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Methadone Today

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Volume II, Issue 6 (June 1997)

Can You Believe It? - by Magic

Protease Inhibitors, HIV & Methadone - by Beth Francisco

Dear Ken T. - by Dr. Andrew Byrne (Australia)

Methadone Today (The Newsletter) - by Ray/DONT

Medications & Substances Causing False Positives - Jefwriter

Briefly Speaking - Short items about drugs in history

Please Note - New information and reminders


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Can You Believe It?
by Magic

There was a flier stapled to my 7-year-old son's school information. Can you believe it. . .? I was shocked, insulted, and most of all, very angry to say the least.

You see, the clinic is overcrowded and needs to move into this area. Not only have 3 out of 6 independent clinics closed their doors in less than a year, but as you all know, government funding has stopped for some patients.

Add to that, our heroin quality is on the rise (Cuban replacing the long-time Mexican Tar); plus, the prices just keep falling. . .! Last year at this time, the price for a gram was between $160 and $200. Now, it's between $110 and $150. Not to forget the many patients who have been kicked off their programs due to the new, petty, noncompliance rules and regulations, last week one of our powers that be in the State legislature tried to get methadone thrown out of Oregon altogether. Talk is flying about a plan to limit your program stay to only one year. There is pressure everywhere.

You know, I always thought our schools taught "our" children acceptance and tolerance for others. . .? If this was a protest of a minority, AIDS/cancer patients (of which we have many), can you even imagine what the results would be? Many lawsuits, I am sure, but with addicts, it's just A-o.k.--without a second thought!!!

I could somewhat understand this assault coming from an organization like a Neighborhood Association--but through our schools (for which we also pay hard-earned money), with impressionable minds, is absolutely criminal. This is a very hateful message only used to poison the students' minds against patients who truly have a medical disease.

We, as a nation, are becoming completely Victorian in nature. In Portland, Oregon, we have the ruling elite behind and all through "our" Neighborhood Associations. They have made it almost impossible to live here what with our "Prostitution Free Zones", the "Drug Free Zones", the Marijuana Task Force, Community Policing, and a host of many more restrictive plans enforced without pity, mainly due to Portland's claim to fame as a lab for social experiments before they become national. Now this!! Nothing surprises me any more.

Oh, did I mention outcome-based education? Big Business is our partner now, and we all know how much they care about "Our" children. Huh? Just look at Tobacco, Alcohol, Nike anyone. . .?

Their great social plan is to enslave "Our" children for a globally-competitive work force--how thoughtful! Pray for "Our" Patients.

Thanks so much. Respectfully. . . . .MAGIC

Editor's Note: The school got its way, and the clinic did not open. However, what they do not realize is that untreated addicts are already lurking on their streets. ‘Two minutes in this direction, Magic says, "there's a guy who has been selling out of his house for four or five years. Three minutes the other way, there's another guy who was kicked off the methadone program and is now selling dope." For every person who loses their spot in a methadone clinic, that's one more robbery or two or three that the moral entrepreneurs have set us up to deal with every day. Will they ever get it through their heads?

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Protease Inhibitors, HIV & Methadone
by Beth Francisco

According to Dr. Marc Shinderman, the Center for Addictive Problems (cap), Chicago, patients who are on protease inhibitors for HIV should be able to get drugs that do not interfere with their stability on methadone, or they should be able to get increases in their methadone dose to keep up with the serum-level-lowering effects of the drug. A new protease inhibitor, Crixivan, by Merick, probably does not lower serum levels of methadone as do Norvir and others.

Dr. Shinderman states that the danger with these drugs is that "once on a protease inhibitor, you get really high levels of HIV virus if you go off of it." What is happening with patients is that they get withdrawal from the antiviral drugs lowering their methadone serum levels, realize that is it the new medicine that is making them unstable on their dose, "stop taking the protease inhibitor, feel better and then lie to or avoid the HIV doctor regarding their compliance with treatment. They then get a big increase in HIV virus. It would be better to get them on Crixivan or get big methadone increases to maintain adequate serum methadone levels. Cimetadine (Tagamet) might even help methadone levels rise. LAAM levels are increased by Dilantin and some other meds which lower methadone levels. This might be the case with protease inhibitors, but I do not have any experience with that combination, yet."

