Methadone Today

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Volume I, Issues 1-3 (December 1995 - August 1995)

Medicaid, Methadone, Managed Care & Budget Cutbacks - by Beth Francisco
Reporter Skews Ritalin Story - by Jon
Methaphobia - by Ira Sobel
Counseling and Compulsiveness - by Michelle
Urinalysis Policies - by Beth Francisco
Clean, Depressed, & Confused - by Rose
Principles vs. Personalities - by Beth Francisco
First Advocacy Meetings Held - by Jon
DONT Ignore Patient Advocacy in Michigan - by Jon
Take Home Policies: What Is Fair? - by Nancy R.
Perception - by Beth Francisco

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Medicaid, Methadone, Managed Care & Budget Cutbacks
by Beth Francisco

As promised at the voter registration drive in Pontiac, I have been looking for information regarding the effect of the new Republican Congress' policies concerning Medicaid and managed care and what that means for methadone patients. From what I have been able to discover, it doesn't look good. The Republican "Contract [ON] America" wants to "cut federal entitlements, and instead give block grants to the states."1

Republicans say they want block grants instead of entitlements for flexibility because they believe they "would have more discretion over the way the money is spent."2 This is not terribly encouraging in Michigan with the governor we have, as we all know Engler is not exactly concerned about the poor, minorities, women, or addicts. The only reason any of these groups have gotten any relief is because of federal entitlements--with one of his first strokes of the pen, he did away with many needed programs.

One of the first federal cuts for addicts is from "The House Ways and Means Committee [since it] is removing substance abuse as a disability under the Supplemental Security Income (SSI) program. Just last year, Congress enacted a new law which limits SSI payments for addicts and alcoholics to three years. Under what the House is proposing for welfare reform, those on SSI might be cut off altogether. Worse still, the committee has decided that these people...would not only lose their SSI, but would become ineligible for Medicaid"3 If addicts are cut from Medicaid, it will be suicide, especially for those who depend upon it to pay for their methadone maintenance.

We are so concerned with saving money and cutting the federal budget that it is absolutely illogical (and downright stupid) to cut addicts off from the one thing that keeps many of them out of prison. It costs about $2,600 per year to maintain an addict on methadone, and it costs ten times that much to "treat" addiction by throwing the addict in prison. When addicts cannot afford methadone treatment, there is always the threat of a return to the streets where an addict can easily be 100 times the drain on society when s/he has to return to larceny and burglary to maintain their habit.

The question is, "How can the addict afford the price on the street if s/he can't afford the methadone clinic?" When the addict is maintained on methadone, s/he is usually making improvements in their life--getting an education, working to support self and family, and improving relationships. The addict has neither the time or inclination to engage in negative behaviors such as larceny, burglary, or any number of other things the addict has to do just to "maintain" on the street. The addict maintained on methadone is not exposing him/herself to AIDS on a regular basis as they were when exchanging needles. The price of one case of AIDS in money alone is a thousand times the cost of yearly methadone maintenance, not to mention the human misery. In plain language, when the physical and/or psychological addiction is taken care of, the addict is just like any other person who wants to improve his life conditions. As we all know, when the addict is on the street, nothing matters except the next fix.

What is really idiotic is the price of methadone maintenance in the first place. It doesn't have to cost $2,600 per year; the reason it does is because of the governmental regulations on it. According to Substance Abuse Report Newsletter:

Methadone regulations are too restrictive and should be relaxed in favor of clinically useful guidelines, according to a report by the Institute of Medicine [IOM]. While stopping short of recommending abolishing the regulations altogether, the report, released December 21, calls for making methadone easier to use for treatment facilities and patients alike.4

When regulations call for arbitrary rules and regulations from somewhere in the great beyond that has nothing to do with real life and real people, costs rise. The doctor, counselor, and addict are in the best position to know how to treat the addiction--not some senator in Washington or Lansing and not some program director who doesn't know us and probably never will.

