 Greetings!!! I wanted to introduce myself to all of you. My name is Deborah Shrira. The desire to give of myself to help others
created the spark that gave birth to "Medical Assisted Treatment of
America, Incorporated."
I could not have done it
all alone, but I began to work with a man, soon to become just as motivated as I was. about seeing the changes brought about involving the stigma and discrimination attached to people dealing with sub-stance -abuse disorders. He was Dean Vereen. We started and have become active assisting people in all the areas from helping them locate treatment, taking calls 24/7, provid-ing all the support possi-ble from encouragement to simply caring enough to listen.We are here to educate and not pass judgement. We are here to love, and not critcize and most of all, we have time when others are busy, and we are here for you when everyone else has deserted you. We are in the process of building a strong community of people joined together by a common bond uniting us all. If you are all alone, now you have a choice - join with us - we will be there for you.
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Welcome!!! I want to thank all of the people that come and visit us on a regular basis and of course all the members that have joined with us. It is all of you that
make it possible for us to provide help. There is much more work that is needed.
Many changes need to occur for people to receive the help they need. It seems to
to me many of us have our priorities confused. We have lost all perspective. It should be more than obvious we need change! We have acquired much know-ledge but if we deem it unimportant and close our minds to our discoveries then, how will we ever progress and overcome???
We at Medical Assisted Treatment of America, Incorporated support "Opiate Agonist Pharmacotherapy." Patients receive daily doses of (prescription opiate
medication) to restore normalcy to a state of relative deficiency of brain opiates.
In concept, it is very similar to insulin treatment for diabetes, where patients receive daily doses of insulin (prescription hormone medication) to restore normalcy to a relative deficiency of pancreatic hormone.
Opiate addiction is a symptom complex with physical, emotional, and behavioral consequences resulting from relative deficiency of the naturally occurring opiates (endorphins) in the brain. When viewed in that context, it is not unlike insulin-dependent diabetes – a symptom complex of physical, emotional, and behavioral consequences resulting from relative deficiency of a naturally occurring hormone (insulin) in our bodies.
Insulin-dependent diabetes can be effectively managed by balancing the body’s insulin deficiency with daily injections of a prescription insulin medication, and thereby preventing a host of secondary medical problems associated with poorly controlled diabetes. Similarly, opiate dependences can be effectively managed with daily methadone treatment to balance the brain’s relative opiate deficiency, allowing patients to function normally and preventing a host of secondary medical problems associated with poorly controlled addiction.
The days where drug addiction was perceived as essentially a moral problem or character flaw are behind us. Cumulative scientific evidence gathered over the three past decades clearly establishes that drug addiction is a disease with a physical basis. The data demonstrates that addiction is a disorder of the human brain that severely compromises a patient’s ability to regulate and control his/her behaviors (compulsive drug seeking).
It has a biological basis in brain just like Parkinson’s Disease (dysfunction of the brain’s motor system) or Alzheimer’s (dysfunction of the brain’s cognitive system) or Major Depression (disruption of the brain’s mood modulating system). *** For addiction, the location of the dysfunction has been determined to be in the part of the brain largely responsible for reinforcement and motivation behind basic drives such as hunger, thirst, survival, and well-being.
Dr. Alan Leshner, former Director of the National Institute of Drug Abuse, describes addiction as the drug seizing control of the addicted person’s brain,thereby usurp- ing first the mind and then the life…by disrupting receptors and neurotransmitter systems in regions of the brain that normally allow the exercise of choice,resulting in uncontrollable, compulsive drug-seeking and use – the essence of addiction.
For the patient with addiction, drug-seeking becomes as primal and instinctual as the need for food and water, often even superceding these basic survival drives. Exercise of intrinsic free choice in the matter becomes nearly impossible at this stage, and external stabilizing intervention becomes necessary.
If you are interested in reading more the biological basis of addiction then you will find more than enough supplied on Medical Assisted Treatment of America.
"Addiction Science" http://www.medicalassistedtreatment.org/95142/index.html
In addition to evidence indicating that addiction is associated with fundamental changes in brain’s endogenous opiate system and its function, there are also many studies suggesting that the addict’s ability to cope with stress is also fundamentally altered.
For example, heroin addicts often do not respond, or respond at abnormally low levels to stressful events when actively engaged in their addiction. Addicts that are abstinent and medication-free show exaggerated responses, or excessive susceptibility to stress.
In contrast, addicts who are treated with long-term methadone maintenance tend to show a normalization of the stress response, as measured by the body’s release of stress hormones.