Most doctors do not know about managing the protease inhibitors in methadone maintenance patients. The patients may not be complaining or may not be listened to, at their clinics. Some patients may be reluctant to reveal their status, (being on methadone or being on medication for HIV) altogether. I think that signs should be posted in clinics to make patients aware that some of these medications can put them into withdrawal and that there are ways to deal with it, without giving up the new, lifesaving protease inhibitor medication. People will die, who do not have to, without this information. Additionally, HIV+ patients on methadone should be aware of a new medication that is highly effective with Crixivan, which is a once-a-day drug, called "266" available for "compassionate use" from DuPont, for those who have found it hard to comply with the three to five time a day dosing routines necessary with other anti-HIV "cocktails".

Methadone Today thanks Dr. Shinderman for this valuable information.

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Dear Ken T.
by Dr. Andrew Byrne (Australia)

Your call for common sense, perseverance and understanding on the part of the public may be asking too much at present. Mr. and Mrs. Average are as yet probably not ready to treat addiction like diabetes, depression and other medical or behavioral problems. However, your expectation that medical people should understand the nature of addiction and its treatment is very reasonable.

In Australia, we now have hundreds of doctors trained in how to prescribe methadone in the treatment of narcotic addiction. At least four states now have family doctors who treat heroin addicts, mostly with methadone. An essential element of the instruction is that doctors, nurses and pharmacists involved be non-judgmental. They need to understand the benefits, limitations and dangers of methadone maintenance treatment (MMT). It is up to individuals to decide their goal in treatment, be it maintenance, abstinence, reduction, analgesia or even 'recreational' uses.

Here in Australia, new patients must take most doses under supervision but weekend take-home doses are usual after three months. Patients cannot be discharged for heroin use, but most doctors will [nonjudgementally] review the treatment if this continues.

Our teaching differs significantly from the American in that the addict is not considered to be 'in recovery' just because they are 'in treatment'. I cannot recall the last time one of my patients mentioned the word 'recovery'. Many do not believe they have an illness in need of treatment, though they obviously all admit to opioid dependence. Some just say that they are consumers and that methadone suits them. I'm certainly not in a position to argue with fellow citizens who seem to know what they are doing, pay for their medication and do not trouble anyone else in the process. I do not mean this in a confronting way, it is purely an observation. Vive la difference!

P.S. Dear Beth, Congrats on another excellent, on-time, newsletter (April). I loved the Italian description and am pleased to have another contact in Italy.

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Methadone Today (The Newsletter)
by Ray/DONT

We are a nonprofit, no payroll newsletter.

1. No one gets paid as much as 1 (this includes the editor, writers, those who help fold and distribute the newsletter--no one!) for the work they do for YOU. Some members donate hundreds of hours a month on behalf of advocacy--and you benefit.

2. We survive on subscription donations and a grant. The grant has just about run out.

3. Donations are not coming in. It costs $5 for stamps for a one-year (12 issues) subscription sent to your home and another $5.00 for printing and other expenses connected with producing the newsletter, i.e. office supplies, equipment, faxing, etc.

4. We fold our newsletters ourselves to save 1 per copy because we cannot afford to have them folded. We distribute 3,500 copies per month--soon to be 5,000.

5. We take money out of our own pockets for distribution, gas, meetings, and other expenses, such as the Methadone Today web site, not yet covered by the grant or subscription donations. By the way, there have been 1400 visits to our web site since November 1996.

6. WE NEED YOUR HELP! A 4-page newsletter costs $250.00 to have printed; a 6-page is $365.00 to have printed.

7. Do you want this newsletter? We bring you the latest information, and we bring you information early so that you can plan what your next step should be.