As far as Medicaid managed care, budget cutbacks will definitely be pushing for more of it. "Managed behavioral health care organizations contract with HMOs or states to provide Medicaid services. They then turn to their provider panels for cost-effective care."5 The definition of managed care is:

a system used by groups (including insurance carriers and corporations) to manage costs while maintaining quality of health and medical services. Specific approaches used by the payer of services include: pre-certification, utilization review, case management and medical necessity review.6

The idea behind managed care is to save money by having a primary provider decide what type of health care you will be allowed under the system. The primary provider decides if you need methadone treatment, so the bottom line is, before you sign up for anything, find out how your primary provider feels about methadone maintenance or any other treatment you now receive on a regular basis.

1"Treatment Providers and State Directors Fear Effect of Welfare Reform" (1995, March 15). Newsletter: Substance Abuse Report. http://access. digex.net/ brpinc/ on Internet's World Wide Web. E-mail to info@enews.com
2Ibid.
3Ibid.
4"IOM Recommends Easing Methadone Regulations. (1995, January 15). Substance Abuse Report Newsletter. http://www.access.digex.net/ brprinc/
5Ibid.
6"Health Policy Glossary." (1993). Health ResponseAbility Systems. America Online (Downloaded 1995, Oct. 18).

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Reporter Skews Ritalin Story
by Jon

On November 16 and 17, WXYZ, Channel 7 in Detroit, aired a two-part series on Ritalin, a drug commonly prescribed to children with Attention Deficit Hyperactivity Disorder (ADHD), Ritalin has long been known as one of the most effective treatments for the disease. It has been under recent scrutiny due to efforts to ease restrictions on the drug in Michigan and elsewhere. Proponents of the drug's therapeutic use believe that its current Schedule II status makes Ritalin unnecessarily difficult for ADHD patients to obtain. Some believe that relaxed regulation of Ritalin will encourage abuse.

Ritalin has been abused for more than twenty years by adolescents and adults. Ritalin's rise in popularity in Michigan may be due in part to the state's strict laws which prohibit most amphetamines. Ritalin is a stimulant but not technically an amphetamine. When prescribed properly, Ritalin is not used as an amphetamine substitute. There is no evidence to suggest that Ritalin is abused any more than other drugs with abuse potential. Yet, Channel 7's report implies that Ritalin abuse is rampant. Reporter Shellee Smith proclaimed that "Michigan is quickly becoming one of the Ritalin Capitols of the world."

Smith's sensationalistic rantings can do nothing to prevent Ritalin abuse. The heavily biased report focused largely on the negative ramifications of Ritalin abuse but said little of the therapeutic aspects of the drug and the thousands of children and adults who benefit from its use. Ritalin patients are stigmatized due to the atmosphere of ignorance that surrounds mental illness and drug therapies. Deceiving the public with overblown, misleading information about any public health issue is dangerous. Smith's report may potentially spread panic among the families of Ritalin patients who have suffered the hardships of coping with their loved one's ADHD. Shellee Smith seems to be using sensationalistic tactics to sell her report under the guise of protecting the public from the "evils" of Ritalin. Who will protect the public from Shellee Smith's recklessness?

As with any psychoactive substance, Ritalin has abuse potential. Smith drew the focus away from more significant aspects of the issue in order to exaggerate this point while employing scare tactics that would appeal to any parent's worst fears. Ritalin abuse among adolescents and adults does exist in Michigan and elsewhere. All drug problems are serious, especially when children and adolescents are affected. But Smith falls far short of proving a Ritalin epidemic in Michigan. Her report provided little hard data and instead relied on a number of adolescents from an area treatment center who appeared to be singled out because of their Ritalin dependencies. The appearance of an epidemic can be easily created if one uses a sample group of hand-picked subjects possessing only those characteristics that support one side of the issue. This brand of yellow journalism is nothing new to Shellee Smith. Earlier this year, she did a similar report on methadone. The story was shamelessly slanted by employing amateurish editing techniques and other instruments of deception such as the use of half truths and distortion of facts. She referred to methadone patients as addicts who "line up to get their fix" at the methadone clinic. Channel 7 videotaped patients inside clinics and, in some cases, allowed their faces to be shown. Smith ignored any positive, therapeutic qualities of methadone treatment while implying that addicts were supporting their habits with hard-earned tax dollars.