Again, the weight of recent scientific evidence continues to support Dr. Dole’s initial theory, that opiate addiction is a persistent derangement of the endogenous ligand-narcotic receptor system, and that opiate agonist treatment is a matter greater than simple substitution or replacement for illicit opioids.
Opiate agonist treatment (methadone) appears to normalize the brain’s relative opiate deficiency allowing the patient to function more normally.
Since 1963, when Dr. Dole initially hypothesized that heroin addiction was a brain disease with behavioral manifestations, and not just a personality disorder or criminal behavior, 40 years of clinical studies have clearly demonstrated the safety, efficacy, long-term clinical utility of methadone maintenance for opiate addiction.
The National Institute of Health published a consensus report unequivocally supporting methadone treatment for opiate addiction, and called for measures to increase patient access to this efficacious treatment modality. The expert panel reviewed an extensive bibliography of 941 references from the National Library of Medicine, MEDLINE and other online databases.
Their conclusions based on overwhelming data supporting reduction in mortality, morbidity, criminality, improved productivity through improved functionality, and public health benefit through reducing HIV/ Hepatitis C viral transmission from injection drug use are as follows:
1. Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it.
2. All opiate-dependent persons should have access to methadone hydrochloride maintenance therapy under legal supervision, and the US Office of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation.
3. There is a need for more improved training for physicians and other healthcare professionals.Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools.
4. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance
programs.
 All patients who suffer from chronic illnesses deserve to be viewed with compassion by both the public and by health professionals. In Dr. Leshner’s words, society views with compassion those patients for whom the brain disease is primarily manifested as physical symptoms, such as Parkinson’s or Multiple Sclerosis.
Society has even learned to accept as legitimate disease, those conditions where brain disease is primarily manifested by emotional symptoms, such as Depression or Schizophrenia.However, those patients with brain diseases where the symptoms are primarily behavioral,such as addiction, are less fortunate.
As we work with such patients, it is our hope that as science continues to elucidate the relationship between the brain, mind, and behavior, that negative stereotypes and societal stigma showered upon such patients with addiction will be dispelled, so as to improve access for safe and effective treatments to patients who suffer from this disease.
Reference: Professional Perspectives on Addiction Medicine
Edited By: Mark Stanford Ph.D..and Donald Avoy M.D.
We receive many complaints from patients about the quality of treatment they are receiving at Methadone Maintenance Treatment Facilities. I am not going to admit all facilities are guilty but I can tell you with confidence, many patients are treated with no respect. When I seen for myself the way the patients were treated it was the most crucial factor involved in my decision to open Medical Assisted Treatment and try to reach out and help these people.
I was totally ecstatic when I read an article that recognized what I had known for many years. If you have never had any problems with substance-abuse then it would almost be impossible for you to even relate to what all occurs in these
facilities, but there are many of us that have been there and can relate. I believe
it is time once again we begin to share the truth about exactly what is happening to us. I think people need to hear the truth for without there will be no change.
"The environments in which behavioral health care is both given and received are toxic for persons in recovery, family members, and the workforce,"according to a recent report commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The report examined the current status of the substance abuse and mental health—also known as behavioral health—workforce and found "overwhelming evidence that the behavioral health work-force is not equipped in skills or in numbers to respond to the changing needs of the American population" (p. 1). Among the weakness contributing to the current "toxic" environment:
• A Critical Workforce Shortage. Difficulty in recruiting and retaining mental health and substance abuse staff was observed, especially those trained to meet the needs of the young and the elderly. For example, "nationwide, only 700 practicing psychologists view older adults as their principal population of focus, well short of the estimated 5,000 to 7,500 geropsychologists necessary to meet current needs"(p. 64). The shortage is particularly acute in rural areas. More than one-half (55%) of U.S. counties have no practicing psychiatrists, psychologists, or social workers, and all of these counties are rural.
• A Narrow Focus on Urban White Adults. Prevention intervention, and treatment strategies are primarily developed by, tested with, and provided by Caucasian, non-Hispanic adults residing in urban areas. Thus, "the unique needs of the country’s rapidly growing ethnically and racially diverse populations . . . . .receive sparse attention, with parallels in a behavioral health workforce that lacks cultural and linguistic diversity and cultural competence"(p. 68).
• Dissatisfaction Among Persons in Recovery.Many persons receiving care described a workforce with "negative attitudes toward the very persons they are to serve "(p. 65). In addition, there was the feeling that "the emphasis on compassionate and caring therapeutic relationships has been significantly eroded in behavioral health care"(p. 65).
