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New York Times Article Critique & Answer - Aaron Rolnick
Senate Resolution 295 - Deborah Abdel-Hadi
Self-inflicted Guy - Odus Green
Doctor's Column - Methadone
by Aaron Rolnick
Despite the considerable length of his article, Kleinfield spends little time discussing the nature of opiate addiction, the success rate of methadone maintenance compared to other treatment modalities, or how methadone maintenance treatment actually works. Instead, due to false and/or inaccurate statements, the article reinforces many people's misperception that methadone is simply substituting one addiction for another, albeit a less harmful addiction that allows some minimal level of functioning.
Kleinfield views methadone as a necessary evil at best, in which the patient is somewhere in between "dope life" and "straight life" without methadone, many addicts would be dead or at least in prison, but methadone itself is "highly addictive"; "imprisons" patients, putting a "vice grip on them"; and at certain doses leaves patients "in a barely functional daze." (One of the patients interviewed said that when she was on 180 mg., "I was wasted, I was walking into walls.") Finally, one of the patients interviewed claims that, "I was a zombie for like four years--that is the dirty secret of methadone--a lot of people stay zombies for a long time, for years." Readers are left with a sense that methadone is only satisfactory for a short time, and makes a depressing "career".
After reading this article, R. Vlahos of Arlington, Virginia, a methadone patient, decided to write a letter (below) to the Editor of the New York Times to express his "disgust" with the article. To his credit, his letter not only mentioned the shortcomings of the article, but explained the very real problems and hardships methadone patients are faced with--primarily as a result of government regulations and clinic policies, rather than the treatment itself.
Dear NY Times Editor,
Sheer volume (of words) is no guarantee of competent investigative journalism - the Kleinfield "Special Report" on Methadone convinced me of that. Having participated in methadone programs over the past four years, I've personally known dozens of patients and spent hundreds of hours in "group" sessions - not to mention spent over $20,000 on the clinic fees.
What I got out of this disjointed 4,000-word ramble was a narrow, depressing view of people chained to a powerful narcotic and very little else. Perhaps it was the article's focus on patients that regularly use other drugs, struggle with unemployment, hold dim views on their life and little understanding of their present situation. . . that made this article so thoroughly disappointing. Because a little more work might have revealed a wholly different side of methadone and a different set of problems as well.
You might ask the question: "why, if methadone has come to be the preferred means of heroin addiction treatment. . . does it reach only about 15% of the addicts who need it?" The reasons, as a little research would reveal, are tremendous amounts of red tape, regulations and restrictions placed on physicians, clinics and patients alike by the DEA, FDA, and state authorities. If patients are "bound" by anything, it is not the "lifeline" of methadone, it is the chains of federal and state regulations, plus those the clinics themselves add to the list. In my last clinic, I paid $5000 per year for the privilege of driving a hour and a half each day to stand in line an average of 25 minutes for my dose. I was given a four-digit number, not a name. There were no Sundays off (nor are there in most clinics). I was breathalysed for 360 days in a row despite the fact I never blew anything above 0.00 (I'm not a drinker).
In my clinic (and many others) we were marched into mirrored bathrooms two at a time and told to produce urine samples while a counselor impatiently tapped his foot. After five minutes, you went back out and waited another 30 minutes to try again. Many people including myself suffered "shy bladder" syndrome under these conditions and could not urinate even after drinking water for hours--even when the bladder feels ready to rupture, one may not be able to relax the sphincter and urinate under duress. In the end, all I could do was leave the clinic, literally urinate in my pants, then go out and risk my life buying heroin on the streets so I could go to work.
Their article might have touched on the fact that clinic personnel literally hold methadone patients' lives in their hands every time they dispense (or choose not to dispense) a dose--and most staff nurses, counselors and directors fully realize this fact. In a world where power corrupts so easily, should any group be given such compete dominion over another?
These clinics enjoy the profitability of private businesses, yet have no competition and the same kind of power over the patients' lives as probation officers or prosecutors. They can medicate you or put you out on the street--sick. If you need to travel on a business trip, they have the power to withhold "take-out" doses or guest doses at another clinic. If you are sick in bed, they have the power to make you get up and travel to the clinic every day, in any weather, despite your condition, until you are hospitalized.
