment
of Heroin Addicts in Switzerland (3rd ed.) was offered to me through one of the lists
I subscribe to.
This report states that the Swiss policy demands an "age
restriction of 20 years for initiation to methadone substitution treatment",
and "two unsuccessful in-patient withdrawal treatment attempts" are usually
required before methadone maintenance is allowed.
In Switzerland, "people
already receiving methadone substitution treatment can continue to be treated
in nearly all district or regional prisons. In 89.66% of such institutions it is
possible to continue treatment for an unlimited amount of time. In another 5.17%
treatment is limited for a time period, which varies between one and twelve months."
For those inmates already incarcerated, methadone treatment is not allowed
to be initiated in approximately half the cases. "When asked to briefly describe
those situations that enabled a new indication for methadone treatment, 26 institutions
indicated that they did so to prevent relapses. This is particularly true for those
persons going on vacation or preparing for dismissal."
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Check Out Your HMO
Before Signing Up
The necessity of switching to HMOs is a sad, but true, reality. Soon, there will
be no other choice, but before you sign up for one, you can call the National Committee
for Quality Assurance (NCQA). The NCQA rates HMOs on their medical care, doctors'
qualifications, and several other factors. One out of every eight HMOs fail this
test. Most of the big ones, which care for about half the people enrolled across
the country, have been rated, though the committee is still reviewing others.
For a copy of the Free Accreditation Status List, call toll free (800) 839-6487 between
9 a.m. and 5 p.m.
Also, Methadone Today and DONT have been advised that the
HMOs are either not paying for methadone treatment or are slow paying. Many of them
have been referring methadone patients to non-methadone treatment centers--in other
words, abstinence-oriented treatment.
Although we have been stressing the
inadequacies of and problems with HMOs over the past year and a half, we cannot repeat
enough that you emphasize to the HMO BEFORE you sign up with them that
you are on methadone maintenance. Also underscore to them that only licensed
clinics are able to dispense methadone, your treatment choice. Insist that
you be given referral to a methadone clinic before signing.
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DETROIT - On March 5, 1997, DONT officers met with Kristy Reed,
Recipient Rights Advisor for Parkview/NPL. At that time, Kristy explained the complaint
process to us. If you have a problem but do not want to file a formal complaint,
call her at 7-Mile Parkview/NPL (810) 532-8015 and tell her what the problem is.
She can arrange for you and the offending person to meet to talk through the problem
with her as mediator.
If, however, you wish to file a formal complaint,
you can get a complaint form at any of the Parkview/NPL clinics. Fill out the form
and mail it to Ms. Reed. She has 14 days in which to investigate the complaint and
get back to you. If you do not hear from her or if you are dissatisfied with her
ruling, you can then file the complaint with the Regional Rights Advisor.
Also, if you would like to take a DONT officer along with you, we have made arrangements
for that possibility. You will need to notify us and fill out a release of information
form for the session. If you do not know your DONT patient advocate, write
to Methadone Today, and we will tell you who your advocate is.
a process that should be used if you experience problems. All too often, we complain
about treatment from certain staff persons but do not do anything about it. This
is a formal, legal process; once it is started, do not worry about repercussions
from filing it.
Although this was explained by the Recipient Rights Advisor
at Parkview/NPL, the procedure should be the same at other clinics, minus the DONT
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4th Century - St. John Chrysostom (345-407), Bishop of Constantinople:
"I hear man cry, Would there be no wine! O folly! O madness!' Is it wine that
causes this abuse? No, for if you say, Would there were no light!' because of the
informers, and would there were no women because of adultery" (Quoted in Berton
Roueche, The Neutral Spirit, pp. 150-151).
1985 - Pentagon spends
$40 million on interdiction.
More tax dollars are spent on the "Drug
War" than on the space program. Shame on us!
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Did You Know?
"Methadone Anonymous" is confusing and only adds to the misconceptions
and myths about methadone. NAMA conducted a "man in the street" survey,
interviewing about 100 people from all walks of life. We asked people: "What
do you think Methadone Anonymous is?"
Most of the answers were, "It's
a detox group; it's for people wanting to get off methadone", or "It's
a group for people who have detoxed from methadone." Very few answered correctly,
less than 18%, that Methadone Anonymous is a 12-step group for methadone patients.
In other words, no one understood what Methadone Anonymous was for!
explained what Methadone Anonymous was, and asked them if they thought the name was
a misnomer. Everyone said yes! (100%) This made it clear to NAMA--as we had suspected--that
the name Methadone Anonymous was confusing to people. I am certain you understand
the myths, misconceptions and confusions that abound regarding methadone maintenance
treatment. So why add to it! And in fact, isn't the name Methadone Anonymous an oxymoron!
Would not "Heroin Anonymous" be more correct? Are not all the anonymous
groups struggling against the preceding word, and are not methadone patients struggling
against heroin, not methadone!
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