• Inadequate and Irrelevant Training. Employers of behavioral health care workers report that "recent graduates of professional training programs are unprepared for the realities of practice in real-world settings, or worse, have to unlearn an array of attitudes, assumptions, and practices developed during graduate training that hinder their ability to function"(p. 66). ***** It is also felt that current professional education fails to provide "substantive training in evidence-based practices"(p. 66).
To address this weakness, seven strategic goals with specific actions were developed
and are discussed in lenght in the report(available online at:
http://www.samhsa.gov./workforce/annapolis/workforceactionplan.pdf ). The report concludes that "the workforce remains the most essential ingredient for success in the devolpment of resilence and for enduriong positive outcomes for people in recovery and their families" (p.25)
Reference: CESAR FAX June 18, 2007 Volume 16, Issue 24
Center for Substance Abuse Research University of Maryland
Yvonne Scruggs- Leftwich WeNews Commentator
(WOMENSENEWS)--Lindsay Lohan, Nicole Ritchie, Kate Moss, Paris Hilton, Britney Spears, Whitney Houston, Amy Winehouse and other beautiful young celebrity women have become prime-time poster girls for the fast life.
Court-ordered ankle bracelets that electronically track abusive levels of alcohol in the body are glamorized as fashion statements. People magazine captioned a society party photo: "Lohan wore a bikini--and her alcohol monitor."
The Examiner tag-lined a similar fashion pose: "Lindsay models her alcohol monitoring ankle bracelet." The brutal dehumanization, generated by drunken excesses and promiscuity, is redefined as high-tension energy and overwrought exhaustion.
 Lindsey Lohan's
Alcohol Monitor
The cure is an escape into a hospital or upscale rehabilitation retreat. That pit stop is then recalibrated by media spin artists as an experience of reflection, remorse and religious epiphany, which only re-whets their appetite and recharges their batteries so that the penitent can emerge, reborn, to do it all over again.
Hyped publicity and excessive amounts of money cushion the "bottom" hit by the media's glamour girls, and consequently, the depth of their actual addiction illness is trivialized along with the larger problem of female addiction in this country.
The tortured, glorified and over-dramatized celebrity victims live in a world apart from thousands--maybe millions; no one knows exactly--of ordinary, demoralized, cast-off women who struggle, from one day to the next, trying to recover their lives from drug and alcohol abuse.
I interviewed a reliable sample of these women and I promised to change their names to protect their privacy. But I also assured them that I would tell their stories because they are not suffering from overzealous media attention or public interest. Quite the opposite. Many are impoverished, unemployed, unskilled and destitute. But my interviewees were lucky enough to have found one of the scarce and unglamorous--but very critical--group residences and drug recovery locations: my family's nonprofit Still Standing Recovery Ministry, run by "Rev. Ed" Leftwich. Many more such homeless addicts wander the streets in most of America's cities and towns.
No paparazzi are chasing blond 19-year-old Ava as she staggers from the crack house after a four or five-day binge. And that's a good thing because Ava looks like hell and smells worse. She is dirty, battered and bruised. She has lost her struggle with the drug-crack-dope-alcohol habit again. She is penniless. She paid for her drugs with bartered goods, often stolen, or with her battered body. Either form of currency bought her a high that was short and unsatisfactory. Now that she also is homeless again her ritual will soon resume.
Pedestrians hardly notice that the paramedics, once again, are scraping Tracey, a 30-year-old black woman, off the pavement at the edge of a public park near downtown. She has been lying there since early morning, apparently asleep, when in fact she has overdosed on methamphetamine. She will be revived in the emergency room (or maybe not, this time) and then placed in the locked-down detoxification ward for three to seven days. She will be discharged wearing the same clothing in which she arrived, still homeless.
Victoria, a 24-year-old Latina, works in a fast-food store trying to maintain a routine that might keep her from relapsing into a crack-induced stupor. Yet when she gets her pay, the siren call of her habit is stronger than her resolve and she "drops by" an old haunt to "check things out."
The pay in her pocket was intended for her rent and her promised contribution to her grandmother who cares for her 4-year-old son. But guilt about her child and her need to stifle loneliness in the company of the guy who is looking her way convince her to take "just one hit" on the crack pipe. There is no such thing as just one hit, so her disease becomes fully active again.
Soon she has lost her job. --- Without income, she moves in with a dealer who supplies her with drugs in exchange for sex and violence.
There are very few published studies that focus exclusively on female drug addicts who are trying to recover. But if we want to help these women, we must devote to them a portion of the attention we lavish on their glitzier, richer counterparts. The problems of these women are obvious and understandable. Just ask 31-year-old Simone.