The report seemed to imply that all methadone patients were inner city welfare cheats getting high for free. Meanwhile, thousands of methadone patients within Channel 7's viewing area were left to explain to their families that they were not patrons of legal dope houses. Targeting methadone patients is a cheap way to revive plummeting ratings which, ironically, are the result of the station's abandonment of its star anchorman who was at the time receiving treatment for his own addiction. Smith obviously did little or no research on Ritalin or methadone. Her source for these hatchet jobs is the worst kept secret in Detroit T.V. news. It appears that she has been relying on her federal significant other for information instead of doing hard investigative reporting.

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Methaphobia
by Ira Sobel

We are living in a day and age when 12-step programs are known everywhere as a successful institution for so many people. Alcoholics Anonymous began with two individuals and it has become the most effective tool used by people in recovery afflicted with the disease of addiction. People are joining 12-step programs every day by the number. Lost souls are coming into the rooms on our hands and knees defeated by our sickness.

For 60 years the goal of Alcoholics Anonymous has been "to stay sober and help other alcoholics to achieve sobriety." That quote is taken from the preamble that is read before most meetings. Each 12-step program is based on that one statement. It means that you are in these rooms to get sober for yourself and to help others all you can to achieve sobriety. No addict should be turned away who asks for help. This is an integral part of AA and every other fellowship.

In a sense, the preamble welcomes newcomers to the program, a program where addicts think more about helping others than satisfying their own wants and needs. It is a selfless program, a place where an addict can feel safe. It gives the newcomer a sense of belonging, that he or she has somewhere to go for help. People go to meetings just to be in the company of other addicts so that they can get better.

There is an underlying tension that exists between people that belong to the Narcotics Anonymous fellowship and people in recovery on methadone. People that attend NA meetings regularly consider themselves in recovery and people on methadone programs are not. Essentially this schism exists because those that attend NA meetings refuse to accept people on methadone because they feel we are not drug-free, that it would be the drug speaking. Their policy is that no one can share if they took a mood-altering drug in the last 24 hours. So the practice has been to not let someone on methadone share or qualify. NA is wrong. Methadone maintenance is not mood altering if you take methadone as prescribed. I think they have an extreme case of methaphobia!!!

Methaphobia is a state of mind in which someone or a group displays an intense fear and a bias against methadone patients and methadone programs. It is very much like people in NA have built-in forgetters. Those who espouse on NA principles put down methadone as an institution. Basically, these people like to play God, doctor, lawyer and pharmacist!!!

We are all addicts and as long as I have a desire to stop using drugs, I should be able to share my experience, strength and hope with a room full of addicts in all phases of recovery!!! That's because I'm in my phase of recovery. A person on methadone can be going to a specific NA group for six months without being able to share while another person, who comes intermittently and has one day back, is allowed to share!!! If the time of the meeting is 4 p.m. and the person was using "some time yesterday" then we have to count hours. I mean shit, is there some kind of time table they use in NA!!! It's so petty that I have to laugh!!! I mean shit, does the NA meeting list have this time table written on it?? Ridiculous.

I have my own story about how NA didn't accept me as part of the group and how I learned about methaphobia the hard way. When I was discharged from my last detox in early 1986, I began going to meetings. At the time, any meeting whether it was a beginners meeting, or a traditions meeting, or CA or DA was important to my recovery. Meetings, meetings and more meetings. At the very beginning, I chased recovery like I chased an opiate. I would go to 2-3 meetings a day all over the city. I went to Cocaine Anonymous, Alcoholics Anonymous, and then I went to Narcotics Anonymous meetings.

