Methadone - Addiction

DECEMBER 2007

WOW ! It is almost the end of 2007.......to me, so much has happened this year, and it was such a wonderful year for me, I really hate to see it all end! Let's see, I graduated from college, became a substance abuse counselor, met Deborah and Dean, got the unbelievable opportunity to work here with the two of them, a chance to become the moderator for both the Methadone and Suboxone Forums, and I met the most amazing people on both of the forums, which I now call family! And my personal life was just as good! How could ANY year beat 2007?

But then again.......with all of the wonderful new things we have planned for 2008, it makes me quickly excited for the new year to get here. I can't hardly believe that any year could beat this one, but I have also learned that if it can be beat, being here with all of you along with some great changes we have planned for 2008 just might make the impossible possible!

Well, I guess I had better get started sharing the stories I have selected for this month. I want to start out with an article which really upset me when I first read it. I have a feeling that you may feel the same way. Not after you read the article, but when, at the end of it, I explain what the article left out. Let's just start by reading it, and then, when you're done, I'll meet you there and explain everything.

By LARA JAKES JORDAN, Associated Press Writer Wed Dec 5, 1:13 PM ET

The rate of drug users who fatally overdose on methadone — a prescription that curbs heroin addiction — is skyrocketing at an alarming pace, a new Justice Department study shows.

The report, released Wednesday, found that methadone-related deaths rose nationwide from 786 in 1999 to 3,849 in 2004 — a 390 percent increase.

By comparison, people who died from cocaine overdoses rose by 43 percent, from 3,822 to 5,461 over the five-year period, which reflects the latest statistics available.

"Methadone is a safe and effective drug when used as prescribed," concluded the report by the Justice Department's National Intelligence Drug Center. "However, patients who are prescribed methadone need to be monitored by a physician."

Methadone suppresses symptoms that drug users experience when going through withdrawal from heroin and other opiates. Over the last decade, it also has been used as a cheaper alternative to pain relievers like OxyContin and Vicodin, which are increasingly being abused as well.

The rising methadone death rate is, in part, the result of more doctors prescribing it to help patients with pain, the report found. The study also noted increases in thefts of methadone as it is being shipped from manufacturers to pharmacies and other retailers.

Additionally, methadone intended for distribution by hospitals, doctors and other health care providers is increasingly showing up at businesses that sell the drug, the study showed. That "may being occurring more frequently than law enforcement reporting indicates," it found.

Most methadone-related deaths occurred when it was used with alcohol or other drugs, the study found. Some were the result of overdoses or misuse of legitimately prescribed methadone by patients who failed to get proper counseling from doctors on how to safely take it.

On the Net:Justice Department: http://www.usdoj.gov

So, does anyone see what the problem is when people only print one side of the story? What happens, is that people totally get the wrong information, and they spread that wrong information about a wonderful medication. This is what is missing from this article:

It tells us that Methadone deaths have INCREASED 390%.....!!!! That is HUGE, and I don't blame them for changing things........ if those numbers really told all of the story.......EXCEPT, they forgot to tell everyone that the number of prescriptions that doctors have written of Methadone have INCREASED BY 715 PERCENT !!!! You read it right....715% !
So, what does that mean???

It means that if deaths have risen 390%, and prescriptions have risen 715%, the percentage of deaths have actually GONE DOWN !!!!

And for those, like me, who need to see proof before they can believe something, here it is:
http://www.usdoj.gov/ndic/pubs25/25930/index.htm#Figure3
NDIC ( National Drug Intelligence Center ) Please read the following: Substantial Increase in Legitimate Distribution

"He who has no Christmas Spirit in his heart will never find Christmas under a tree."

The Drug Enforcement Administration (DEA) announced this week that U.S. pharmaceutical companies have voluntarily agreed to restrict access to larger-dose methadone tablets beginning on Jan. 1, 2008.

The 40-mg methadone hydrochloride tablets will only be distributed to hospitals and authorized opiate addiction and detoxification facilities, the DEA announced. The move was intended to curb the rising number of methadone overdoses and illegal diversion of the drug.

