Methadone Today
Volume IV, Issue VI (July 1999)
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ARM Attends 12th Annual Conference on Drug Reform
Policy - by Odus G.
U.S. Congress Considers Substance Abuse Parity
Mandate - by Aaron Rolnick
Y2K - The "Millennium Bug": Do Methadone
Patients Need To Worry? - by Nancy Rose
Patient Letter
Another Patient Letter
Doctor's Column - Breast Feeding
& Y2K
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ARM Attends 12th Annual Conference on Drug Reform
Policy
by Odus G.
Recently, the Drug Policy Foundation held its 12th International
Conference on Drug Policy Reform in Bethesda Maryland. The Conference
was an unqualified success and covered a plethora of topics related to
Drug Policy Reform. One of the highlights was a Legislative
Training Session, with experts on the most recent legislation and advocacy
techniques presiding. Following the classroom training, the entire
entourage boarded buses and actually met with their respective elected
representatives to voice their concerns with the current Drug Policy.
Also meeting for the first time were the patient advocacy group,
NAMA, and the methadone policy advocacy group, ARM. One of the topics
which concerned them both was the proposed legislation put forth in Senate
Resolution 295 and 423.
These types of legislation, presented solely on a moral basis,
denies the excellent record methadone maintenance treatment has attained
and instills fear of the treatment instead. ARM is especially
appalled at the statement in resolution 295 which reads, "Whereas. . .
methadone addicts are unable to function as self-sufficient, productive
members of society". This writer truly bristles every time he reads
it!
An offshoot of S. 295, S. 423, The Addiction Free Treatment Act
of 1999, also relies on morality as its basis and seeks to deny payment
from the government for methadone maintenance treatment. If passed,
this bill would also affect cash pay patients who was enrolled in any clinic
that accepts federal money.
Other subjects covered at the conference included "Economics,
Race, and User Representation" as well as "Women, Families and Harm Reduction
in Treatment." There was an update on International Issues, as well
as a session on marijuana reform.
There was also a session that covered the Internet's contribution
to drug policy reform. Truly, this was a conference that covered
all issues of drug policy reform in a manner that included everyone.
Also of interest to the methadone groups attending the conference
was the presentation of the "Norman E. Zinberg Award for Achievement in
the Field of Medicine and Treatment" to Dr. Vincent Dole. In true
Dr. Dole fashion, he turned over all credit for his work to his partner
(in work and in life), Dr. Marie Nyswander. Truly, these are both
great people who worked selflessly so that others could live a better life.
Our hats are off to them both.
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U.S. Congress Considers Substance Abuse Parity
Mandate
by Aaron Rolnick
The U.S. Congress is currently working out the details of "substance
abuse parity legislation." The purpose of this legislation is to
"[require] private insurers to cover. . . addiction treatment on a par
with other health coverage." In other words, health insurance companies
must provide as much coverage of substance abuse treatment as with any
other medical treatment (i.e.: if an insurance policy covers 80%
of doctor's office visits [outpatient care] up to a limit of $5,000 per
year, the policy must also cover at least 80% of outpatient substance abuse
treatment/visits to a counselor or clinic on an outpatient basis, with
coverage up to at least $5,000 annually).
The main discrepancy between the House version of the bill, and
the Senate version of the bill is regarding what types of substance abuse
treatments will be included in the requirements. U.S. Senator Paul
Wellstone's (D.-Minn.) version of the parity bill would, "cover all varieties
of addiction treatment [including methadone maintenance], (Alcoholism &
Drug Abuse Weekly, Feb. 16, 1998)." In the House, U.S. Representative
Jim Ramstad's [R.-Minn.] version of the parity bill would only cover "‘abstinence-based'
treatment." (abstinence-based treatment is politically correct-speech
for anything but methadone maintenance [and LAAM] treatment).