Despite these and many other obstacles, I have known many methadone patients to get married, raise families, run businesses, go back to school, become professionals, and in short lead loving, productive, successful lives. I think this says something very important for both the many addicts who want to "do the right thing" and methadone therapy itself. Unfortunately, your "Special Report" seemed oblivious to these sides of the truth.
by Deborah Abdel-Hadi
Here are portions of Senate Resolution 295 of Oct. 9, 1998, I have interspersed my comments (in italics) with the quotes.
Mr. COATS (for himself, Mr. MCCAIN, and Mr. COVERDELL) submitted the following resolution:
Whereas. . . the use of methadone in treatment for heroin addiction results in the transfer of addiction from one drug to another drug;
Whereas heroin addicts and methadone addicts are unable to function as self-sufficient, productive members of society;
Whereas methadone addicts who attempt to become drug free experience the same difficult withdrawal process as that experienced by heroin addicts;
Whereas the Clinton Administration, through the Office of National Drug Control Policy, is directing the drug policy of the United States toward the wrong goals by announcing a new heroin policy;
Whereas that heroin policy would double the number of heroin addicts transferred to methadone addiction, loosen controls with respect to the licensing of methadone dispensers, and promote methadone addiction as the principal means of ending heroin addiction;
. . . be it Resolved, That it is the sense of the Senate that--
(1) the Federal Government should adopt a zero-tolerance drug-free policy that has as its principal objective the elimination of drug abuse and addiction, including both methadone and heroin;
(2) Congress should conduct a thorough examination of the national drug control policy of the United States to determine the reasons for the failure of methadone and methadone maintenance programs to eliminate heroin addiction;
(3) Congress should carefully examine alternative approaches to curing heroin addiction, and focus on treatments that eliminate dependence on, or addiction to, any substance or drug
Methadone maintenance programs alone force individuals into a life of government-sponsored drug dependency.
From the fees patients are paying to clinics, I don't see much government sponsorship of anything. I don't think the senators understand the difference between addiction and dependency, either. Many people don't--but one would hope that those making the laws and appropriating the funds would understand. In the simplest terms possible, addiction is a pattern of behaviors a non-addicted person would find unreasonable and that often have adverse consequences. Dependency is a physical condition, and can exist independently of addiction. Rather than looking at the medication and blaming it, the senators should look at the over-regulated and punitive nature of the current system. Its focus on law enforcement rather than health care might give them some of the answers they seek.
Our policies and programs must be designed to free heroin addicts from their addition, not hook them on another government-condoned drug.
What are alcohol and cigarettes if not addictive, government-condoned drugs? Our policies need to be rational and based on facts, not social acceptance of certain drugs and denigration of others.
The resolution we are submitting today calls on Congress to focus on developing effective policies and programs for ending heroin addiction. We should be looking at all alternatives to methadone treatment, especially those that do not involve transferring addiction or dependence on substances.
Methadone IS that "effective policy". Of course more research is needed, and we do need to look at alternatives. Methadone does not work for everybody. There is no "one size fits all" solution, no magic wand. Of the available treatments, methadone is the most studied and most successful. It is the best we have today and can be made much better by increasing accessibility and increasing accountability of providers. Over and over, studies have shown that it works. Individual accounts have shown over and over that it works. Restricting availability of the treatment modality with the highest success rate because of moral judgment and stigma is in itself immoral.
**** OK, here's the invitation:****
We need to hear from those who are methadone users, . . .previous methadone users, and those who administer methadone. We need to look at statistics,. . .current funding, and . . .current problems within the programs.
Let's make sure they hear a lot! The hearings have not yet been scheduled (but probably will be after the Impeachment Trial is over), and when they are, the testimony needs to show how methadone worked for many people after drug-free programs failed.
I don't believe we have solved anyone's drug addiction if we can still call them an addict. Methadone users are addicts and they face the same withdrawals as those on heroin.