"The 5 mg and 10 mg formulations indicated for the treatment of pain will continue to be available to all authorized registrants, including retail pharmacies," according to the agency. "The 40 mg strength is not FDA approved for use in the management of pain. Thus, the distribution and availability of the 40 mg formulation will be limited to registrants in only those settings using the 40 mg formulation for the appropriate indication" -- namely methadone maintenance for opiate addicts.

Life is short ! Break the rules ! Forgive quickly ! Kiss slowly ! Love truly, Laugh uncontrollably, and never regret anything that made you smile !!

JACKSONVILLE, FL -- A baby with a skull fracture and methadone in its system has led to criminal charges against a Jacksonville mother.

Victoria A. Klein, 37, is facing aggravated child abuse charges.

Police responded to a call at Baptist Medical Center where doctors treated a young child for a skull fracture Monday night. Doctors also found methadone in the child's urine.

Police say Klein had been the only one around the child prior to the emergency room visit.

Police are not releasing the age or gender of the victim, except that the child weighs eight pounds and is about a foot tall. Police say the child is in critical condition.

December 12, 2007

Legalize drugs? That's what I advocated in this space a month ago. By allowing licensed clinics to sell or dispense hard drugs, we could take business away from violent dealers and let rationality and regulated economics rule the streets instead of robbery and murder.

Not so fast, say people who really know about heroin supply and demand. The hard-drug trade, say former patrons, doesn't have much to do with rationality.

"I don't think that's going to stop the dealers from dealing," says Felicia, 47, a recovering addict who notes that even legalized methadone is bought and sold on the streets. "It may slow it down some. But there's always going to be someone out there that's going to sell to me. Always."

A full discussion of selling Bad Azz heroin (named after a rap album) like Johnnie Walker scotch should include those who have copped a dime bag on the corner. I asked Felicia and two other recovering addicts at Man Alive's Lane Treatment Center on Maryland Avenue - Ronnie, 46, and Shari, 35 - about the pros and cons of legalization. This is their column.

Their first point is that drug use is more than sticking a needle in your arm or a crack pipe in your mouth. "It ain't about the using," said one. "It's about the getting."

Drugs are part of a way of life - robbery, gangs, prostitution - that would persist even if the delivery method changed, the women said. "Addiction is not just getting high," said Felicia, who like the other addicts isn't especially proud of her past and didn't want her last name used. "It's the whole thing - copping [buying on the street], stealing, whatever you do."

Alcohol is legal, but "people out there will rob for a fifth of liquor because they can't get a dollar and 50 cents," she said. "They steal, they trick. They do the same thing. I've got friends that will go out there and hustle harder than me for a drink." Methadone also is legal, but plenty of methadone patients who are clean of heroin still break the law, she said.

Legalization wouldn't eliminate illegal dealing, the women suggested. Heroin and cocaine fuel a multimillion-dollar economy that supports much of the inner city. Under legalization, "even people that don't use [are] going to find a way to get it, and they're going to sell it" - possibly to kids, said Ronnie. "Somebody's going to find a way to make a profit off the government."

"You're not going to give up this way of making money," said Felicia. "There's too much money in this stuff for it to become legal. They don't want to give up their cut."

And legal dispensation of hard drugs might not sate a citywide craving. Fearful of overdoses, legal clinics will know when to say when. But of course demand for addictive drugs goes way beyond medical guidelines, which could keep the corner bazaar alive.

"So I'm going to go and get this free drug that the government is going to put out there," said Ronnie. "Now if it's good, and I like it, what am I supposed to do now? I don't know how many times a day they're going to give it out. Is it just that one time, or what?"

And if heroin and coke are legalized, what about Ecstasy? What about crystal meth?

"You're never satisfied," said Felicia. "I don't care if they give it to you. You're always going to want more."

Legalization certainly wouldn't reduce the population of addicts. Quite the opposite. Shari has two teenage boys. The misery they have witnessed caused by heroin and cocaine - including the recent overdose death of her stepfather - will keep them off drugs, she believes.

But what about other kids? She pauses a long time. "That's hard to say." Legalization might remove drugs' forbidden-fruit allure, she says, but she's not sure.

Legalization won't stop addicts' risky behavior, all three women warned. "If they're giving it to you, you're still going to find a way of sharing a cook or a needle," said Felicia. "Or unprotected sex. That's not going to stop that." They also worried that legal purveyors might increase addiction by advertising or boosting potencies.