8. We have a large library and want all methadone patients to have access to our information. We distribute this literature to legislators, policy makers, medical facilities, patients and methadone maintenance staff to dispel myths about this misunderstood, life-saving medication.

9. We work behind-the-scenes to change policies that affect you so that you do not have to fight when you go for your medication, etc. We want prisoners to be able to continue with methadone maintenance while in prison; we work with NAMA for medical maintenance for those who have been in the clinic for a long time and who could be integrated into their general practitioner's practice. These are some of the many issues we continue to tackle daily. Our group, Detroit Organizational Needs in Treatment (DONT), is a chapter of the National Alliance of Methadone Advocates (NAMA) with 20,000 members across the United States and other countries. You can join; you can help. We need your support; we need your dollars.

We may be able to last a few more months if we plan very carefully--if you will help, we can last indefinitely. If you cannot afford $10, send $5, if you can't send $5, send $3 or some postage stamps, but we must start receiving some donations if we are to continue fighting for you.

This means you too, counselors--we are now working on issues that concern you via payment through HMOs. And, don't you get information through the newsletter that you normally would not receive? Counselors can subscribe for the same amount as patients.

We work on issues that affect the clinic too. Clinics can receive 100 copies of Methadone Today per month ($120 per year donation) to give out to patients who cannot afford the newsletter. We have had a few clinic directors donate different amounts (two from out of state). On issues where there is a conflict, the patient takes priority, but clinics do benefit from our work.

Many of you have been receiving the newsletter for almost 2 years (patients, counselors and clinics), and most of you have not contributed at all. Don't you think it's time you did? If you donate $10 right now for the next 12 issues, that means you will have paid an average of $3 per year ($40 in the case of the clinic) for Methadone Today.

For $10 per month, you can receive the newsletter delivered to your home and be assured that DONT is still here working on the issues that concern you, educating the people who control your lives through your medication.

If not us--who? If not now--when?

This newsletter can quit methadone painlessly--can you? Clinics are being closed all over the United States.

To those of you who have contributed, we appreciate your support so very much, and we are sorry we had to take up this space which could have been used for more information for you.

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Medications & Substances Causing False Positives
Jefwriter

According to a report by the Los Angeles Times News Service, a study of 161 prescription and over-the-counter medications showed that 65 of them produced false positive results in the most widely administered urine test. Ronald Siegel, a psychopharmacologist at UCLA said "The widespread testing and reliance on tell-tale traces of drugs in the urine is simply a panic reaction invoked because the normal techniques for controlling drug use haven't worked very well. The next epidemic will be testing abuse."

Byrd Labs has in its possession an internal document from the Syva Company, makers of the widely used EMIT test. This document, leaked by a disillusioned company employee, lists more than 250 over-the-counter medications and prescription drugs that can cause false positives (this is only a partial listing.

AMONG THE ITEMS REPORTED AS CAUSING FALSE POSITIVE TEST RESULTS ARE:

*Pain relievers such as Advil, Nuprin, Motrin and menstrual cramp medications like Midol and Trendar. All drugs containing the widely used pain reliever Ibuprofen, are known to cause positive samples for Marijuana. Non-steroidal anti-inflamatories such as Naproxyn have cross reacted in blind tests. These are often prescribed for runners, sports injuries to joints, and those suffering from arthritis.

Syva labs has recently reworked its Cannabanoid test and claims to have eliminated this problem. But a Science Magazine article (July 8, 1988) lists Ibuprofen as cross reactive. Under the new government guidelines THC testing levels will be reduced to 50 nanograms. Many more THC false positives can be expected in 1994.

*Dristan Nasal Spray, Neosynephrine, Vicks Nasal Spray, Sudafed, etc. and others containing ephedrine or phenylpropanolamine. Over-the-counter appetite suppressants which contain propanol amine. Most common nasal decongestants can cause a positive reading for amphetamines; amphetamine false positives are the most common. Recent articles in the Journal of Clinical Chemistry, Vol. 38, No. 12, 1992 and Vol 39, No. 3, 1993 warn that medications containing chlorpromazine, fluspirilene, and others may yield a positive when tested for amphetamines.