"Solving addiction" is for the individual to do. No one, certainly not the government, can solve anyone's addiction. Nor has the government any business in calling people addicts, unless that definition includes everyone who takes a medication prescribed by a doctor to in some way alter the way the person's brain/body functions. It is the government's role to make sure that health care decisions between doctors and patients are not unfairly influenced by intrusive regulations.
Now is the time to send letters to our senators. Personal stories, told in one page, would send a strong message as to how methadone maintenance has not interfered with patients' self-sufficiency and productivity. Counter any of their statements with what you "know" about methadone.
Letters could include a copy of the consensus statement on methadone, if available, which contains the conclusion of many agencies that methadone does work, and works better than any other treatment approach. The National Institute of Health (NIH) consensus statement can be found in the February 1998 issue of Methadone Today or at: http://text.nlm.nih.gov/
Senator John McCain (R/Arizona)
Senator Dan Coates (R/Indiana)
Senator Paul Coverdell (R/Georgia)
The Republican members of the Labor and Human Resources Committee are: Susan Collins (ME), Mike DeWine (OH), Mike Enzi (WY), William Frist (TN), Judd Gregg (NH), Time Hutchinson (AR), James Jeffers (VT), Mitch McConnell (KY), and John Warner (VA). Several of these senators are from states that do not have methadone programs at all, so getting accurate information to them may serve not only the purpose of stopping Resolution 295, but may also help make treatment available to individuals who currently are unable to obtain it.
The Democratic members of the Labor and Human Resources Committee are: Jeff Bingaman (NM), Christopher Dodd (CT), Tom Harkin (IA), Edward Kennedy (MA), Barbara Mikulski (MD), Patty Murray (RI), and Paul Wellstone (MN).
The telephone number for the committee is (202) 224-5375. Phone calls to the committee or to senators do not need to go into detail--simply a statement that the caller is opposed to Resolution 295 is all that is required.
Send a letter to your senators too.
Please let your voice be heard!
Most of this newsletter has been dedicated to those who have responded to policy makers, medical personnel and the community regarding methadone maintenance. We have to constantly be on the lookout for those who would misrepresent methadone maintenance treatment (MMT).
We must respond when we hear anyone criticizing the treatment that has saved our lives, whether that criticism comes from a politician who truly believes his/her rhetoric or is using us to further his/her political career. When we read a newspaper article, see an editorial or hear about legislation that misrepresents MMT, we need to respond. Let's not wait for anyone to tell us to pick up pencil and paper, take the typewriter out of its case or turn on the computer. We need to do this automatically--set the facts straight.
Last year, Barry McCaffrey, the Drug Czar, said we need to expand MMT to include physician prescribing. Many understand this to mean that this is going to happen, but we still have a long way to go. For example, Senate Resolution 295 questions the validity of MMT and proposes to at least delay it--they would like to eliminate it.
So when we have a chance to respond, we have to make it our responsibility to do so. Whether it is writing a letter regarding Resolution 295 to set the record straight, responding to an editorial, speaking to a group of medical students, or writing to a television program about a misstatement of fact about MMT, we must do it--no one will do it for us. ---
I love Methadone Today. It's a real eye-opener. The personal stories open my heart, as well.
I wanted to clarify information from NAMA (National Alliance of Methadone Advocates) published in the November issue. What's not well known, because it hasn't been widely reported, is that the costs of treating people with AIDS has come down drastically. At least three recent studies have reported that hospital costs are down dramatically and pharmaceutical costs are UP greatly, but overall, the costs remain much lower than what was previously seen. So the upper level of $300,000 a year for a symptomatic PWA (person with AIDS) is now rarely seen (actually, that's an extremely high figure even for "the old days"). As most of your readers have probably heard, hospitalizations and deaths due to AIDS are down substantially.
The HIV field changes constantly. Your readers who take methadone and would like a free subscription to our magazine, Positively Aware (which comes out six times a year), should contact me. We focus on HIV clinical care and some social issues such as finance and prevention.
Thank you for all the great work you do.
Note: Thank you, Enid. We appreciate
all feedback and/or corrections. - Beth.
Okay my list1 friends. Do y'all want to hear the stupidest clinic story of the week?