Completely legalizing hard drugs has been much discussed but never done, although Switzerland and a few other countries allow legal, "medicalized" injection of heroin for the worst addicts. The policy has been linked to reduced crime.

Any nation trying it would encounter devilish complications, several of which the recovering addicts at Man Alive identified. Policy could address their concerns - steer dealers into new careers, require on-premise drug consumption to prevent resale, beef up addiction treatment programs. But terrible unintended consequences would no doubt remain.

Even so, we need to try something different. If by legalizing addictive drugs we fuel the forces of irrationality, would that be less irrational than what we're doing now?

jay.hancock@baltsun.com

Copyright © 2007, The Baltimore Sun

SANFORD (Dec 12): Town officials in Sanford are expected to spend the next six months revising its zoning ordinance to allow a methadone clinic somewhere in town, but not downtown.

Why not ban them altogether?

According to Mike Starn, communication director for the Maine Municipal Association, a municipality cannot outright ban a methadone clinic because doing so would violate the Americans with Disabilities Act and the Maine Human Rights Act.

Both the federal and state acts "give protection to certain individuals and classes of people who might be discriminated against," Starn said. "'Drug addicts' are a class that are protected under the Americans with Disabilities Act. Therefore, a municipality could not place a land use restriction on a clinic to treat them."

While Starn said there's nothing to stop a municipality from trying to ban a methadone clinic, the ban wouldn't hold up in court.

Several years ago the city of Rockland tried to pass a ban preventing a methadone clinic from moving into town, but Starn said the developer took city officials to court for discrimination. The case was settled and dismissed when the two parties found a mutually agreeable site for the proposed clinic.

"The town should be looking at other communities that tried to fight to not allow a methadone clinic" to see how they handled the situation, Starn concluded. "You can't use land use regulations as a tool to discriminate." http://www.keepmecurrent.com/Government/story.cfm?storyID=46868http://www.keepmecurrent.com/Government/story.cfm?storyID=46868

Well, another year gone by, and I cannot wait to see what 2008 brings us all. And until then, make sure that you always take steps toward your recovery.....Just be careful where those steps lead you......Santa wasn't !

"What's Happening?" " Inquiring Minds Want To Know?" November 2007

NOVEMBER 2007

This year has surely gone by fast! I can hardly believe that it is November already! The Halloween decorations are down, and yes, we are already thinking about the Christmas ones that will be going up.

There has been a lot of news this month, and I think that we'll simply get started with the first article, which, when I read it, brought to my mind a question I had never thought about before. Although this doctor was found not guilty, why is it that many times, when a hospital or clinic gets blamed for the death of another person, the hospital is usually fined, and the doctor who was presiding over the patient usually loses their license.

I wonder why it is so different from a "person" who causes the death of another, by such means, as giving another medication that causes their death. I have recently read where someone got 10 years for that offense. I was also wondering how they can sometimes simply blame the hospital, and in that case, no one else is convicted for it. Just something I have thought about. Email me, and tell me what your thoughts are about this are. Rozi.Director@MedicalAssistedTreatment.org Well, I have a lot of news to get on here, so let's get started......

Times-News writer Medical personnel racing from their cars into the Valley Hospital in Spokane, Washington, each morning pass by a man talking to God.

The man,Thomas Byrne, a former physician's assistant who now works in Spokane. Byrne
says he's made this ritual part of his morning routine ever since the family of a 61-year-old
chronic pain patient accused him of causing her death by a methadone overdose in Twin
Falls in 2003.

That scrutiny ended on Tuesday. Ending a nine-day civil trial, a Twin Falls jury found Byrne, his supervising doctor and the Southern Idaho Pain Institute of Twin Falls not responsible for malpractice or for breeching the standard of care.

But Byrne says the death of Rosalie Schmechel still weighs heavily on him. Schmechel, a new patient who died six days after she first appeared in his office, suffered methadone poisoning, according to a forensic pathologist.

"There were times during the course of this I really questioned whether I really wanted to continue being a medical provider," said Byrne, who works in the Spokane hospital's emergency room. "It makes you have doubts, when you are being questioned about all the issues that came up at trial."

