Methadone Today

JUST AS I GOT THE LAST ONE TRAINED RIGHT... by Bao Dai - About a Counselor

Counselor Perspective. . . . - by K.R. Krupinski

Fears - Cindy

Fooling the Bladder Cops - by Nancy (DONT Member)

Help for Hepatitis C - Xalia

Briefly Speaking - Short items about drugs in history

Back Page - Prisoners of the Drug War - Don't Let Them Be Forgotten - by Nora Callahan http://www.november.org

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If there are such things as Universal Truths, included among them is the rather trivial rule that people tend to become accustomed to familiar routines - even unpleasant ones. Methadone Maintenance Treatment does not affect that trait. Arguably, since methadone might subconsciously represent freedom from the abysmal abyss of hard core heroin addiction, the routine might be a highly important one for patients..

While the administrators of almost all clinics were exposed to this phenomena when they switched the type of methadone dispensed (say from the orange diskettes made by Lily to the generic white diskettes - a case where there were real pharmacological differences for a small minority of patients requiring slight adjustments in doses, but a much higher incident of psychological reactions, virtually all negative - it seems that many clinics just chalked this type of patient unrest up to that old "obsession with drugs that should be expected from a bunch of junkies."

Small, seemingly trivial, and when all is said and done, unimportant changes in a patient's clinic routine can also cause stress to wildly varying degrees depending on the individual patient.

The manner in which a given clinic handles such changes is probably demonstrative of the manner in which it views its patients

Of course there will always be changes which occur suddenly and no one can do a thing about it. There are a lot of changes, however, which clinic management will not acknowledge, unless directly asked and then the attitude is almost always "It's none of your business, but since you're butting in, we'll tell you the minimum..." - as if changes they want to claim are inconsequential can only be communicated on a strict "need to know" basis (and patients never "need to know" anything, save clinic dispensing hours).

Such changes do, however, affect patients, and potentially their recovery. It would take so little on the part of the clinic to minimize the potential harm which might result from the change, and in the case of methadone patients, such harm can include relapse and death.

I have an image of myself as "easy going" (in fact, I won the Governor Edmund Brown, Jr. Award in 1972 for "Going with Flow" so I was surprised this morning at the level of stress caused when I personally stumbled into such a situation when I asked if old Jorge, my well-trained counselor was in, as I had purposefully come early in order to turn in two prescriptions which I regularly receive and for medication for which they do not test (although that's exactly the type of thing they like to randomly change to keep even the most compliant patients discombobulated).

So at 8:15 I stepped over pools of bodily fluid spewing from sick fiends trying to complete reams of paperwork with lots of small print which is required (along with $15) for the clinic to put anyone on a 21 day detox*.

The receptionist, Rugerio, imparted more information than is customary at the clinic, blithely risking his career when he told me "Jorge doesn't work here anymore."

Rugerio finally came clean and told me the name of my new counselor, Loretta. Then I took my seat and I waited to be dosed and I thought...

"Loretta, hmmmmm.... Oh crap is she going to want to try and really counsel me about something? Is she going to accept these duplicate originals of the scripts or is she going to make me come rattling in here on Monday, my pockets stuffed with pills? Is she going to hassle me about employment even though the former Director Frank understood that I am self employed and no one can verify my hours, and got my take home privileges okayed by the State over a year ago? And what will she think about my plans to stop practicing law except for a few non (or hardly) paying clients and become a chauffeur. Will she want me to detox even though I know damn well that even if I did I'd be abusing something - anything - and end up wrecking the stretch limo with some executive in the back?

After I dosed I wandered through still more sick junkies filling out still more forms to Jorge's old office. Before I even got to the door Loretta had become some sort of amalgamated mutation with all the worst features of the dozen or so counselors I have had while on methadone. "She is surely a Christian zealot who never, under any circumstances, makes mistakes and who used every intoxicant she could throughout her own methadone maintenance before Christ came down from Calgary and took her to an N.A. meeting; she did not have the first clue about methadone, but knew she knows all about it and had no need, let alone interest, in learning anything, especially from some stupid junky who is going to try and pull something over on her to get the drug he craves like a rabid boar; she assumes that whatever I'm doing I must be wrong or I wouldn't be on "this poison."

Not only that, but she lacked any of the good qualities that were possessed by any other counselor.

Indeed, I had as many potential misconceptions about Loretta as I assumed she had about me.

