Methadone Today

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Response to MMT Inmates - by Steven C.

The Killing of the Fourth Amendment - by Sean Francisco

Dear Methadone Today - Suzanne D.

TIP/TAP Series - MMT in Jails & Prisons - Nancy Rose (DONT Secretary)

NAMA Column - Joycelyn Woods

Doctor's Column - A parent asks about his daughter who is on methadone

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     After seeing the story in the latest Methadone Today about MMT inmates, I thought an article from the Orlando Sentinel (May 3, 1998) might be of interest.  The article is the result of an incident at the Orange County Correctional Facility here in Orlando, Florida.

     The inmate, Susan Bennett, 42, was jailed for forging prescriptions.  She had an addiction to painkillers and was in methadone maintenance treatment (MMT).   She was completely ignored, virtually untreated, and neglected by guards and the jail's medical staff.  Her withdrawal (uncontrollable vomiting and defecating) culminated in a heart attack, resulting in her death.  Her family sued Orange County and settled with them for $3 million.

     Three LPNs were fired over the incident, and the article describes the resulting finger pointing. The nurses blame administration for not having enough medical staff, and administration said, "The issue with the death was that three or more nurses failed to perform their duties as nurses."

     I know from some of my fellow MMT patients at my clinic that here in Orange County, jail staff will not give any help to someone jailed on methadone maintenance, no matter what the person's dosage or time on methadone.  I am originally from Massachusetts where last I knew (8 years ago when I left), someone who is arrested can still get their dose or at least be detoxed.
Personally, I feel the county's policy here in Orlando to be disgraceful and despicable.  Hopefully, the $3 million settlement will result in a better policy.

     Editor's Note:  When I hear someone describe withdrawal from opiates as a "bad case of the flu," I know that they have never withdrawn from them.  One person described withdrawal as "a bad case of the flu, pneumonia, and a good ass-kicking all rolled into one."  Although that gets a little closer, it still doesn't convey the depth of misery that this woman must have gone through before she died.  If it's not cruel and unusual punishment, I would like to know what is.  One of the nurses said that they have been told not to think of "them" as patients; they are inmates.  Speaks volumes, does it not?  I agree with Steven that it is disgraceful and despicable, and something needs to be done to prevent this from happening.  Hopefully, the $3 million settlement will make jailers think before denying a patient's methadone.

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     Law enforcement, in the guise of the DEA, FBI, Customs, down to your local police departments are sharing in the profits from seizures to increased budgets.  The Fourth Amendment just gets in their way.  Like anything else in their way, they simply killed it or found new and clever ways around it.  They did it at the expense of the people.

     The Fourth Amendment to the Constitution of the United States of America reads: The right of the people to be secure in their persons, houses, papers, and effects against unreasonable searches and seizures shall not be violated, and no warrants shall issue, but upon probable cause, supported by oath or affirmation, and particularly describing the persons or things to be seized."

     The purpose of the Fourth Amendment is to stop the government, i.e. police officials from having omnipotent power over the people and streets of our country.  It should be the most mourned casualty of the war on drugs.  It is just the first step.  The Second Amendment has been under assault for decades, and it is the one thing that guarantees "We the People" have a defense against a government beyond our control.  How much longer can the First through the Fourteenth Amendments stand?

     As an expedient to their war on drugs, law enforcement officials have created "courier profiles."  These profiles, in theory, identify the type of person likely to be involved in transporting or otherwise dealing in the drug trade.  The result is that Joe and Mary Average are being accosted, detained, harassed, their money seized, and embarrassed by police for "looking like someone fitting a profile."  A profile!  Not a description from a credible witness to a crime whereby probable cause would exist.

     Jill Darby, a flight attendant on a personal trip, was at Stapleton airport in Denver.  She was asked by a man who failed to identify himself if he could search her purse and luggage.  To her the man did not look like a cop, so she refused to be searched.
 In seconds, Jill found herself surrounded by men with badges.  She was shoved forcibly into a wall, breaking her finger; they found nothing.  They found nothing because she was doing nothing.  She was guilty of fitting a profile--black, nicely dressed, and the first one off a plane.

     Willie Jones owned a landscaping company.  He was flying to Houston, TX to make a business purchase.  Willie refused to be searched by the DEA agents accosting him.  Once again, he was forcibly searched.  The DEA agents found only the $9,000 cash with which he had planned to make his business purchase.  The DEA "detained" the money.  Willie was handed a slip of paper noting the seizure of "an undetermined amount of US currency."  He asked the agents to count the money.  They claimed it was against agency policy and refused. Willie is also a black man who fit a profile.