"I could really use some help in the mental health area and knowing how to get clean and stay clean," Simone says. "I have survived on dope. I consider myself a homeless person, and I was homeless, once for almost two years . . . in terms of living with some man or sleeping on a couch in someone else's house. But I've slept in a box on the street too. I know how to survive. I learned how to 'remote myself,' to have (commercial) sex but not really be there.
Simone says she grew up poor but managed to go to college for two semesters. Then she started acting in ways that might echo the young superstars but have far worse consequences in her case.
"I got introduced to stripping in bars. I mean, I tried to continue going to school but partying was too important . . . Within a year of my first hit (on a crack pipe) I was strung out . . . I was only 19. I had a son (but) I gave him up because he was getting big and demanding and he was cutting into my get-high-time. Frankly, I wanted him to have a better life than I'd had. When I got busted with an A-1 felony for having dope all in my stuff . . . I began my stint of using, abusing, tricking (prostituting), homelessness. I'd use my last $20 to buy crack.
"I knew nothing about recovery or about doing something different. I really didn't think anything was wrong with me. Really. Here I am looking at a fifteen-to-life sentence, and I really didn't think anything was wrong with me?"
Simone went in and out of local alcohol crisis centers and in and out of various detoxification programs. "I'd do the halfway house thing and I'd get cleaned up for a little bit . . . but I was young and there was a lot to come that I had no clue that I was headed toward."
Simone told me she's afraid that she'll never live life the way it ought to be lived. "But as long as I'm alive, I've got a chance."
Today she is serving a long jail term. The official charge was violation of parole, stemming from numerous previous arrests. But what she's being punished for is her unglamorous, self-destructive and disregarded life style and addiction. It's a common outcome for ordinary, female street addicts.
An even worse but also not uncommon outcome was Tracey's.
About one year after my interview with her, her body was found in a dumpster.
Dr. Yvonne Scruggs-Leftwich chairs the Center for Community and Economic Justice Incorporated's Sojourner Truth Forum for Interactive Justice and is a professor at the National Labor College in the Washington, D.C. area. Her newest book, "Sound Bytes of Protest," will be published this October.
Women's eNews welcomes your comments. E-mail us at: editors@womensenews.org.
 Lindsey after she ran her Mercedes off the road.
 Lindsey's Mercedes
Would I be totally right in saying if it had been you or I in the above pictures, what do you think would have happened to us? Can you tell me they haven't received
preferential treatment? Money has lead our officials astray totally corrupting our justice system. We sit silently by and allow it all to happen. We have no right to complain unless we are actively involved in trying to bring changes about.
I can say Lindsey Lohan, Paris Hilton, Nicole Ritchie and many others have shown us the results of the"Abstinent-Oriented Rehabilitation Centers" they have attended and for one,I am very grateful. They never worked for me. I would not be sitting here tonight, even alive, if someone had not shared with me about "Methadone."
It totally turned my life around and gave me a second chance. I was so grateful to get off the merry-go-round that I changed careers and felt compelled to let all of you know about "Opiate Agonist Pharmacotherapy." I have been down the road you are traveling on and I am here to tell you there is no reason that you can't overcome your addiction with the help of "Opiate Agonists" like methadone .
In and out of rehabilitation and all over the tabloids, celebrity addicts like Lindsey Lohan, Britney Spears and Nicole Ritchie are damaging the image of "Addiction Treatment Programs," some observers say.
Reuters reported that incidents like Lohan being arrested for drunk driving after leaving a recovery program with an alcohol-monitoring bracelet, or Spears twice spending less than a day in treatment programs before being admitted for the
third time, make "a mockery out of rehabiltation programs" said Harris Stratyner
of the Caron Foundation.
"In some ways it is starting to make rehabilitation programs look like a joke and that is sad because hundreds of thousands of people a year are saved," he said.
While relapse is common in addiction recovery, celebrities often seem to operate by their own rules during their spotlighted struggles with alcohol and other drugs, seemingly coming and going from treatment as they please.
"I would hope that people understand addiction is a very serious illness and that the perception in the public mind doesn't become that this is all a joke," said Jon
Morgenstern of The National Center on Addiction and Substance Abuse at Columbia University . "In the last thirty years, because high-profile people have
sought treatment, it's become more socially acceptable that people do have alcohol and drug problems and need to get help. So I hope that tide is not turning against us.