Thus armed I walked into her office and introduced myself, explaining why I was there. It was obvious she was extremely stressed herself.

I was not brash or short with her, for I know that even if she was my worst nightmare counselor I could improve upon things even if just a tad, with kindness.

And she was not rude. She seemed a bit unsure of herself. Nevertheless, she managed to send signals which hinted at her true feelings - she was in charge and I only existed to enable her to get a pay check.

First, she did not introduce herself or accept my outstretched hand as I told her who I was and explained my relationship to her. Motioning to the four large pill bottles some other patient had apparently brought her she snapped: "Well, I'm doing this now," but it was a meek snap.

I put my own prescriptions on her desk and quietly explained that nothing need be done until she had the time, and then I didn't need them back... "No rush - just do it whenever you get around to it."

I left, wondering if she would ever get around to it.

But I realized something on the way home. There were no pleasantries exchanged. And that, upon meeting anyone for the first time under any circumstances, was unique in my experience.

Picky, picky, picky, aren't I? Well, frankly I don't care. However, I know a lot of different people in MMT, and obviously patients are at all different levels of recovery. Opiates (and other depressants) are often the drugs of choice for those of us who simply cannot stand the intolerable agony of being. Perhaps many of us are overly sensitive. So what? We didn't order anyone to work at a methadone clinic.

Like I said, I was surprised by the stress produced in me by such a seemingly trivial change. I imagine such stress might be magnified greatly for Jorge's former patients who had real serious problems in life - spousal abuse or who were facing possible jail time or who were HIV positive, or had just discovered their kids had started hiding rigs in places.... These people presumably poured out their hearts to Jorge and shared things with him one only shares with a counselor. Now maybe Jorge wasn't the best counselor in the world, but I have to imagine he was a whole lot better for these folks than the idea of dealing with some rookie who looks like she probably never saw a joint in her life.

The fact of the matter is that such stress could be minimized by Management fairly simply. A week before the change took place, patients could be notified in order that "goodbyes" might be briefly said, or the patient might get a chance to be reassured that any little quirk about the patif ent's program was documented in the clinic file, and thus the things such as Betty's inability to attend counseling sessions except on Mondays or Bill's already approved week visit to his dying mother in New Hampshire (where there are no clinics) would not become issues with the new counselor. Ideally Jorge's final week could have been spent showing Loretta the ropes and introducing her to patients. After all, the first few days on a new job are no joy ride for a new employee either.

If such an arrangement would not be feasible, a simple handwritten notice at the front desk reading - "Jorge is no longer with the clinic. If Jorge was your counselor, your new one is Loretta, who can be found in Jorge's office. Please take a minute to stop by and introduce yourself" - would be a nice touch. After all, the new counselor has, to varying degrees, depending on the clinic and the patient, the patient's fate in his or her hands.

No one wants to meet her new counselor for the first time to be informed, the day after the lab threw out specimens making re-tests impossible, that her last urine was positive for something she knows she didn't take, (and this has happened to me before Jorge was properly trained). It doesn't really begin the relationship, which is supposedly the most intimate one should have at a clinic, on the right foot.

It took me several months of vigilant work to get Jorge to be a good counselor, and even then he wasn't going to win any prizes, but he did his best. I suspect it takes at least that long for many, who desire such relationships, to develop an open and honest one with any counselor. And now I have to break in a new counselor from scratch, and at least some of my fellow patients must feel as if neither Jorge nor the clinic ever really gave a damn about their very real problems. Personally, Jorge could have saved me a lot of hassles I anticipate by just going over my case with Loretta.

Such things are inevitable, of course. No patient can reasonably expect a poorly paid counselor to stick around a job which requires him to arise before four everyday.

But clinics, PLEASE! It's a lot less stressful if we know ahead of time that we're in for a change, or at least are advised of the change sometime before we either want or are required to see our new counselor.

I would like to think that if Frank was still Director instead of "What's His Name" with whom I have not exchanged a single word in three months (I'd say "hi", but he always is looking away, and I don't know his name anyway), this wouldn't have happened as it did.

But then Frank up and just disappeared as well, without any goodbye or explanation.

Didn't anyone ever tell these bozos that unnecessarily frustrating a person in recovery increases the possibility of relapse Of course I suppose if it was their job to care about such things, they would.

So shut up and dose already!