     Hall of Fame baseball player, Joe Morgan, was making a phone call in the terminal of Los Angeles International Airport.  An LAPD detective approached and handcuffed him from behind.  Joe was interrogated and eventually released.  His crime?  Being a black man on a phone in an airport.  Let's not forget--he fit a profile.  He later won a $750,000 settlement.

     You may ask--what's the point?  The point is--according to law enforcement, we all fit a profile.  These profiles are the invention of the badge toter in front of you, and they can be changed to suit any situation they like, whenever they like.  It gives them the protective blanket of "probable cause" to do whatever they wish, without the aforementioned "sworn or affirmed" warrant.

     These profiles claim: speeding, scrupulously adhering to traffic laws; tinted windows, un-tinted windows; making eye contact, avoiding eye contact; being the first off a plane, being the last off a plane, or being one of the ones in the middle group off a plane; dressing loudly, dressing conservatively, or just looking average and blending in is the profile of the doper.  No matter what you happen to be doing at a given moment makes you fit the "profile of the moment."  Fourth Amendment. . .May you rest in peace.

     I am thirty years old, white, and I do not use or smuggle drugs.  I own and drive a Cadillac Fleetwood Brougham; it is a nice car.  I wear a cowboy hat; it is a nice cowboy hat.  I usually drive the speed limit in town.  I thought the only profile I fit was that of a thirty-year-old white guy who wears a cowboy hat while driving his caddy.  I was wrong.  I seem to fit the profile of a thirty-year-old white guy wearing a cowboy hat driving his caddy. . . while smuggling drugs.

     I was pulled over not long ago.  It was around midnight, and I was on my way home from the ranch where I keep my horses.  I was not speeding, all my lights work, and the car is legal in all respects.  I was pulled over this night for no other reason than I fit this officer's profile.

     The officer approached my car with his hand on his .40 caliber Glock.  You can see caution was in order, as I am such a dangerous criminal.  The officer reached my door and ordered me out of my car.  This is usually the way things happen on the television show "COPS" just before you are arrested.

     I asked why I was being pulled over.  I was informed that I was in an "area frequented by drug dealers and prostitutes."  I looked somewhat puzzled, but I handed him my valid Arizona driver's license, current registration, and proof of insurance.
 
     The officer asked me if I had anything in my car that "I didn't want him to find."  I said, "No."  He then asked me if he could search my car.  I said (you guessed it), "No."  He asked if he could search ME.  I again said, "No."

     The officer ordered me to turn around and face my car.  I did so and was patted down.  He said it was for "My safety and yours". . . there was that probable cause.  He went on to search my car.  This was all after I had refused to give him consent.

     The officer then told me that "ninety percent of the people who refuse to let me search their vehicle are carrying drugs."  There was that nasty little profile again--invented on the spot to deny me my rights under the Fourth Amendment to the Constitution.

     The only thing the officer found was my cellular telephone.  He asked why I had it and who I called.  I told him it was none of his damned business, and I was rapidly growing tired of our little interchange.  His only reply was, "It is a tool for drug dealers."  There it was again--the profile had reared its ugly head.

     Another police officer arrived to check the stop out.  It happened to be a Sheriff's Deputy who has known me for awhile and keeps his horse where I keep mine.  I was relieved to see him as my temper was on the verge of blowing.  I did not want to catch an assault case for beating this asshole to a pulp.

     The recently-arrived deputy greeted me with a handshake and a smile.  He asked the Tucson officer who had me stopped what was going on.  After they had talked out of my earshot, I was told I could go.

     When I saw my "friend" at the ranch, he explained to me about "profiles."  He said he didn't agree with them but they were here to stay.  I had been pulled over because the officer didn't like the way I looked.  It is just that simple.  His own personal profile told him that I was involved in the drug trade.  Wave goodbye to your Constitutional rights.  Fourth Amendment. . .I am sorry to see you wounded so gravely.  The rest of our rights are sitting like dominoes on a shaky table.

     Editor's Note: Methadone patients feel especially vulnerable when being stopped by the police when leaving the clinic.  Although we have a legal medication, some patients have had their methadone dumped (apparently this amuses some officers).  If this happens to you, you may want to file a complaint.
 