My wife and I were doing our taxes, and I was wondering if the methadone clinic bill was tax deductible. So, I called my "Friendly Methadone Clinic"; you know, the one where I pay $3,640 per year? For $7.16 worth of medicine? Yeah, that one!
Well, I asked the "lady who takes my money" (also known as the owner's daughter) if my methadone bill was tax deductible. I was told (and she was serious folks), "Well, Mary (the dosing nurse, you know, the one with the snobbish attitude?) does taxes on the side, and she says that it is NOT tax deductible because the government considers it a "self-inflicted" disease!
I was speechless! "self-inflicted?" What the hell is THAT? If I eat greasy food all my life and get high-blood pressure, is THAT a "self-inflicted" disease? If I smoke and get cancer, is THAT a "self-inflicted" disease? I was mad as hell.
I wouldn't have looked into it any further had they not been so, so. . . . I don't know the word! Well, anyway, I called the IRS to confirm my suspicions that it was, indeed, tax deductible. My suspicions were confirmed. Except for the first certain percentage, it IS tax deductible.
The point I am making is that the nurse has the attitude that "it is self-inflicted." That attitude permeates the way she does business. Actually, that represents the crux of the biscuit at most bad clinics. They are bad clinics strictly because the people who work there deal with the patients with that thought in their heads, "Well, it is self-inflicted; he did it to himself. Why should I care about him?"
That attitude is easily recognized by patients. The best
one can say about it is that it is a very unprofessional way to act, especially
for a nurse, who is supposed to be a professional. If she were in
an ICU and I was wheeled in after open-heart surgery, would she ask me
if I had eaten properly during my life? Or did I eat greasy food,
thus rendering my blocked arteries "self-inflicted"? That is in NO
WAY pertinent to the situation. Geez, God forbid she should ever
have to work on a patient with AIDS! If all medical professionals
had this attitude, we'd all be screwed.
Nancy told the group about her history of opiate addiction, successful recovery with methadone maintenance, experience with 12-step groups (Narcotics Anonymous and Methadone Anonymous), and methadone patient advocacy. She described how an addict's brain chemistry may be permanently altered/damaged by continued opiate use, and how methadone maintenance corrects the opiate receptor ligand system, resulting in a patient feeling "normal", not high. She talked about the "hidden population" of methadone patients who have been "clean" for years and living stable, productive lives but who are hidden from society because of the stigma of methadone.
Nancy explained how the clinic system works and about the need for "medical maintenance" and "physician prescribing." She referred to the mass of studies done over the past 30 years documenting the benefits of MMT, such as decreased crime rates, increased employment, reduction in HIV, AIDS, TB, increased overall health, reduced homelessness, and a great savings to taxpayers! MMT is much less expensive than paying for housing addicts in prison, paying for still-using addicts on welfare or ADC, and/or paying for foster care for children of incarcerated addicts.
DONT (Nancy) is invited to speak to doctors at Riverview later this year. We need methadone patients all around the country to advocate for themselves and their chosen treatment by talking to groups of people in their city or town. Show them that we are not like the stereotype of the methadone patient (i.e., the person who takes a megadose of medication, then goes home and nods all day--we know that for the most part this is not true; we need to let others know it). In this way, we will continue to spread the word about the success of MMT.
Schaffer Library of Drug Policy
Major Studies of Drug and Drug Policy
Marihuana, A Signal of Misunderstanding - The Report of the US National Commission on Marihuana and Drug Abuse
Licit and Illicit Drugs
Short History of the Marijuana Laws
The Drug Hang-Up
Congressional Transcripts of the Hearings for the Marihuana Tax Act of 1937
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Basic Facts About the Drug War
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Guide to Heroin - Frequently Asked Questions About Heroin
LSD, Mescaline, and Psychedelics
Drugs and Driving
Children and Drugs
Drug Abuse Treatment Resource List
American Society for Action on Pain
Let Us Pay Taxes
Marijuana Business News
Reefer Madness Collection
Medical Marijuana Throughout History
Drug Legalization Debate
Legal History of American Marijuana Prohibition
Marijuana, the First 12,000 Years
DEA Ruling on Medical Marijuana
Legal References on Drugs
GAO Documents on Drugs
Response to the Drug Enforcement Agency
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