Reference: Reuters July 25, 2007 News Summary
How about some feedback on any of the articles above? I want to hear what all of you are thinking out there? I will publish whatever you write as long as you write
in good taste. You don't have to agree with me. How about it people? - - Have any of you had any success with these "Drug-Free" Residential Inpatient Rehabilitation Centers? If you did then I am a person that would love to hear about it.
I will start by sharing how I feel about "Drug-Free" Rehabilitation Programs. I am
not surprised at all because they were unable to help any of the celebrities. Most of them are like "Luxurious Resorts." . . .They are there to help you taper off the
drugs you have been using comfortably without having to resort to 'cold turkey.'
I am personally thrilled the celebrities are exposing them for what they really are.
I am sure they are treated much better than the average people if they are allowed to leave and return. . . . They need their money to keep these high-priced luxury resorts going but personally I have spent time in more than one. I haven't seen anything they offer worth the price they charge.
They can afford to keep going to them but the "average person" even with Medical Insurance can barely afford them. I had "Medical Insurance" and had to literally beg to even stay two weeks at one. Certainly, they can detoxify you and they gave me medication to help my agonizing withdrawal but not nearly enough. I have to admit it was much better than going "cold turkey!"
They did feed us balanced meals. ... Yes, we were given physicals and our blood drawn to see if there were any vitamin deficiencies . I believe they did offer us the
privilege of testing for any STD's. I always received multi-vitamins and folic acid.
We had Group Therapy and attended classes they had chosen specifically for us.
I basically knew most of what they were teaching but I could not see how all of it was going to stop my cravings. I was able to take a break and obtain some much needed rest and recuperation.
You know now how I feel about them but if you have been with us very long, then you would have known ,but I do believe every person especially our teenagers and college students should certainly be required to attend one before they are ever prescribed Methadone Maintenance Treatment.
We at Medical Assisted Treatment would like to take the time to congraulate HBO
for their exemplary work on their 14-part documentary "Addiction." We learned so much from the series and they deserve praise! Let's give them a hand to show our appreciation.
|  Special Thanks
to
" Nora Volkow,"
and
Home Box Office | |
HBO's vaunted 14-part documentary "Addiction" has won an Emmy award from the Academy of Television Arts and Sciences.
The series was honored with the Governors Award, the Academy's highest honor, which is given in recognition of programming that demonstrates commitment to important social causes. The other 2007 Governors Award winner was American Idol's "Idol Gives Back" segment.
"We salute these programs for harnessing the power of television to educate and inform viewers about two very significant issues that touch all of us," said Academy chairman Dick Askin.
"HBO's 'Addiction' was a landmark venture that stripped away misconceptions about addition and offered hope to addicts and their loved ones with information about new and effective treatments," Askin added.
The Emmy was presented to "Addiction" collaborators HBO, funder The Robert Wood Johnson Foundation, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism.
During her acceptance speech in Los Angeles, NIDA director Nora Volkow thanked the Academy as well as HBO for its "vision in developing this project, which has allowed us to reach millions with our message -- that addiction is a chronic, relapsing brain disease.
It does not care if you are rich or poor, famous or unknown, a man or woman, or even a child. If science-based treatment principles are followed, addiction treatment can work, and people can reclaim their lives."
Editor's note: Visit AddictionAction.org to learn more about the ADDICTION series and how you can use it to create positive change in your community.
Reference: Join Together September 18, 2007
If you missed the series, then we have made it possible, for you to connect and watch segments of HBO's "Addiction" Documentary. If you are interested in the latest scientific research then you must see it. It's a eye-opening experience! Click
on link below to connect with HBO® Addiction.
http://www.hbo.com/addiction
Each morning, nearly 300 people file into a nondescript building on East Washington Avenue to receive their daily dose of methadone, a synthetic form of heroin used since the late 1950s to treat opiate addiction.
For them, this daily trip helps arrest the indignities that come with being a drug addict.
"I've tried going off it several times, but I always go back to heroin," says Roman, a recovering addict who asked that his last name be withheld. "I can get a year or two clean, but something goes wrong in my life, and I go back. I relapse here and there, but my life goes pretty good on methadone."
Roman, 45, has been a patient at Madison Health Services - one of two methadone clinics in Madison - for just more than a decade.
Over the last several years, the Madison clinics have undergone some significant changes, including a surge in patients addicted to prescription painkillers, a shift toward more comprehensive treatment and, most recently, the introduction of a new withdrawal-curbing medication called suboxone, hailed by many as more effective than methadone.
The long-lasting effects of both drugs permit addicts to bypass the excruciating detoxification process as they begin recovery. Unlike methadone, which often has unpleasant side effects, suboxone's side effects are minimal. Furthermore, it can curb emotional cravings and ease depression.