Following are some tips from the American Civil Liberties Union (ACLU) if you are ever stopped by the police:
  Be polite and respectful.
  Stay calm and in control of your words, body language, and emotions.
  Don't get into an argument with them.
  Remember, anything you say or do can be used against you.
  Keep your hands where they can be seen.
  Dont' run.  Don't touch any police officer.
  Don't resist even if you are innocent.
  Don't complain on the scene or tell the police they are wrong or that you're going to file a complaint.
  Do not make any statements regarding the incident.  Ask for a lawyer immediately upon your arrest.
  Remember officers' badge & patrol car numbers.
  Write down everything you remember ASAP
  Try to find witnesses & their names & phone numbers.
  If you are injured, take photographs of the injuries as soon as possible, but make sure you seek medical attention first.
  If you feel your rights have been violated file a written complaint with police department's internal affairs division or civilian complaint board.
     What you say to the police is always important.  What you say can be used against you, and it can give the police an excuse to arrest you, especially if you bad-mouth a police officer [we, as methadone patients, especially do not want to be arrested].
 
     You don't have to consent to any search of yourself, your car or your house.  If you DO consent to a search, it can affect your rights later in court.  If the police say they have a search warrant, ASK TO SEE IT.

     Police may "pat-down" your clothing if they suspect a concealed weapon.  Don't physically resist, but make it clear that you don't consent to any further search.  It is not lawful for police to arrest you simply for refusing to consent   to a search.

For more on this issue, see ACLU Freedom Network - http://www.aclu.org
 

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    I am elated to read a paper from the patient's point of view, not hearing everything negative about my medication!  You see, every time I make a mistake, it's the medication.  Every time I fall asleep anywhere but the bed, I'm "nodding."  It does not matter that I have twin girls, 13-months old, who are up at 5:30 a.m.  If I forget to buy something at the store, it's my medication.

    I was a practicing addict for four years--the only time I stopped was during my pregnancy, but as soon as the twins were born, I was off and running.  Well, I knew my children deserved more, so a good friend took me to the clinic and waited with my children during intake.

     That day saved my life.  I don't wake up in the morning wondering, "Who can I borrow from?  What present of the twins can I return for cash?"  No, I get up, have coffee, feed the girls breakfast, and take care of myself.  I put much more into personal hygiene than I used to; my children are no longer a burden--they are a joy.  Instead of trying to get them back to sleep because I am too sick to deal with them, I want them to wake up.  My house is clean, I don't go to stores to steal to return items for cash, I have a life!  I care about things.  When I was using, all I cared about was how to get money for the next blow.  I now have clothes, my girls have clothes, and I don't sell their diapers.

     But for every success story, you know there has to be a negative.  From someone very close to me, I always hear how using methadone is just like using heroin.  Although he sees the positive change, he is so against the medication.

     In a previous issue, it was said in an article that people who down methadone are either ignorant or jealous.  I strongly believe he is jealous.  I don't get high every day, although people think I do.  I use my medication to make my life as normal for my children and me as possible.

     I want to thank my clinic, especially my counselor--without her, some days I would have gone back to using.  A year ago today, I was the most miserable person; today, I want to wake up.  I have no thoughts of using.
 
     Don't let anyone discourage your treatment.  We know it works!  We are now healthy, happy, working people one day at a time.  Thank you clinic doctors, nurses, and especially my counselor.  My children and I thank you.  -  Suzanne D.

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     TIP 20 (Matching Treatment to Patient Needs in Opioid Substitution Therapy), page 10, reminds treatment staff that "Among the most important factors to be understood when assessing the progress of an opioid addicted patient is the probability of relapse. . . . Studies have shown that roughly 80% of all patients resume daily use of opioids within the first year of leaving treatment . . . . [Opiate] addiction is a chronic relapsing condition that many people will battle for the rest of their lives."

     With that in mind, "Some patients may need indefinite or lifetime methadone maintenance. . . these patients may be appropriate for medical maintenance, and they should be permitted to continue in this phase indefinitely..." (p. 47).  For those who may not know what "medical maintenance" is: "Patients who have achieved a high degree of stability and are able to function effectively but who continue to need methadone to maintain this level of stability" are allowed to receive up to 6 days take home methadone and "typically are seen by their counselor or therapist once or twice a month" (p. 47).

     So that there is no misunderstanding, NAMA and DONT's definition of medical maintenance is that the patient sees a doctor in a regular office setting once per month.  The doctor writes for up to one month's worth of methadone (at his discretion) to be obtained at a pharmacy.