Schmechel's family still has reason to feel anger toward him, Byrne said.

The verdict did not feel like vindication, Byrne said. But having a jury rule in his favor did eliminate many of his feelings of self-blame.

On Sept. 26, 2003, many doctors were switching their patients from OxyContin to the less expensive drug methadone. Byrne started Schmechel, who suffered from chronic low back and leg pain, on three daily 10-milligram doses of methadone. By October 2, she was dead.

Dave Comstock, the Schmechel family's attorney, cited studies from the Federal Food and Drug Administration showing that methadone can be deadly if not administered carefully.

Shortly after the death of "Rosie," as her family calls her, Ada County Forensic Pathologist Dr. Glen Groben's autopsy determined she died an overdose of methadone.

"Since that time it has been the family's mission to try to see that this doesn't happen to anyone else," Comstock said. "They are devastated. It's a hard pill for this family to swallow because this is something that they have been emotionally invested in for nearly four years."

Dr. Arthur Lipman, professor of Pharmacology at the University of Utah, testified that the defendants breeched the "standard of care" by rapidly increasing Schmechel's doses. He viewed the change as "dangerous" and "reckless," Comstock said after the trial.

Other medical experts testified the defendants had met the standard of care.

Schmechel also suffered from severe cardiac stenosis, said defense attorney Steve Hippler, of Givens Pursley.

Groben could not explain in the trial how 30 milligrams a day brought the methadone concentration in her blood to a toxic level.

"Everybody agreed that 30 milligrams a day was a reasonable starting dose," Hippler said. "It was a safe plan. It was a reasonable plan. Nothing from the autopsy tells us definitely what happened."

The jury agreed. The Idaho Board of Medicine also agreed in a non-binding decision before the Schmechel family filed the civil claim in Oct. 3, 2005.

Vaughn Schmechel, Rosalie's widower, declined comment.

By Cass Friedman
Times-News writer

There is nothing like returning to a place that remains unchanged to find the ways in which you...yourself have altered. Nelson Mandella

I've included an article from Scotland, so we can see that methadone is helping everywhere:

This was a new kind of high. The good kind, the real kind. Happy and healthy like never before, Clare Curran and Adam Howden, Scotland's first graduates of addiction recovery, beamed and clutched their scrolls.

They were getting their pictures taken, perfect photos for their families' mantels, perfect proof that there is life after drugs.

"I don't want to look yellow," Clare told the photographer. "I was yellow when I came here."

Little more than three months ago Clare was injecting heroin in her neck. Her latest portraits make that hard to believe. After 12 weeks in Leap, the Lothian and Edinburgh Abstinence Programme, Clare looked what she is - what she wants to be - a healthy 33-year-old mother-of-three.

Adam, too, was the picture of health. "He used to be the colour of that sofa," Clare said, joshing and pointing at the maroon couch Adam was sitting on. "Before I came here I was told I had a year to live if I didn't stop drinking," Adam, 45, said. "Your body recovers remarkably quickly." It's the mind that takes longer to get better, he might have added.

Their graduation ceremony was on Friday, at Malta House, the former Kirk building in Edinburgh's upmarket Stockbridge where Leap is based. "We've got the fancy biscuits today," said David McCartney, Leap's clinical head, as he opened proceedings. "I think we all know why."

There was a cheer from the 50 or so people who had gathered for the event, families, professionals and Clare and Adam's peers, the fellow addicts who hope they too can graduate as clean and sober.

Malta House is the only place in Scotland - perhaps Britain - that tries to replicate the programme - and results - of residential abstinence treatments in a community setting. It is where a lucky few newly detoxed alcoholics and drug addicts can go after cold turkey, where they can get help through the vital first few weeks after, say, alcohol or heroin. It is where addicts meet their demons.

"I doubt Adam knew what his problem was. I doubt Clare knew what was happening to her," said Dr McCartney as he described, to the audience, the pair as they were 12 weeks ago. "How did they get from the position they were in? They showed a characteristic that is not usually associated with the word addiction. They showed courage."

