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U.S. Congress Considers Substance Abuse Parity Mandate - by Aaron Rolnick
Doctor's Column - Breast Feeding
Recently, the Drug Policy Foundation held its 12th International Conference on Drug Policy Reform in Bethesda Maryland. The Conference was an unqualified success and covered a plethora of topics related to Drug Policy Reform. One of the highlights was a Legislative Training Session, with experts on the most recent legislation and advocacy techniques presiding. Following the classroom training, the entire entourage boarded buses and actually met with their respective elected representatives to voice their concerns with the current Drug Policy.
Also meeting for the first time were the patient advocacy group, NAMA, and the methadone policy advocacy group, ARM. One of the topics which concerned them both was the proposed legislation put forth in Senate Resolution 295 and 423.
These types of legislation, presented solely on a moral basis, denies the excellent record methadone maintenance treatment has attained and instills fear of the treatment instead. ARM is especially appalled at the statement in resolution 295 which reads, "Whereas. . . methadone addicts are unable to function as self-sufficient, productive members of society". This writer truly bristles every time he reads it!
An offshoot of S. 295, S. 423, The Addiction Free Treatment Act of 1999, also relies on morality as its basis and seeks to deny payment from the government for methadone maintenance treatment. If passed, this bill would also affect cash pay patients who was enrolled in any clinic that accepts federal money.
Other subjects covered at the conference included "Economics, Race, and User Representation" as well as "Women, Families and Harm Reduction in Treatment." There was an update on International Issues, as well as a session on marijuana reform.
There was also a session that covered the Internet's contribution to drug policy reform. Truly, this was a conference that covered all issues of drug policy reform in a manner that included everyone.
Also of interest to the methadone groups attending the conference
was the presentation of the "Norman E. Zinberg Award for Achievement in
the Field of Medicine and Treatment" to Dr. Vincent Dole. In true
Dr. Dole fashion, he turned over all credit for his work to his partner
(in work and in life), Dr. Marie Nyswander. Truly, these are both
great people who worked selflessly so that others could live a better life.
Our hats are off to them both.
The main discrepancy between the House version of the bill, and the Senate version of the bill is regarding what types of substance abuse treatments will be included in the requirements. U.S. Senator Paul Wellstone's (D.-Minn.) version of the parity bill would, "cover all varieties of addiction treatment [including methadone maintenance], (Alcoholism & Drug Abuse Weekly, Feb. 16, 1998)." In the House, U.S. Representative Jim Ramstad's [R.-Minn.] version of the parity bill would only cover "‘abstinence-based' treatment." (abstinence-based treatment is politically correct-speech for anything but methadone maintenance [and LAAM] treatment).
Unfortunately, the Ramstad bill may have the edge in a Republican Congress. Even some Congressmen who would prefer all substance abuse treatments be included in the parity mandate may vote in favor of the Ramstad bill if they believe that it is the last, and only, chance of passage of a substance abuse parity bill before the next election. William Cope Moyers, vice president for public affairs at Hazelden Foundation agrees, "It's now or never [for the passage of a substance abuse parity bill by Congress]."
This writer does not agree with the sentiment that any parity bill is better than nothing. Precedents are important— judges, attorneys, union negotiators, and business owners all understand the importance of it. The Ramstad bill would set a dangerous precedent: it leads the way for future legislation, as well as health care policies and employment contracts that exempts methadone maintenance therapy and methadone patients from health care benefits, discrimination laws, etc.
Besides that, this bill would promote and legitimize the stigma and discrimination against methadone patients that already exists. People who view methadone maintenance treatment as merely a substitute addiction will be reinforced in their beliefs (if the government exempted it from parity, then it must not be a legitimate treatment).
New York City Mayor Rudolph Guiliani and Senator John McCain, vocal opponents of methadone maintenance treatment, would be vindicated and strengthened by the bill's passage—people will assume that politicians who opposed methadone treatment from the beginning had good, legitimate reasons for opposing it (after all, Congress would have included methadone maintenance in the parity bill if it were a valid treatment, right?)
In conclusion, Congress has three options: (1) Pass
the Ramstad bill as-is, which would "mandate parity substance abuse coverage,"
but only for "abstinence-based" treatments [not methadone therapy]; (2)
Pass Wellstone's version of the parity bill, which would require insurers
to provide coverage of all substance abuse treatments [including methadone
maintenance treatment] "on a par with other health coverage"; or (3)
Not pass any substance abuse parity legislation—and hope that in the future
Congress will pass a bill similar to Wellstone's version [see (2) above].
This writer would prefer the outcome described in (2) above but otherwise
believe that Congress should vote against the Ramstad bill even if it results
in the outcome described in (3) above.