 Suboxone® Buprenorphine and Naloxone
Subutex® Buprenorphine
If you are interested in knowing more about this new
medication, then please visit our website at:
http://SuboxoneAssistedTreatment.org
"It's proving to be an unbelievably fantastic drug," says Karen Romonouski, clinical director for Madison Health Services. "The more they use it, the more they're finding out how good of a drug it is. You literally lose all of your desire to use."
Methadone clinics, according to addiction expert Dr. Mike Miller, benefit communities by helping to reduce crime, unemployment, homelessness, disease transmission, family dysfunction and other addiction-related social disorders.
The clinics are regulated by the State Methadone Authority, a division of the Department of Health and Family Services, and each clinic undergoes a biennial recertification review to ensure regulatory compliance and patient safety.
Miller, the American Society of Addiction Medicine's president and medical director for Meriter Hospital's NewStart Alcohol and Drug Treatment Program, says that Madison Health Services' shift toward comprehensive treatment is a significant advance in opiate-addiction treatment.
"They've kept me out of a lot of criminal activity," says Roman, referring to the counselors he's worked with at Madison Health Services. "The people here care about you. I know they've dealt with me and my problems, and I had a lot of problems."
CRC Health Group, which owns 62 methadone clinics nationwide, including five in Wisconsin, purchased Madison Health Services five years ago. Since then, the traditional "dose-and-go" model of treatment has been replaced by a broader approach aiming to address the underlying causes of a patient's addiction. Methadone clinics nationwide have taken similar steps.
It gets back to providing the good, quality care that makes us a more successful company," says Phil Hershman, CRC's regional director. "The for-profit part allows us to provide comprehensive treatment." He adds that the new approach moves addicts through the program faster, opening room for others wanting treatment. Demand for treatment, he says, has been spurred by significant increases in the number of prescriptions written for opiate painkillers.
Though he can't speak for Madison Health Services specifically, he says that at some clinics up to 50 percent of patients are addicted to painkillers. "Especially in the last two to three years, we've seen much more pill abuse," he says.
The $14 patients spend daily (currently, only five patients take suboxone, which costs $18), covers not just methadone, which costs less than $1 per dose, but the cost of providing counseling and case management services. Roughly two-thirds of patients have insurance that covers the treatment. Those who don't - pay out of pocket.
"We do an all-inclusive, very intensive broad snapshot of all of the different issues our clients have struggled with," says Romonouski. "We also look at strengths, because we can build on those while we try to decrease the areas that are giving them problems."
Madison's other methadone clinic, Quality Addiction Management at 902 Ann Street, still uses the dose-and-go maintenance model. About 10 percent of patients are discharged for infractions like selling their take-home dose or continued use of other drugs. Most patients, she says, complete their treatment plans. And, a rare few, like Roman, will likely take methadone for life.
Patients nearing the end of their treatment taper slowly off the drugs.
Romonouski, an addiction treatment specialist for nearly 20 years, was hired by Madison Health Services in late March. ---It was her first time involvement with methadone. Like many people, she had several misconceptions about methadone clinics.
"My image of a methadone clinic was that they were dirty, that there'd be dirty needles in the parking lot, that basically it was a legalized drug abuse," she recalls. "That's proven to be very false."
Contrary to pop culture's portrayal of methadone clinics as legalized drug parlors, Madison Health Services is similar to any medical facility. After checking in, patients wait their turn to visit the medication-dispensing nurse. Informational materials on topics ranging from AIDS to addiction and pregnancy adorn its walls.
Patients receive a take-home dose on Saturdays, which they are required to keep in a lockbox until Sunday, when the clinic is closed.
Patients are tested for drugs frequently and meet regularly with one of the clinic's six counselors. A treatment plan is developed to help patients develop better life management and coping skills. Romonouski says environmental factors often trigger relapses, so counselors help patients develop ways to thwart them.
"Counselors will even help patients find housing in a safe neighborhood, where people aren't going to be pounding on their door at three in the morning saying, 'Hey, I've got some money, let's go get some coke,' " says Romonouski. "Even if you're in recovery, that's an awfully hard invitation not to take."
Late last year, Jesse, who also asked that his last name be withheld, was released from the Dane County Jail, where he'd spent eight months on a shoplifting charge. The sheriff's department doesn't provide methadone to incarcerated addicts, Jesse, who was hooked on OxyContin, endured horrific withdrawals during his first few weeks in jail.