One of the first things I learned at the beginning was to be rigorously honest. So, I went to my first NA meeting that was held at Water View Hospital. It was a "big book" meeting. Since I felt it was my duty to come clean about my detoxing off methadone, I told people I "was down to 15 mgs." This was a mistake. I was unaware of the methadone clause of NA. The concept of methaphobia was all new to me. To my naive mind, I was doing the right thing. You know, it's about being honest today, but because of NA, I found out that day that, unfortunately, it's not about being stupid!!!

Right there, that instant in time, before the meeting even started, I was blackballed. I didn't even have a chance at sharing. One girl said that I had a "ticket in my back pocket." I didn't find the compassion and understanding from NA. It's too rigid. I do not go to NA meetings. If I can't share and voice how I am doing in one fellowship, then I've gone to other fellowships for the support I very much need.

To this day, I still have a major resentment against NA. Now, I don't propose a full boycott of NA meetings. What I do suggest is that if people in recovery need a place to go, they should attend other 12-step groups. I also hope that people like us on methadone should attend MA meetings at your program and at other programs. At MA meetings, we share so honestly about the heavy odds against you and me. People at MA meetings display an intense desire to get well. It's so exciting when people cheer for someone that shares about their good fortune. There is an intimacy that exists in MA meetings that I've never experienced with other 12-step support groups. These meetings are so new and refreshing. An MA meeting is not filled with aging people that nod out. No, it's about people who want to get better. In essence, I've let go of my resentment and I've learned not to fight NA but to go to MA. That's where I want to be. PEACE.

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Counseling and Compulsiveness
by Michelle

My counselor gave me an assignment last week to make a pro and con list of an issue I was struggling over. In doing so, I began to grasp the beneifts of list making as a problem-solving tool. So, I made another list for why I should go back to school now and a list for why I should wait; a list of reasons to tell my family about methadone and a list of the reasons not to; a list of the things I still miss about drugs and a list of the things I don't. In short, I reduced the major dilemmas of my life into several numbered phrases that fit on small pieces of scrap paper. When I brought the finished product to my counselor's office, he noticed a pattern in the nature of my "self help." I had compulsively listed the pros and cons about being compulsive about my compulsions. Everything that I had addressed was based on overdoing something and the problems that taking everything to the extreme had caused me, yet I had done even this in excess, producing twenty-some lists.

I remember something I heard long ago spoken by a true substance abuser: "If you can't be intense about something, why be anything at all?" I took this statement to heart because it was exactly how I felt. I had to be the most, the worst, the wildest, or whatever superlative fit the situation. My competitiveness stemmed from a fear of anonymity but essentially was part of my character makeup. I was, and still am, an extremest, and it seems inevitible that my ultimate drug of choice would be the superlative of them all--heroin.

With a personality like mine and a hankering for intensity, I visited the usual spots (some against my will) and landed here at the clinic where superlative sorts line up every day. Not all the other patients desire things in the way that I do (borderline nutso), but we all have had at least a small taste of what it means to be driven. Let's face it, being an addict takes initiative and know-how. The point that my counselor made after reading my lists and noticing my compulsiveness was that this energy needs to be used in productivity. Was this something that I had never heard? No, but for the first time I considered letting myself be the best instead of the worst. The worst, the baddest, the meanest, the wildest--that was always a sure thing. the best is something that I'm definitely going to have to work hard at.

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Urinalysis Policies
by Beth Francisco

Most of us who have been in treatment for any length of time have had trouble with "dirty urines"--we have either had the problem of the test picking up a substance that should not be there or of having "no methadone" detected. There are three things which can cause these instances:

1. An over-the-counter drug caused a false positive.
2. The lab made a mistake.
3. We have "used" something we should not have, or we have not taken the methadone.

There are many over-the-counter drugs which cause false positives. Steps are being taken to see that no one is falsely accused of something they did not do. The new lab we will be using will be saving urine samples for a period of time. If there are any questions, they can be re-tested. Also, I am supplying counselors with a list of the drugs I am familiar with that can cause false positives.

These results are not engraved in gold as there is always the possibility of human error. Again, if you feel there is a mistake, the sample can be re-tested. Talk with your counselor regarding procedure.

