Methadone Today
Volume IV, Issue II (February 1999)
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New York Times Article Critique & Answer
- Aaron Rolnick
Senate Resolution 295 - Deborah Abdel-Hadi
From the Editor - Beth Francisco
Letter to Editor
Self-inflicted Guy - Odus Green
DONT Rep Gives Lecture
Doctor's Column - Methadone
and Alcohol
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New York Times Article Critique & Answer
by Aaron Rolnick
In the January 2, 1999 New York Times, an article was published that
purports to profile the lives of methadone patients. In "On Permanent
Parole: A Special Report. Days On Methadone, Bound By Its Lifeline,"
author N. R. Kleinfield interviews three methadone patients and attempts
to convey to readers what life is like for those on methadone maintenance.
The article repeats many of the myths that already permeate society:
-
methadone patients (even those who abstain from illicit drugs) are
not clean
-
methadone patients are merely addicted to methadone instead of heroin
-
most methadone patients still use illicit drugs (Kleinfield asserts
that methadone is not effective at blocking "the simple craving
to get high,")
-
few methadone patients are functional enough to work for more than
short time periods.
More than anything, Kleinfield is guilty of poor research, drawing
facts and conclusions based on his personal opinion or the assertions of
a patient who seemed to blame methadone for the shortcomings of the clinic
system. Kleinfield has no background or expertise in drug treatment,
and an addiction expert should at least have been consulted.
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.
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Senate Resolution 295
by Deborah Abdel-Hadi
Just before last year's election, a resolution was introduced in
the US Senate that could dramatically change the lives of all methadone
maintenance patients. We have heard about positive changes that may
be coming soon--expansion of methadone maintenance treatment, medical maintenance
pilot programs, accreditation--but this resolution shows that opinion on
these issues is far from undivided. With the new legislative
session underway, now is the time for action, the time to speak out and
let our voices be heard.
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)
241 Russell Senate Office Bldg..
Washington, D.C. 20510
Phone: (202) 224-2235
Fax: (202) 228-2862
John_McCain@McCain.senate.gov
Senator Dan Coates (R/Indiana)
404 Russell Senate Office Bldg..
Washington, D.C. 20510
(202) 224-5623
Senator Paul Coverdell (R/Georgia)
200 Russell Senate Office Bldg..
Washington, D.C. 20510-1004
(202) 224-3643
Fax: (202) 228-3783
PaulCoverdell@Coverdell.senate.gov
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!
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From the Editor
by Beth Francisco
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.
---
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To the Editor
Ron M.
Dear Beth,
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.
Sincerely,
Enid Vazquez, Associate Editor, Positively Aware
Test Positive Aware Network
1258 W. Belmont
Chicago, IL 60657
(773) 472-NEWS; fax (773) 404-1040
e-mail: TestPos@aol.com
Note: Thank you, Enid. We appreciate
all feedback and/or corrections. - Beth.
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Self-inflicted Guy
by Odus Green
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.
I relate this story simply because it epitomizes the difference
between a professional and a nonprofessional. I just wish this list*
was required reading for ALL clinic workers. I'll stop now, folks.
Y'all have a great month.
*This refers to the "methadone list" online where methadone patients
talk about their experiences and problems, ask questions, share information
and give each other support. For anyone wishing to join the "list,"
go to: http://www.tir.com/~yourtype/methlist.htm
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DONT Rep Gives Lecture
The DONT group is always looking for an opportunity to talk to various
groups of people--like physicians and other medical staff, politicians
and lawmakers, the media and the general public--about the benefits of
methadone maintenance treatment (MMT). On October 30, 1998, Nancy
Rose was invited by Dr. Deborah Jo Levan (an internist) to speak to a group
of physicians, residents and interns at Riverview Hospital in Detroit.
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.
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