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As a counselor employed at a large, private methadone clinic located in the Midwest, I was dismayed by some of the letters sent in by *[patients] who have experienced numerous and frequent problems with counseling staff. Some people felt that counselors were not properly trained, while others believed that counselors were not supportive or aware of the diverse needs of [patients]. One person even believed that the counselor was jealous that they were now drug free and succeeding in life! To all the people who have expressed dissatisfaction in treatment, I would like to say--"There is hope!"

There ARE counselors who are educated, have good communication skills and actually do the best they can to assist the [patient] and show that they understand the struggles methadone patients face. I know that this is true because I work with some of these counselors myself! It is not always an easy task to satisfy the individual needs of each [patient], but I know counselors (and attempt to be one myself) who do everything possible to make the [patient's] life easier by doing such things as petitioning for early take home privileges (including getting take homes for people well over 100mgs.), raising doses to adequate levels (once again, well over 100mgs.), if clinically indicated), split dose take homes for fast metabolizers, having special very early morning hours for employed [patients], petitioning for [patients] who have take homes already to get up to 14 bottles for out-of-town travel, and keeping the clinic open late in cases of poor weather. There are also frequent in-house speakers (as well as the opportunity to attend seminars) so that the counselors can keep up on new treatment developments. No one pushes premature withdrawal, as the owner's philosophy (who is an M.D.) Is ‘patient-determined doses'. This, along with the availability and empathy of the staff help make [patients] feel that they have a say in treatment.

I know that I am doing something right when a [patient] tells me, "Thank you, you helped me," or if they send a card stating the staff has ‘been there' for them. Because of this, I believe that all [patients] should have access to the best treatment available, because it does make a difference. There actually should be more competition in methadone treatment for the [patient's] patronage. That way, if one clinic does not try to compromise with [patient] needs, then they could switch to another clinic that will.

All [patients] should be aware of the education, training and experience of their counselor. A person must be informed to have control over their treatment situation. Publications such as this one assists [patients] by letting them know that they have a voice--and it lets the treatment staff know what they should improve on, so that there can be a unified effort to fight against heroin addiction--instead of each other!

K.R. Krupinski MA, LPC, CADC
Center for Addictive Problems, Chicago, IL

Note: *The word ‘patient' was inserted where the word ‘client' was used. This is the first article we have received from staff in the two years plus that we have been publishing Methadone Today. Although we have encouraged a dialog between patient and staff and asked for the "other side of the story", this is the first time someone has taken us up on it. Hopefully, this will be the first of many responses to patient concerns.

And, thank you K.R. Krupinski for the tone of your response. This should help break down some of the barriers erected between patient and staff and, as you say, "fight against heroin addiction--instead of each other!"

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The Hurricanes of the Gulf Coast presented me with a few problems in the past as well as a friendly snow storm while on a visit up north. It is a shame what we addicts go through to keep our take homes and to even get our dose. Do the clinics stay open so if we come upon a road block or some unforseen force slowing us down? Not mine. How about the weekend (Sat.) when I had a flat on the way to pick up my weekend doses (my clinic was closed on Sundays back then), and the dosing nurse would not wait for me to get there...so the 2 days without my methadone was truly a nightmare.

This way of life is not for everyone. The constant fears that we go through every time we go to the doctor or get a cold and have to take medications. You're faced with the possibility of getting a dirty UA ‘cause some dumb lab tech didn't wash the dopler before testing your urine--after testing a dirty for coke or speed. I always go through a time of high anxiety even though I am clean--and I wonder where my grey hairs are coming from!

Then, say you hurt yourself and need something for pain--is it gonna put you into withdrawals or make you have a seizure? I have heard the horror stories!!!

So what do we all do about these things? Your guess is as good as mine! I guess we can keep talking to our powers in charge--the clinics and pray that we do make some changes. I know our collective voices do help to make changes because we did in my own home clinic. It just takes time and patience--(the two things we addicts are not comfortable with). Just a thought or two.

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I was somewhat surprised to see an advertisement for a product called "TEST FREE." The ad claims Test Free is a product you can add to your urine (for a urine test) that will "successfully eliminate the detection of any substance that could trigger a positive test result." The ad further states that the company who produces Test Free, Zydot Unlimited, Inc., "does NOT condone or promote the use of illegal drugs" but developed this product to protect the American public from potential "false positives," unqualified labs, undertrained technicians, lab errors, etc. They give a lengthy list of over-the-counter and prescription drugs that may cause false positives. False positives or other errors may cause a person to lose a job or potential job, mess up probation, be denied medical insurance, etc.