Although false positives and human error are a real concern for us, there are those who play with the program and use other drugs to supplement their methadone. You know who you are. It does not make you a bad person, but it does cause problems for the program and, most importantly, for yourself. If you are using other substances, talk with your counselor--be honest.

Your counselor should have a pretty good idea if you are telling the truth or not. If your drug of choice shows up in your urine screen every other time you drop and re-testing shows the same result, your protests will certainly be suspect. If, however, you are doing what you are supposed to be doing, you should be taken at your word. That is why it is important to let your counselor know what is going on with you. If you have been following your treatment plan but all of a sudden show behavior changes, and then come up with a dirty urine, you might have some explaining to do. An honest relationship with your counselor is essential and beneficial to you in more ways than one.

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Clean, Depressed, & Confused
by Rose

Before entering the methadone program, I had no life. I could not function without a blow, and I believed that nothing could help me. I always said I would never use methadone. But I went to the clinic out of desperation. the medication helped me to stop using heroin. I was surprised that I actually enjoyed my counseling sessions.

For two years, I did everything that I was supposed to do. I began to like myself. My appearance improved, I gained weight, and I felt good. My clinic's doctor and my counselor recognized my progress and granted me take-home privileges. I was beginning to live again.

Just when I thought that things couldn't be better, a terrible thing happened. The man whom I loved for fourteen years died. It hadn't occurred to me that I might have to cope with being alone. I was half crazy out of my mind and felt I had nowhere to turn. . .I relapsed.

I don't think that I believed I would find the answers I was looking for by returning to heroin. I was running from my problems as I had in the past. The help I needed was right under my nose. I told my counselor the truth about my relapse and started attending group therapy at the clinic. I had the solutions I needed within me. The support I received from my counselor and the group helped me to find them.

I was back on the right track and doing well. I had nearly ninety days clean again. Then I saw the clinic doctor for a routine medical exam. The doctor asked why I suddenly had several opiate urine reports after having a clean record. I explained the circumstances, but she revoked my take-home privileges anyway. To make matters worse, she said that my privileges would be restored ninety days from that day instead of ninety days after my most recent positive urine report.

The story doesn't end here. I was feeling depressed about what had happened to me. I didn't think there was anything left to go wrong. Then I got the news: Another urine report was positive for opiates! When I relapsed, I was honest with my counselor and admitted to using heroin. But this time, I was clean! I realize that this might arouse suspicion in some people, but I have no reason to be dishonest. Something must have gone wrong at the lab--maybe the samples were switched. My counselor said that nothing could be done. I would have to wait ninety days again before I would get my take-home privileges. I believe that my clinic and the lab that they hire should work harder to eliminate error. It's difficult enough to fight a drug problem without being penalized for the mistakes of others.

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Principles vs. Personalities
by Beth Francisco

Many of us are familiar with the term "Principles before Personalities" from Twelve-Step meetings we have attended in our attempts to be free from drugs and/or alcohol. The 12th Tradition states, "Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities." The definition of principle is "an essential truth upon which other truths are based", or "a rule by which a person chooses to govern his conduct, often forming part of a code." The definition of personality is, "the totality of characteristics which make up a person."

Addicts are not the only ones guilty of breaking this tradition. One of the most egregious expressions of putting personalities before principles is the double-standard by which Harry Anslinger, the first commissioner of the Bureau of Narcotics, treated street addicts as opposed to those with good connections. Senator McCarthy was of "sufficient prominence" to have had the protection of the commissioner while he obtained his narcotics from a Washington pharmacy without interference from Bureau agents. However, Anslinger was opposed to any treatment which supplied narcotics to addicts on the street, and he rigorously enforced laws against them. He depicted those who smoked marijuana as monsters, and his campaign against it was liberally strewn with ads about them as wild-eyed drug fiends who butchered whole families. If Anslinger's principles truly opposed drugs instead of the people he slandered, McCarthy's narcotic use would have been included in his opposition. This preferential treatment is clearly a violation of "Principles before Personalities."