The Y2K problem is a computer glitch which arises from a simple error made back in the 1960's when the first computer systems were created. To save on a computer's memory, computer programmers used two digits rather than four to designate the year (for example, 99 rather than 1999). Unfortunately, when the year 2000 arrives, many computers may read the date ("00") as 1900 rather than 2000! When this happens, some computer systems may shut down, and others may spew out bad information.
Some experts feel this may have the potential to cause computer
shutdowns on a global level causing a number of disasters, such as massive
power blackouts, the failure of hospital, factory, and fire equipment,
the collapse of banking, food shortages, riots, and worse. Nuclear weapons'
systems in all nations are computer-dependent.
World governments, financial institutions, utility companies, and other businesses are spending billions of dollars in a race against time to make sure that Y2K doesn't cause a problem for their computers when January 1, 2000 rolls around. The Social Security Administration is one of the federal agencies that now report being 100 percent Y2K compliant. Close to 100% compliant are the Department of Veterans Affairs and the Department of the Treasury (which gives out benefit checks), and others.
"Experts" advise private citizens that it might be wise to have some extra cash on hand before the first of the year in case ATM's won't work. They say some people may experience power outages, so keep flashlight batteries and other supplies on hand like you would for any possible emergency. Some families are reported to be stocking up on canned food and bottled water and obtaining a gas-powered generator in case of a power outage.
Most home computers and appliances shouldn't be affected, say experts, unless they're very old. The "Y2K Q&A" column in the Detroit Free Press informs us that the days and months of 1972 mirror those of the year 2000 (including being a leap year). So if a computer's clock is reset to 1971 before January 1, 2000, the computer will not have to deal with the date rollover to 2000. The computer will continue to work normally, but the year will be wrong. This may be OK if you only use word processing, but they say it may cause some confusion for other date-sensitive software, such as spreadsheets, computer banking, bill paying, and others.
So, can Y2K possibly affect methadone treatment clinics? Do methadone maintenance patients need to worry? Could there possibly be a problem with delivery of the medication from the pharmaceutical company (sometimes from a different state than the clinic)? Many clinics use computers for payment information and for dosing. A patient wrote to Methadone Today's "Dear Doctor" column asking these very questions.
It seems logical that the wisest thing to do would be for clinics to have a plan in place for any kind of emergency, in addition to any potential Y2K problem. This includes having extra stock bottles on hand in case dosing-machines break down or there are power failures.
What if a clinic has a fire? Some kind of disaster plan must be in place--to send patients to a nearby clinic or hospital to be dosed. Obviously, our medication is vital to us, like heart medicine is to a heart patient or insulin is to a diabetic. Oh yes, there is the occasional person (hopefully not any staff members) who thinks we should be able to live without it for a day without great harm, that we can "survive withdrawals", but this attitude is unprofessional and uncaring. Since addiction is a disease, and patients need prescribed medication to live normally (and we can get very sick without it, including possible relapse), methadone patients deserve the same respect given any patient with any disease. I'd like to see the time come when people think of us as patients trying to get well and stay well.
I believe every patient has a right to know what kind of "disaster plan" is in place at their clinic in case of an emergency. And clinics have a responsibility to their patients to make sure their medication is available no matter what emergency may arise.
*Information for this article came from the Detroit Free Press "Y2K/Q&A"
column (several dates), and Time Magazine (January 18,1999 issue).
[To check if your home computer is Y2K-compliant, the Detroit Free Press reports you can get a Y2K "test" by downloading from www.nstl.com. The Ymark 2000 program can tell if your computer will have a problem handling the year 2000. If there is a problem, then contact the computer maker for directions. Another possibly useful site: www.y2k.com.]
I just received my April issue of Methadone Today. I was somewhat surprised, then elated to see my letter and cartoon printed in the issue! I surmise you used the name "Allan" as the writer of the article to protect my anonymity. Anyhow, I appreciate your printing it, for it will not only be helpful to others in my situation, it also gave me a boost in my self-esteem -- to see something positive of mine, serving as a valuable tool in the community.
I have a question to ask: is there anybody on a methadone maintenance program who is also on probation or parole in Wayne County (Michigan)? If so, I assume they must have their parole or probation officer's approval and cooperation. If somebody has this "luxury", perhaps they would be so kind as to write to me. It sure would dispel any trepidation I have because I will be paroled very soon.
Beth, if you print this letter, could you ask that they write to me in care of your newsletter? Thank you so much.
(Editor's Note: Marshall was to be paroled in late May
1999. If any Wayne County reader is on parole or probation and also on
methadone maintenance and would like to write Marshall, please send your
letter to Methadone Today, PO Box 164, Davison, Michigan 48423-0164, and
I will be happy to forward it to him.)