We, in the DONT group, do not advocate illegal drug use either. We decided to make other methadone patients aware this product exists because we know methadone patients are still discriminated against for many jobs. We, of the DONT group, have NOT personally tried this product, so we do NOT know if it works; use at your own risk! Test Free is available at "Heads-Up" in Mt. Clemens, Michigan or "Smoke N Stuff" in New Baltimore, Michigan.

Also, please do not buy this product intending to "scam" your clinic; if you add this to your urine to make heroin "disappear," remember, it is supposed to wipe out everything, including your methadone--which will cause you to have a "dirty" urine anyway!

If you fail a drug test for a job because your urine shows methadone, please consider fighting it. As our Editor stated in our October issue, the Americans with Disabilities Act (ADA) prohibits denying employment to methadone patients for taking methadone. You could file a complaint with the Equal Employment Opportunities Commission. I suppose if it happened to me personally for a potential job, I would also give the Personnel Office literature on the success of methadone treatment if my urine showed methadone or some literature on "false positives" if my urine showed a false positive. It probably wouldn't get me the job, but at least I would have tried to educate them. Methadone patients shouldn't even have to worry about this kind of discrimination.

If you are interested in further information on urine testing, there is a lot to read on the Internet. One particularly interesting treatise (from which I co-opted the title "Fooling the Bladder Cops"!) can be reached by: URL: http://www.csun.edu/~hbcsc096/dt.

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In the U. S. approximately 150,000 cases of Hepatitis C are reported annually to the Center for Disease Control.
Hepatitis C is the a leading cause of liver transplantation.

85% of all individuals infected with HCV will develop chronic liver disease.

The National Institutes of Health reported that nearly 4 million Americans are infected with the Hepatitis C virus.
Hepatitis C is 4 times more common than HIV AIDS.

Approximately 8,000 to 10,000 Americans die each year, and the number is expected to triple by the year 2000.

In 1991, the last year for which numbers were available, medical and job related costs from Hepatitis C were estimated at $600 million.

There is NO vaccine for Hepatitis C, and the only currently available therapy has a low response rate.

A large number of patients have no clearly identifiable risk factors, but some of the risk factors include Blood Transfusions prior to 1990, tainted blood products before 1990, Gamma-Gard, hemodialysis, health care exposure, sharing drug snorting devices, needle stick injury, organ transplantation, body and ear piercing, high-risk sexual behavior, tattooing, and intravenous drug use. Thirty percent of people infected do not know how they became infected.

Common symptoms reported by patients with Hepatitis C include abdominal pain, fatigue, elevated liver enzymes, loss of appetite, intermittent nausea, vomiting, weight gain or loss, loss of concentration, depression, and rarely jaundice. However, many people with HCV report little to no symptoms, but can still have serious liver disease.

If you would like more information about Hepatitis C please contact the following organizations:
Hepatitis Foundation International, 800-891-0707
30 Sunrise Terrace, Cedar Grove, NJ 07009
Hepatitis Education Project, 800-218-6932 or 206-447-8136
P.O. Box 95162, Seattle, Washington 98145-2162
Hepatitis C Support Project of San Francisco Helpline: 415-834-4100
548B Clayton St., San Francisco, CA 94117
HEPATITIS C FOUNDATION, 800-324-7305
1502 Russett Drive, Warminster, PA. 18974
American Liver Foundation, 800-223-0179
1425 Pompton Avenue, Cedar Grove, NJ 07009-0179
Amegan Pharma. for brochures on HVC 800-77-AMGEN

May I suggest the following web sites:
Hepatitis Haven - http://www.tiac.net/users/birdlady/hep.html
The Hepatitis Place - http://www.geocities.com/HotSprings/5633
Hep C Home Page - http://www.geocities.com/HotSprings/5670
Peppermint Patti's Junk Drawer - http://www.alaska.net/~clotho
Sandi's Crusade - http://www.octonline.com/usr/dusanm/sandi
Hepatitis - http://members.aol.com/VikkiSM/hepage.html
HepC Alert http://www.geocities.com/HotSprings/8289/mem1.html
Daniel's Hepatitis C Web Site - http://village.vossnet.co.uk/c/crina
Ingo d'Alquen' Multilingual Hepatitis Homepage - http://ourworld.compuserve.com/homepages/MultimeIdA
Brian's Chronic Hep http://ourworld.compuserve.com/homepages
BACafe Hepatitis C HCV - http://www.flash.net/~twb/BACafe
happy_hepper's - http://www.geocities.com/HotSprings/2630
MMacdou797's - http://members.aol.com/mmacdou797/index.html