We can all learn from this by asking ourselves in any situation, "Are my values consistent? Do I treat everyone in a consistent manner, or do I give preferential treatment?" If you recognize yourself breaking the rules, ask yourself "Why?" Do you break the rules for people you like and apply stricter rules to those you don't? Sometimes we don't listen to what a person has to say because we don't care for him/her personally, and often that is the very thing we need to hear. I would often sit in a meeting listening intently to what each person said, then at the point that a certain "personality" spoke, I would tune her/him out because I didn't like that person. That's a red light, bell-ringing situation for me.

Finally, "Principles before Personalities" means that we watch out for that intruder, the ego. We all want recognition; we all need recognition, and there's nothing wrong with that. However, when working toward our common goal of recovery, it's not about you, and it's not about me; it's about us. Recovery is a journey; we all have something to offer on that journey, and none of us can do it by ourselves, contrary to what the ego tells us.

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First Advocacy Meetings Held
by Jon

DETROIT - The first methadone patient advocacy meetings took place in Detroit and Roseville last month. Interest in patient advocacy has spread rapidly throughout the state. Though it is largely centered in the Detroit metropolitan area, inquiries have come from as far away as Grand Rapids and Muskegan. Patients from Flint and Toledo, Ohio have also expressed an interest in the movement.

Back issues of Methadone Awareness, the newsletter of the Philadelphia and Atlantic City chapter of the National Alliance of Methadone Advocates (NAMA) have been circulating around Detroit for several months. A group of Detroit patients were already in the process of forming an advocacy group when they became aware of NAMA through Methadone Awareness. Meanwhile, a counselor at a Detroit clinic read about NAMA in Addiction Treatment Forum. Soon, another newsletter, the M.A.L.T.A. Messenger began circulating around clinics in Detroit. Methadone as A Legitimate Treatment Alternative (MALTA) is a NAMA affiliate in California.

Detroit patients were infuriated this year by malicious attacks on methadone by the local broadcast media. Two of Michigan's largest clinics were targeted, but all of the state's methadone programs have felt the impact of the heavily biased reports. Patients were left to try to explain to their families and employers that methadone is not legal dope. Some were pressured by their spouses to detox.

In Lansing, attempts are being made to limit public assistance benefits to methadone patients. Patients have been harassed by government officials attempting to persuade them to go into 28-day inpatient programs. These are only a few of the problems with being a methadone patient in Michigan. These and other issues have prompted the formation of the organization, Detroit Organizational Needs in Treatment (DONT). The first meetings have been successful. DONT is in the process of becoming a chapter of NAMA.

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DONT Ignore Patient Advocacy in Michigan
by Jon

Detroit Organizational Needs in Treatment (DONT) is the new methadone patient advocacy organization in Michigan. there is a critical need for methadone patient advocacy in Michigan. There is a critical need for methadone patient advocacy in Michigan. Negative media coverage, harassment from the government, and clinics with inhumane policies are some of the problems we face. Together, we can form a strong voice so that our pleas can he heard. DONT will create avenues of communication between patients, givernment officials, and program administrators. We must find a middle ground where we can come together to strive for understanding of one another.

We cannot continue to lay quietly in the background while officials in Washington and Lansing make decisions about our lives. We cannot endure policy changes without our consultation. Many of us are registered voters. DONT members who are not registered to vote will register. Most of us have the power to choose the clinics where we receive treatment. As individuals, we had little impact when quitting programs to express dissatisfaction. And, all too often, we left one program only to find more dissatisfaction at another. As a group, we have power and discourage members from remaining in programs with unreasonable policies.

Unfortunately, some of us are beginning to lose the right to choose. Patients with Medicaid are being ordered out of their programs and are forced to enroll in whatever program the state decides they should be in.