Unfortunately, the Ramstad bill may have the edge in a Republican
Congress. Even some Congressmen who would prefer all substance abuse
treatments be included in the parity mandate may vote in favor of the Ramstad
bill if they believe that it is the last, and only, chance of passage of
a substance abuse parity bill before the next election. William Cope
Moyers, vice president for public affairs at Hazelden Foundation agrees,
"It's now or never [for the passage of a substance abuse parity bill by
Congress]."
This writer does not agree with the sentiment that any parity
bill is better than nothing. Precedents are important— judges, attorneys,
union negotiators, and business owners all understand the importance of
it. The Ramstad bill would set a dangerous precedent: it leads
the way for future legislation, as well as health care policies and employment
contracts that exempts methadone maintenance therapy and methadone patients
from health care benefits, discrimination laws, etc.
Besides that, this bill would promote and legitimize the stigma
and discrimination against methadone patients that already exists.
People who view methadone maintenance treatment as merely a substitute
addiction will be reinforced in their beliefs (if the government exempted
it from parity, then it must not be a legitimate treatment).
New York City Mayor Rudolph Guiliani and Senator John McCain,
vocal opponents of methadone maintenance treatment, would be vindicated
and strengthened by the bill's passage—people will assume that politicians
who opposed methadone treatment from the beginning had good, legitimate
reasons for opposing it (after all, Congress would have included methadone
maintenance in the parity bill if it were a valid treatment, right?)
In conclusion, Congress has three options: (1) Pass
the Ramstad bill as-is, which would "mandate parity substance abuse coverage,"
but only for "abstinence-based" treatments [not methadone therapy]; (2)
Pass Wellstone's version of the parity bill, which would require insurers
to provide coverage of all substance abuse treatments [including methadone
maintenance treatment] "on a par with other health coverage"; or (3)
Not pass any substance abuse parity legislation—and hope that in the future
Congress will pass a bill similar to Wellstone's version [see (2) above].
This writer would prefer the outcome described in (2) above but otherwise
believe that Congress should vote against the Ramstad bill even if it results
in the outcome described in (3) above.
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Y2K - The "Millennium Bug": Do Methadone
Patients Need To Worry?*
by Nancy Rose
What is "Y2K" - the so-called "millennium bug"? Can it possibly affect
methadone treatment clinics? Do methadone patients need to be concerned
about it?
The Y2K problem is a computer glitch which arises from a simple
error made back in the 1960's when the first computer systems were created.
To save on a computer's memory, computer programmers used two digits rather
than four to designate the year (for example, 99 rather than 1999). Unfortunately,
when the year 2000 arrives, many computers may read the date ("00") as
1900 rather than 2000! When this happens, some computer systems may shut
down, and others may spew out bad information.
Some experts feel this may have the potential to cause computer
shutdowns on a global level causing a number of disasters, such as massive
power blackouts, the failure of hospital, factory, and fire equipment,
the collapse of banking, food shortages, riots, and worse. Nuclear weapons'
systems in all nations are computer-dependent.
But, other experts feel the problem is being greatly exaggerated
and say that there will be only minor inconveniences at most. The reality
may lie somewhere in between these two extremes.
World governments, financial institutions, utility companies,
and other businesses are spending billions of dollars in a race against
time to make sure that Y2K doesn't cause a problem for their computers
when January 1, 2000 rolls around. The Social Security Administration is
one of the federal agencies that now report being 100 percent Y2K compliant.
Close to 100% compliant are the Department of Veterans Affairs and the
Department of the Treasury (which gives out benefit checks), and others.
"Experts" advise private citizens that it might be wise to have
some extra cash on hand before the first of the year in case ATM's won't
work. They say some people may experience power outages, so keep flashlight
batteries and other supplies on hand like you would for any possible emergency.
Some families are reported to be stocking up on canned food and bottled
water and obtaining a gas-powered generator in case of a power outage.