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1925 - Robert A. Schless: "I believe that most drug addiction today is due directly to the Harrison Anti-Narcotic Act, which forbids the sale of narcotics without a physician's prescription. . . .Addicts who are broke act as "agent provocateurs" for the peddlers, being rewarded by gifts of heroin or credit for supplies. The Harrison Act made the drug peddler, and the drug peddler makes drug addicts." "The Drug Addict." American Mercury, 4:196-199 (Feb 1925), p. 198.
1929 - About one gallon of denatured industrial in ten is diverted into bootleg liquor. About forty Americans per million die each year from drinking illegal alcohol, mainly as a result of methyl (wood) alcohol poisoning. Sinclair, Andrew. Era of Excess, p. 201.
1937 - Shortly before the Marijuana Tax Act, Commissioner Harry J. Anslinger writes: ‘How many murders, suicides, robberies, criminal assaults, hold-ups, burglaries, and deeds of maniacal insanity [marijuana] causes each year, especially among the young, can only be conjectured" (John Kaplan, Marijuana, p. 92).

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Rob Killian invited me to take part in the press conference held in Seattle to kick off the Initiative 685 Drug Medicalization and Prevention Act (Washington State). I purchased a "turn around ticket". I returned to the airport and took an earlier flight home as there were plenty of seats available.

The Alaska airlines ticketing agent asked, "Do you have any luggage to check?"

"No."

"Any carry on's?"

"No," I replied.

"Just your purse?"

"Yes," I said.

"Are you a member of our frequent flyer plan?"

"No," I said, "but maybe I should be."

The agent then produced a long white tag saying, "Please bring your purse to the counter. We are searching all purses today."

He placed a tag on it and told me it would be searched.

Now doesn't this make perfect sense? Well, maybe there's been some terrorist threat, I was thinking with dread.

It became obvious in the security check point that not all purses were being checked that day. Only mine that I could see. I realized that I'd fit the "profile" of what the FAA is pressured by the DEA to watch for. All the contents were emptied out, and a terribly embarrassed woman began to go through my belongings--my wallet had $20 in it, and I wondered if there had been $500, would I have that money tonight? Or just a receipt? My make-up bag . . . and then my empty purse was x-rayed again.

The whole time this invasive process was going on, I was saying, "Now isn't this ridiculous? I know that you are looking for money or drugs because I purchased a turn around ticket only yesterday. But you see, if I was carrying drugs you could have me arrested for or cash you would like to confiscate, I wouldn't have left them in my purse. But I am not smuggling drugs -- I am simply an American citizen being violated right now because of the War on some Drugs."

I repeated this loudly so that the people who were watching my personal belongings scattered all over the table would know what all this is about.

I steamed on the plane, and before leaving, I stopped to talk to the pilots. They invited me into the cockpit.

"Listen guys," I said. "I know that this situation isn't your fault, but you have meetings now and then I'm sure. Maybe you can pass this along. Here's what happened...." and then I continued, "At work they make us pee in bottles... at an airport you are made a spectacle because you fit a so-called ‘profile'." How far is this war on drugs going to take us?

Pilot #1 says, "I piss in a bottle before I fly, and most likely when I deplane, I will have to piss in a bottle again. Next, they will begin to draw my blood."

I said to Pilot #1, "And sir, I really don't give a damn what you do on your days off -- so long as you fly this plane sober."

And he told me that not one plane crash has ever been attributed to the pilot being under the influence of drugs. And I gave my anti-drug war spiel...one that I'd been saving for two pilots in a cockpit. They were really going off about how ridiculous all these intrusions were, and I asked them to visit our website because intrusion becomes destruction for some of us - gave them a few website addresses to look up - (drcnet.org included), and they wrote them down. And I asked these two men to help support organizations that were working for change in our current drug policy.

Constructively I got rid of my anger -- well, the part that was threatening to boil into rage. The experience reminded me that people are beginning to realize that this war on the people isn't a war on drugs - and malcontents are everywhere... even in cockpits.

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