It is not our intent to make irrational demands. We simply wish to be treated with the respect and dignity afforded to patients receiving other kinds of medical treatment. Methadone is an effective treatment for our disease. Those of us who are successful in methadone treatment are serious patients. We feel that we get inadequate recognition or none at all. Thos few patients among us who are not interested in treatment get a disproportionately high level of attention. It is those very few who make no attempt to seek recovery who tend to loiter near clinics or divert their medication. Yet, these few patients are given the spotlight when politicians need a cause to promote their own self-serving agendas. These are also the patients whom the media portrays as "typical" methadone patients. Cancer patients have diverted medication. Yet there are no known cases of cancer patients being refused treatment for diverting or being portrayed as typical by the media or government.

We intend to begin communication with clinics and government officials by wiping the slate clean. We are concerned with the present and the future. We invite the State of Michigan, CSAS, and all methadone programs to work with us, to hear our concerns. We know that we are not on a one-way street. What do you need from us? We will work with you to eliminate the negative appearance of methadone treatment. We will help to eliminate diversion and abuse. In return, we simply ask that you hear our pleas--we must have the respect and dignity we deserve.

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Take Home Med Policies: What Is Fair?
by Nancy R.

I have been on methadone for over twenty years. I continued using street drugs such as heroin and Dilaudid for the first ten years of my methadone treatment (1975 to 1985). But during the second decade, 1985 to present, I have used only methadone. My urines have been negative for illicit drugs. I began to use methadone as it was intended to be used and turned my life around. I work full time and am taking college courses at night to complete work on my bachelor's degree. I got married and have reestablished family ties. I am involved with Narcotics Anonymous and feel that I am growing spiritually. I credit methadone with saving my life!

So what is my complaint? My concern is with the State of Michigan's regulations concerning take-home privileges. Under the regulations, methadone patients who have been prescribed 100mg or more per day must receive special permission from state and federal authorities to have take-home privileges. One time per week take-home medication is out of the question unless you have a serious medical condition or travel hardship.

I am most comfortable at 150mg. I have been trying to decrease my dosage to below 100mg so that I can be eligible for once-a-week take homes. I believe that the state should drop this arbitrary dosage of 100mg for determining eligibility for the number of doses a patient is allowed to take home. This decision should be left to the clinic's physician. Dosage and take-home priviliges should be determined on an individual basis. My clinic doctor and counselor know my ;unique history. They know how much I have improved my life. They also know that I lead a busy life with work and school. Going to the clinic every day under these circumstances seems like a punishment. Shouldn't I be able to have take-home medication while maintaining at a dose that I am comfortable with? Haven't I earned this privilege?

I feel strongly about this. This particular regulation affects many patients. Our advocacy group must work together to learn how state regulations are changed in order to provide more individualized treatment for methadone patients.

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Perception
by Beth Francisco

We are a society of drug takers. We have a pill for everything from headache to backache, to go to sleep or stay awake, contraceptives or fertility pills, and we want to feel good right now. The problem is, the government has decided which drugs are no good for us and which are okay. People can't help but be confused--myself included. It was okay for me to take narcotics for a long time while addicted under the care of a doctor. There was no social stigma, they were affordable, and I could function. When I first started buying drugs on the street, I was taking the same drug that I got from the doctor, but it was at that point that I became stigmatized as a weak, incompetent person. What had changed? Not the drug certainly, and I still had the same pain, so what had changed? My status, overnight, and the fact that I had to buy my drug at such an inflated price that everything I had saved and worked for became the drug dealer's property.

I was sent to a psychiatrist who diagnosed me as manic-depressive (this was the diagnosis of the day--now it's called bi-polar), and he prescribed Lithium and an anti-depressant. "Don't take their drugs--take mine!" was the message I got. I took his drugs, and I couldn't function. I had to hang on to the walls to walk because I was so disoriented, and I couldn't write because my hand jerked too badly. When I told the doctor I could not take his medication, he said, "Well, I'll prescribe another drug to counteract the other drugs." That makes a lot of sense! If I did take his drugs, I would not be a social outcast, but I wouldn't be able to function; if I didn't take mine, I wouldn't be able to function. If I did take mine, I would be an outcast and a criminal because possession is a crime. This is madness--the addict, just by virtue of being an addict, is labelled as a bad person.

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