I just received my first copy of Methadone Today—given/sent to me through the good graces and thoughtfulness of my younger brother.
I must begin with major kudos and accolades for you and the staff and all contributors to Methadone Today. Every single article and letter struck a nerve and hit home with me—or someone I know at my clinic. A real Godsend!
My story is not unlike all of our stories--a 40-plus-year struggle with opiates with all of the accompanying baggage and wreckage--rehabs, meetings, stigma galore, depression, confusion, even a 10-year stint in AA/NA . . . most of it spent in therapy trying desperately, earnestly, and honestly to figure out what the hell was wrong with me. You name it, and I did it. During this period of "sobriety" (I use the term loosely, as it implies "soundness of mind"), I married the woman of my dreams—an old friend I bumped into at an AA meeting when I was just over a year clean. We had [have] two beautiful children, bought two beautiful homes, and had all the appearances of a well-to-do middle-class family on their way up.
Our second home involved a move back to the rural community where we were both raised—a return "home." It seemed as though we had arrived in our heaven. We both ran our own successful businesses, the kids were healthy and happy, I had built my "dream shop" in our large new mountain retreat, we both were into our meetings of AA/NA, we had a large circle of wonderful friends and good spiritual lives—on and on, ad nauseum.
Nearing my tenth year of total abstinence, I was on my way to do an estimate one sunny fall day, taking a back road I hadn't traveled in years. Suddenly I saw an old connection/friend I hadn't seen in over 12 years alongside the road. Not thinking for a moment, I pulled over to offer him a lift. Long story short—the "back country road" I had "chosen" was now known as "smack alley", and my old connection was doing just that—connecting.
Within 15 minutes I had my tie from around my neck around my arm and bought an ounce of tar heroin from "Jack." Needless to say, I never made my 10-year AA/NA anniversary. I spent the next four months hiding my addiction from my wife, shooting dope in my basement shop under the guise of "meditating" in the early mornings when I needed a fix. Things quickly unraveled, and I finally called my wife that fateful day and told her all.
Naturally, she was shattered. "We" spent the next year or so trying to "get me back on track": three rehabs, two of them residentials, a million meetings, thousands of "steps", more therapy—you get the picture.
It was during this torturous period that I was introduced to methadone maintenance treatment by a local shrink with an empathy—and some real knowledge—about opiate "addiction." It was he who told me that perhaps I actually needed an opiate to feel real, that not unlike the diabetic who is "insulin challenged" that perhaps I was "neuro-chemically challenged" and merely needed a neurochemical "supplement" to feel O.K.
Skeptical at first, I approached my first methadone clinic with all of the misinformation one has when uneducated about methadone maintenance treatment. I even tried to get off of my treatment by volunteering for an FDA clinical study in the West Indies—under the direction of a neuropharmacologist from the University of Miami. I spent two weeks on this island after being dosed with a drug called ibogaine, a psychedelic plant from West Africa, and being very thoroughly poked and probed (as only the FDA can do!).
However, two weeks after my return from this incredibly extravagant attempt at once again trying to rid myself of my "addiction", I was strung out on heroin. After a three-month "terror run," I crawled back to my old clinic and am happy to say have been "on the good foot" for nearly three years now.
Believe me when I say I will NEVER again attempt to get off of my methadone maintenance treatment. I am a methadone patient—I take what I consider a lifesaving medication called methadone because I am afflicted with a neurochemical imbalance disorder that has very inappropriately been labeled "addiction."
My wife never did grasp this truth. She hung onto the 12- step/therapeutic belief that my "addiction" was all about a legalized high, copping out on "sobriety", and being weak. So for ignorance, I lost my beautiful family, my business, and much of what I'd worked so very hard for, for many years.
I'm working hard on the resentments I packed up and took with me. The "IF ONLY's" and the "SHOULD HAVE's" are finally starting to thin out--not because of methadone—because I am able to keep a straight head while I deal with my past. But without methadone maintenance treatment, none of my progress these past few years would exist—period. I would surely be locked into that horrific cycle of jails, institutions, and death.
Thanks for taking the time to read this. May God guide the powers that be into realizing the miraculous truth about methadone maintenance treatment so that we—as patients—can begin to enjoy life; unencumbered by ignorance, stigma and backwards attitudes. Perhaps someday—in the not-so-distant future--we will able to enjoy medical maintenance, the lifting of draconian practices by many clinics, and the true freedom that any medical patient has a right to.
Via con dios, SF
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
Frequently Asked Questions About Drugs
Basic Facts About the Drug War
Charts and Graphs about Drugs
Information on Alcohol
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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