Upon his release, Jesse, 29, felt emotionally ready to stay clean, but stepped back into a circle of drug-using friends, including his girlfriend, whose daughter he'd help raise for nine years. Last December, the two decided to get clean, but it wasn't long before things fell apart.
"I'm not with her anymore," says Jesse. "She started the program, but isn't really changing things. She's still using."
An addict for nearly a decade, Jesse has cut loose many of his friends, found a new girlfriend and plans on taking some art classes at Madison Area Technical College. Going into his ninth month of treatment, Jesse isn't sure how long he expects to be on methadone.
"It'd be scary without it," he says. "I'd probably lose my mind without it."
Reference: NATHAN J COMP Correspondent for The Capital Times
A Calgary doctor is studying a new form of methadone to determine if it can be used to relieve excruciating "breakthrough" pain in cancer patients.
Dr. Neil Hagen is overseeing a study of up to 60 patients in Calgary, Edmonton, London and Ontario who are using a liquid form of methadone to determine its
effect on breakthrough pain - intense bursts of pain with episodes lasting on average of thirty minutes.
"At the end of the day, if we find a new way to manage breakthrough pain, we think it could greatly change the qualityof life for cancer patients who have otherwise unrelieved episodes of cancer pain,"Hagen, of the Alberta Cancer Board, told CBC News.
People with cancer that has spread to the bones, for example can experience breakthrough pain from just moving their limbs. Even simple actions such as standing up or taking a bath can cause terrible pain.
Helping stem the pain isn't easy, as traditional drugs, like morphine pills, take about thirty minutes to work.
"That means it's just beginning to work at the point the flare up pain is ending,"
Hagen said in a news release. "So what's used around the world for this common pain problem is quite inadequate.
In his search for a treatment the body can absorb quickly, Hagen has converted methadone into a highly concentrated liquid that patients place under their tongues. The drug has potential because small blood vessels under the tongue quickly absorb the fat-soluble methadone.
He said his research which is in its second year, shows the methadone drops relieve pain as quickly as he had hoped, in as little as five minutes.
"If there was a way to manage pain pre-emptively by putting a few drops of liquid under your tongue five minutes before you get up or go to move, it could surely revolutionize a person's quality of life," said Hagen.
Calgary cancer patient and karate teacher Frank Prystupa said the tretment has worked for him.
"You can live a normal life with it," he told CBC News. "It helps your life at home with your family . It helps you to get out to work and do things that you want to do.
Reference: CBC News July 18, 2001
If you have any questions you would like answered then please send them to me at the e-mail address at the end of the page. We will be choosing one each month to be answered on"The Director's View."
Many United States methadone clinics “ban” benzodiazepines (i.e., Valium, Xanax); that is, any use of benzodiazepines [which is determined by drug testing] is treated as illicit drug use --- even if the patient was legitimately prescribed a benzodiazepine by a physician. Do you agree with this policy?
I would be intersted in knowing if you feel the prescription of benzodiazepines are ever justified in methadone patients?
Wayne
Dear Wayne,
The issue of benzodiazepines is almost the same as alcohol. Sometimes such use could be classified as “discretionary” or even “recreational” but on other occasions it is very clearly “therapeutic,” such as for epilepsy or panic attack treatments. I know some patients who say a certain amount of alcohol is, for them, therapeutic, and nobody would consider a “couple of drinks” after a day’s work necessarily dangerous.
Benzodiazepines have a great deal in common with alcohol, and we should never reject a patient from methadone treatment for drinking excessively or for taking tranquillizers. However, such behaviour (sic) should flag the need for close assessments and added services to be offered, knowing of the increased risks involved.
The very issue of a patient having two doctors should not arise since before putting a patient onto methadone, a good specialist clinic would normally seek a referral from the patient’s usual doctor and send a report of progress so treatment is coordinated. Unfortunately, owing to the nature of some clinics, this does not always happen and patients’ treatment can become a confusing “hodge-podge” of arbitrary and ill-conceived decisions.
It is simply illogical to base important decisions relating to opiate addiction treatment on the patient’s use of benzodiazepines or alcohol. They are in treatment by definition for opiate dependency, and other intercurrent problems need to be treated individually and sensitively. Cannabis [marijuana] is the most obvious, where apart from simply education on the dangers, such as with fatty foods, there is little point in any medical intervention in most cases for patients on methadone maintenance treatment.
My feeling is that all people are better of without benzodiazepines if they can cope with reductions. Most can reduce to zero as long as they are receiving adequate doses of methadone, which abolish cravings for 24 hours. For a small proportion, perhaps 10%, repeated attempts at reductions have resulted either in relapse to uncontrolled drug and alcohol use or the occurrence of unacceptable anxiety/ panic symptoms.