Most home computers and appliances shouldn't be affected, say
experts, unless they're very old. The "Y2K Q&A" column in the Detroit
Free Press informs us that the days and months of 1972 mirror those of
the year 2000 (including being a leap year). So if a computer's clock is
reset to 1971 before January 1, 2000, the computer will not have to deal
with the date rollover to 2000. The computer will continue to work normally,
but the year will be wrong. This may be OK if you only use word processing,
but they say it may cause some confusion for other date-sensitive software,
such as spreadsheets, computer banking, bill paying, and others.
So, can Y2K possibly affect methadone treatment clinics? Do methadone
maintenance patients need to worry? Could there possibly be a problem with
delivery of the medication from the pharmaceutical company (sometimes from
a different state than the clinic)? Many clinics use computers for
payment information and for dosing. A patient wrote to Methadone
Today's "Dear Doctor" column asking these very questions.
It seems logical that the wisest thing to do would be for clinics
to have a plan in place for any kind of emergency, in addition to any potential
Y2K problem. This includes having extra stock bottles on hand in
case dosing-machines break down or there are power failures.
What if a clinic has a fire? Some kind of disaster plan must be
in place--to send patients to a nearby clinic or hospital to be dosed.
Obviously, our medication is vital to us, like heart medicine is to a heart
patient or insulin is to a diabetic. Oh yes, there is the occasional person
(hopefully not any staff members) who thinks we should be able to live
without it for a day without great harm, that we can "survive withdrawals",
but this attitude is unprofessional and uncaring. Since addiction
is a disease, and patients need prescribed medication to live normally
(and we can get very sick without it, including possible relapse), methadone
patients deserve the same respect given any patient with any disease.
I'd like to see the time come when people think of us as patients trying
to get well and stay well.
I believe every patient has a right to know what kind of "disaster
plan" is in place at their clinic in case of an emergency. And clinics
have a responsibility to their patients to make sure their medication is
available no matter what emergency may arise.
*Information for this article came from the Detroit Free Press "Y2K/Q&A"
column (several dates), and Time Magazine (January 18,1999 issue).
[To check if your home computer is Y2K-compliant, the Detroit Free Press
reports you can get a Y2K "test" by downloading from www.nstl.com.
The Ymark 2000 program can tell if your computer will have a problem handling
the year 2000. If there is a problem, then contact the computer maker
for directions. Another possibly useful site: www.y2k.com.]
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Dear Methadone Today,
I just received my April issue of Methadone Today.
I was somewhat surprised, then elated to see my letter and cartoon printed
in the issue! I surmise you used the name "Allan" as the writer of
the article to protect my anonymity. Anyhow, I appreciate your printing
it, for it will not only be helpful to others in my situation, it also
gave me a boost in my self-esteem -- to see something positive of mine,
serving as a valuable tool in the community.
I have a question to ask: is there anybody on a methadone
maintenance program who is also on probation or parole in Wayne County
(Michigan)? If so, I assume they must have their parole or probation
officer's approval and cooperation. If somebody has this "luxury",
perhaps they would be so kind as to write to me. It sure would dispel
any trepidation I have because I will be paroled very soon.
Beth, if you print this letter, could you ask that they write
to me in care of your newsletter? Thank you so much.
(Editor's Note: Marshall was to be paroled in late May
1999. If any Wayne County reader is on parole or probation and also on
methadone maintenance and would like to write Marshall, please send your
letter to Methadone Today, PO Box 164, Davison, Michigan 48423-0164, and
I will be happy to forward it to him.)
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Dear Ms. Francisco,
I just received my first copy of Methadone Today—given/sent to
me through the good graces and thoughtfulness of my younger brother.
I must begin with major kudos and accolades for you and the staff
and all contributors to Methadone Today. Every single article and
letter struck a nerve and hit home with me—or someone I know at my clinic.
A real Godsend!
My story is not unlike all of our stories--a 40-plus-year struggle
with opiates with all of the accompanying baggage and wreckage--rehabs,
meetings, stigma galore, depression, confusion, even a 10-year stint in
AA/NA . . . most of it spent in therapy trying desperately, earnestly,
and honestly to figure out what the hell was wrong with me. You name
it, and I did it. During this period of "sobriety" (I use the term
loosely, as it implies "soundness of mind"), I married the woman of my
dreams—an old friend I bumped into at an AA meeting when I was just over
a year clean. We had [have] two beautiful children, bought two beautiful
homes, and had all the appearances of a well-to-do middle-class family
on their way up.