     In TIP 1 (State Methadone Treatment Guidelines), page 119, under the chapter on "Treatment Duration", it says, "Patients should always be encouraged to remain in continuing treatment; pharmacotherapy should be reinstituted if and when a relapse has occurred, is feared, or is predicted"  and "Because of the high relapse rate to heroin and the risk of...HIV infection...addicts should be encouraged to remain in methadone maintenance treatment indefinitely."

   Page 120 continues after listing several studies, "It is clear that decisions about duration of treatment should be individualized, with any generalization favoring long-term maintenance.  Indefinite treatment is appropriate for many patients who fit the criteria for chronic, intractable heroin addiction...The answer to the question, How long should methadone maintenance treatment last? is simple:  as long as it needs to, or simply, long enough" (emphasis theirs).

     TIP 1 summarizes: "Duration of methadone maintenance treatment should be determined by an individualized decision-making process.  It must be stressed that long-term, even indefinite treatment is appropriate for many methadone maintenance treatment patients!" (p. 123).
     An added note to counselors:  from TAP 7, Treatment of Opiate Addiction with Methadone--A Counselor Manual, under Chapter 3 (Methadone Maintenance), it states, ". . .it is not realistic or therapeutically beneficial to routinely promote the goal of detoxification from methadone.  To do so can suggest that what the patient is doing to deal with his or her heroin addiction is, at best, only temporarily acceptable.   The focus upon getting off methadone maintenance implicitly conveys a negative attitude about the treatment.  The patient who is not ready or able to withdraw from methadone is then left with the choice of being in a "bad" treatment or of returning to heroin use" (p.15).
 

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     John Anderson who is president of Methadone Awareness and Advocacy Coalition (MAAC) in Kamloops, Canada reports there are now more than 100 people on methadone treatment in the Kamloops area (population 100,000).  Together, MAAC and our sponsoring agency, The AIDS Society of Kamloops, has made a difference in the interior of BC.  The Executive Director is very supportive of MAAC and the methadone program; with her help and NAMA's, we could break some stereotypes and dispel some of the myths surrounding methadone.

Meetings and Conferences
     The Lindesmith Center, in cooperation with Beth Israel Medical Center, Columbia University School of Public Health, Montefiore Medical Center, New York Academy of Medicine, and Yale University Center for Interdisciplinary Research on AIDS is sponsoring two conferences.  There are some scholarships available if you contact Holly Catania at (212) 548-0695 and tell her you are a member of NAMA (if you belong to a chapter you are an automatic member of NAMA) and ask if you can have a scholarship.

     The First International Conference on Heroin Maintenance - Saturday, June 6, 1998 - 9:30 AM to 5:30 PM.  This conference will mark the first US presentation of the Swiss program by Professor Ambros Uchtenhagen, M.D., Ph.D. Principal Investigator of the Swiss National Project on the Medically Controlled Prescription of Narcotics.

     Expanded Pharmacotherapies for the Treatment of Opiate Dependence - Friday, September 25, 1998 - 9 AM to 5 PM.  Several countries are using opiates for maintenance treatment, including: codeine, palfium, morphine, buprenorphine and injectable methadone.

Place: New York Academy of Medicine
 Fifth Avenue and 103 Street
 New York City
Fee: $40/50 (lunch included) $20 students

The National Letter Writing Campaign
     And don't forget your letter this month.  By the end of the year, important legislators and policy makers will have received letters telling them that "methadone saves lives."  I am certain that many patients think it is useless to write a letter or that other patients are not doing it.  Well, we have already begun to make an impact.  We have received a stack of letters that are copies of the letters that patients sent, and we have also begun to get letters from patients who received a response from their legislator.  So far, they are positive.  So, get out your pens!

     In April you were asked to write your representative in Congress and May was your Senator.  Now for June--write to your Governor, and if you live in a state where patients have to drive long distances, tell him that no one should have to go more than thirty miles to their program or a doctor--that this is above and beyond what is expected of anyone else in recovery and that patients should be putting their energies into their recovery, like restoring their family and getting employment instead of having to worry about getting their medication.

     If you don't have one, you can get a copy of the draft letter from your local chapter (or use the one in the February Methadone Today.  And, of course, don't forget to drop NAMA a line telling us that you wrote a letter and who you wrote it to, or you can tell your local chapter, and they will forward the information to NAMA.

 National Alliance of Methadone Advocates
 435 Second Avenue
 New York, NY  10010
 Attn:  The National Letter Writing Campaign
 
 

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