These patients should be given access to small doses of supervised diazepam in most cases,which should be given along with their methadone, with dispensed doses for take-home days. Some patients can regain control of their tranquillizer use, but others will need continuing supervision up to three times weekly.
Dr. Andrew Byrne
General Practitioner, Drug and Alcohol
New South Wales, Australia
We respect Dr. Byrne's belief that ideally treatment should be coordinated. How-
-ever, such coordination rarely exists in the United States between substance abuse treatment and other medical treatments. In the case of treatment of certain mental illnesses, so methadone clinics (either the physician who makes dosage/treatment decision or an in-house psychiatrist)will actually provide such treatment including the the prescription of medications (i.e., anti-depressants for clinical depression or benzodiazepines for anxiety).
But the majority of methadone clinics do not have in-house psychiatrists and will not provide treatment for mental illness beyond the “counseling” provided to patients. Although these clinic counselors may be able to help with some of the psychiatric problems, many methadone clinic counselors are not psychologists or psychiatrists and are, therefore, not qualified to treat mental illnesses. . . and, of course, cannot prescribe medications.
It is our experience, many methadone clinic physicians have no interest whatso-ever in providing treatment for mental illness or anything else aside from drug addiction. These physicians may refer patients to outside doctors but will not take any kind of role in such treatment.
At many clinics, patients cannot even see a doctor unless they have a specific issue directly related to drug addiction/ methadone treatment. We bring this up, not as a criticism of clinic physicians, but to point out the way it is. We do not necessarily expect methadone clinics to provide treatment for mental illnesses and other medical conditions, but if they are not going to provide such treatment, they ought to respect medical treatments provided to patients by outside doctors.
Thus, we believe, a universal ban on certain medications by methadone clinics is unreasonable. ***** If an outside doctor prescribes a medication, the clinic should accept that it is medically necessary.
Another interesting issue Dr. Byrne raises is how methadone clinics should handle certain non-medical drug use--at least in cases where the patient is not addicted to the drugs being used. Many methadone clinics do not concern themselves with alcohol use if there is no evidence that the patient is addicted to alcohol, as long as s/he is not actually under the influence of alcohol when attending the clinic. In part, this is for practical reasons--breath and blood tests generally only detect alcohol while the individual is under the influence.
Clinic staff may also be unwilling to address moderate alcohol use, since alcohol is a legal drug. Except in a handful of states, treatment providers are not required to test for marijuana. Still, many methadone clinics do regularly test for it. *** We question whether they should be testing for marijuana, at least in cases where there is no evidence of marijuana addiction.
Methadone clinics have been known to basically drive patients out of treatment for marijuana use. ***We cannot agree with such tactics when the consequences of cessation of methadone maintenance treatment are far worse than any possible harm resulting from marijuana use.
One final observation is that the patient should seek a second and maybe even a third opinion on the best course of treatment for a panic or other anxiety disorder--or any other mental illness--where benzodiazepines are being prescribed. Given that treatment is often improperly coordinated, multiple medical opinions are important in order to get proper medical treatment.
We would like to say that all physicians are well-informed regarding methadone maintenance treatment and potential drug interactions, but this is not the case. As Dr. Byrne states above, increasing the dose of methadone may eliminate the need for benzodiazepines or at least reduce the required dose of benzodiazepines.
Methadone increases the effects of benzodiazepines, and vice versa, benzodiazepines increase the effects of methadone.Therefore dose determinations can be quite complex. ******For example, a methadone patient who stops taking: benzodiazepines will need a methadone dose increase just to present the onset of opiate withdrawal symptoms.
Reference: Dr. Andrew Byrne, General Practitioner Drug and Alcohol
New Southwales, Australia
 Medical Assisted Treatment believes: There are situations that warrant the use of both these medications together.They should be closely monitored when given together. There have been many deaths caused from the combination of the two. Please never take the two together ....
unless you are under " closely- watched
supervised medical care. Either of them
can kill you by alone but together your
chances are next to nothing.
I hope you have enjoyed visiting with us today. ~ I will see you in October with more news. If you have any feedback then please I would love to hear what you have to say. It doesn't take long to send an e-mail to me. I would like to hear
from all of you and if there is a subject you would like to hear more about then
let me know. We are here to help you. You are not alone. We are here for you if you only need someone to listen. Until October...
Deborah Shrira, Editor "The Directors's View"
deborah_shrira@MedicalAssistedTreatment.org
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