*Vicks Formula 44M containing Dextromethorphan, and Primatene-M containing pyrilamine as well as the pain reliever Demerol, and prescription anti-depressant Elavil test positive for opiates up to three days. Even Quinine water can also cause a positive reading for opiates.

*Poppy seeds such as on the Burger King roll, on a bagel from your favorite deli, etc. The Journal of Clinical Chemistry, Vol. 33, No. 6, 1987 reports: "The quantities of poppy seed ingested in this study represent this study (25 and 40 g) may be expected to be contained in one or two servings of poppy seed cake.

Therefore, poppy seeds represent a potentially serious source of falsely positive results in testing opiate abuse." Clinical Chemistry goes on to conclude: Not only is it difficult to distinguish heroin or morphine abuse from codeine, but dietary poppy seeds can give a strong positive result for urinary opiates for several days duration that is confirmed by GC/MS analysis."

*Nyquil Nighttime Cold Medicine will test positive for Methadone up to two days.

Antibiotics. Certain newly developed antibiotics have caused positive sample urine tests. Ampicillin is suspect. Amoxicillin has caused positives for cocaine.

*Diazepam tests positive for PCP as well as the ingredient in some cough medicines, Dextromethorophan.

*Your own enzymes. A small fraction of the population excrete large amounts of certain enzymes in their urine which can produce a positive drug test. Dr. John Morgan of the Dept. Of Pharmacology of New York City University writes: "A false positive test could occur in some individuals because they excrete unusually large amounts of endogenous lysozyme or malate dehydrogenase." Dr. Morgan judges that natural enzyme interference may run as high as 10% of positive samples.

*Black Skin. (This is not a joke!) Those of African origin, certain Orientals, or Pacific Islanders might test positive for marijuana. Dr. James Woodford, a toxicologist associated with Emory University labs hypothesized the pigment melanin which protects the skin from the sun approximates the molecular structure of the THC metabolite to cross react on the marijuana urine test. Dark-skinned Caucasians such as those from the sub-continent of India could also read positive on marijuana tests. The body eliminates some melanin in a dark person's urine sample.

*Passive marijuana inhalation. If you attend a rock concert or ride in a car where marijuana is smoked nearby, even if you do not partake, the second hand marijuana that you might inhale can give your test a positive result for several days.


ON THE NET
Web sites for more information on urine testing, false positives, etc
.
http://www.calyx.net/urine-test.html
http://www.passdrugtests.com

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Briefly Speaking

1792 - The first prohibitionary laws against opium in China are promulgated. The punishment decreed for keepers of opium shops is strangulation (Szasz, T., 1975, Ceremonial Chemistry, New York: Doubleday/Anchor).

1905 - Senator Henry W. Blair, in a letter to Rev. Wilbur F. Crafts, Superintendent of the International Reform Bureau: "The temperance movement must include all poisonous substances which create unnatural appetite, and international prohibition is the goal" (Crafts, W.F. et al, Intoxicating Drinks and Drugs).

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Please Note

Home Pregnancy Test Kits: Methadone can cause false positives. Check with your doctor if you test positive for pregnancy with a home test kit.

Reminder: Bill Read, Methadone Today/DONT attorney will help you with non-criminal cases regarding methadone/patient discrimination. Notify Methadone Today/DONT in writing of the problem, and we will forward it to Attorney Read.

Dr. Dean Edell: This doctor was instrumental in pushing for the Medical Marijuana initiative. He is also an advocate of medical methadone maintenance--doctors being able to prescribe methadone for patients in regular doctor's offices. His show regarding health can be heard late Sunday afternoons, 5-8 p.m. on radio station 1270 AM--Detroit. He is on other stations also; check to see if you can listen to him in your area.

"There is a destiny that makes us brothers; none goes his way alone. All that we send into the lives of others; comes back onto our own." - Edwin Markham

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