Our second home involved a move back to the rural community where
we were both raised—a return "home." It seemed as though we had arrived
in our heaven. We both ran our own successful businesses, the kids
were healthy and happy, I had built my "dream shop" in our large new mountain
retreat, we both were into our meetings of AA/NA, we had a large circle
of wonderful friends and good spiritual lives—on and on, ad nauseum.
Nearing my tenth year of total abstinence, I was on my way to
do an estimate one sunny fall day, taking a back road I hadn't traveled
in years. Suddenly I saw an old connection/friend I hadn't seen in
over 12 years alongside the road. Not thinking for a moment, I pulled
over to offer him a lift. Long story short—the "back country road"
I had "chosen" was now known as "smack alley", and my old connection was
doing just that—connecting.
Within 15 minutes I had my tie from around my neck around my arm
and bought an ounce of tar heroin from "Jack." Needless to say, I
never made my 10-year AA/NA anniversary. I spent the next four months
hiding my addiction from my wife, shooting dope in my basement shop under
the guise of "meditating" in the early mornings when I needed a fix.
Things quickly unraveled, and I finally called my wife that fateful day
and told her all.
Naturally, she was shattered. "We" spent the next
year or so trying to "get me back on track": three rehabs, two of
them residentials, a million meetings, thousands of "steps", more therapy—you
get the picture.
It was during this torturous period that I was introduced to methadone
maintenance treatment by a local shrink with an empathy—and some real knowledge—about
opiate "addiction." It was he who told me that perhaps I actually
needed an opiate to feel real, that not unlike the diabetic who is "insulin
challenged" that perhaps I was "neuro-chemically challenged" and merely
needed a neurochemical "supplement" to feel O.K.
Skeptical at first, I approached my first methadone clinic with
all of the misinformation one has when uneducated about methadone maintenance
treatment. I even tried to get off of my treatment by volunteering
for an FDA clinical study in the West Indies—under the direction of a neuropharmacologist
from the University of Miami. I spent two weeks on this island after
being dosed with a drug called ibogaine, a psychedelic plant from West
Africa, and being very thoroughly poked and probed (as only the FDA can
do!).
However, two weeks after my return from this incredibly extravagant
attempt at once again trying to rid myself of my "addiction", I was strung
out on heroin. After a three-month "terror run," I crawled back to
my old clinic and am happy to say have been "on the good foot" for nearly
three years now.
Believe me when I say I will NEVER again attempt to get off of
my methadone maintenance treatment. I am a methadone patient—I take
what I consider a lifesaving medication called methadone because I am afflicted
with a neurochemical imbalance disorder that has very inappropriately been
labeled "addiction."
My wife never did grasp this truth. She hung onto the 12-
step/therapeutic belief that my "addiction" was all about a legalized high,
copping out on "sobriety", and being weak. So for ignorance, I lost
my beautiful family, my business, and much of what I'd worked so very hard
for, for many years.
I'm working hard on the resentments I packed up and took with
me. The "IF ONLY's" and the "SHOULD HAVE's" are finally starting
to thin out--not because of methadone—because I am able to keep a straight
head while I deal with my past. But without methadone maintenance
treatment, none of my progress these past few years would exist—period.
I would surely be locked into that horrific cycle of jails, institutions,
and death.
Thanks for taking the time to read this. May God guide the
powers that be into realizing the miraculous truth about methadone maintenance
treatment so that we—as patients—can begin to enjoy life; unencumbered
by ignorance, stigma and backwards attitudes. Perhaps someday—in
the not-so-distant future--we will able to enjoy medical maintenance, the
lifting of draconian practices by many clinics, and the true freedom that
any medical patient has a right to.
Via con dios, SF
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