This ceremony wasn't just for Adam and Clare. Their fellow addicts - never more than 20 at a time - were given their say, too. Recovery, it seems, is a team game. "You've been an inspiration to me," said one. "I started to worry about you. I haven't even been worrying about myself for a long time, so that was big." Another added: "The real work starts on Monday." When the peers finished there was another voice, a tiny one, from the back. "Yey," it said. "Mum done it."

Then it was the turn of the graduates. "I had never seen recovery before," said Clare, blowing kisses to her children. "I didn't know that it worked. I didn't know that people got better." Then, both grinning and fighting back tears, she said her thanks. Leap and other people who helped her, she said, had restored her "faith in the human race".

Adam agreed. "I was that shattered when I came here," he said. "I didn't know where I was going or what I was doing. Now I have got a choice. I didn't have any choices before I came in here."

Then one, rare sour note. "I feel sorry for the ones that are not here," Adam said. "Because I know where they are."

Not everyone has made it through Leap. Nor would they be expected to. Dr McCartney wants half of all Leap graduates to be clean and sober six months after their ceremony. Even the best residential units cannot do that: their average success rate is a third of patients. Compare that with methadone, the heroin substitute used to manage most drug addicts. ......After three years of methadone treatment, only 4% of addicts are clean.

Later, relaxing over tea and some of the promised biscuits, Adam described the Leap drop-outs. "I saw their eyes," he said. "They were gone again. Their addiction wanted them back. They're knackered."

NOW LIFE BEGINS: Adam Howden from Crieff and Clare Curran from Leith in Edinburgh have graduated from Leap and are looking forward to a dependency-free existence. Picture: Julie Howden

Clare knows what that means. She started on glue at 12, while still at one of Edinburgh's better schools. She graduated to other substances, everything from ecstasy to cocaine. Once she stole the epilepsy drugs of her sister's dog. "I was numb for days," she said. "I have been an addict for two-thirds of my life. I've been in jails, I've been in institutions. It was death that was waiting for me."

What do they think of Leap? "It's the last chance hotel," said Adam, his eyes brightening up. "That's your quote."

How bad did it get for him? "Last year I was carted off to the nuthouse for talking to a giant chicken, Foghorn Leghorn," he said. "It wasn't really there, you see. Now I am brand new."

David McCartney, their doctor, knows how hard it has been, how hard it is when the giant imaginary chickens come home to roost. He and other addiction professionals have a little saying they use for such situations. "The good news about recovery is that your feelings come back," they tell addicts. "The bad news about recovery is that your feelings come back."

Clare and Adam aren't going to be dropped now. Leap - and its partners at Edinburgh council and elsewhere - keep a watching eye on them, as do self-help groups. Their treatment has cost between £400 and £500 a week. A lot, but a fraction of the cost of residential recovery and a pittance compared with the soaring economic and social toll of each addict on Scotland. More than 50,000 people are addicted to heroin. They are responsible for at least as many children.

Policy-makers too will be watching how Adam and Clare and the next graduates fare. If they stay clean, Scotland might just look at scaling up Leap.

The Leap diplomas were handed out by Tom Wood, a former deputy chief constable of Lothian and Borders Police and a member of a special group set up to review drugs policy for Scotland's Futures, Holyrood's think tank. Mr. Wood knows what is at stake.

"I don't think many people understand what kind of hurdles you have had to overcome to to get where you are," Mr Wood told Clare and Adam at the ceremony. "If you don't succeed, this place won't succeed. That is why I say 'Thank you'. There is a very real debate about how we address addiction, all addictions. There has never been a greater chance to step away from all those things which have been unsuccessful and bring in new things we know will work. But we need evidence and you are our evidence."

Fellow sufferers are key to recovery.

What is said in the room, stays in the room. The recovering addicts at Lothian and Edinburgh Abstinence Programme, or Leap, know far more about their peers, their fellow sufferers, than anybody ever wants to know about anybody. And it isn't nice.

Malta House, Leap's base, is where addicts rediscover themselves, and things they would rather not face. Through a combination of intensive group therapy and one-on-one support, the 20 or so patients at the facility gradually heal the wounds of what, often, is a lifetime of drug or alcohol abuse. They can only get on the programme if they are clean and if they have been referred by another professional.

But they are not locked up: the latch, says chief doctor David McCartney, is always open. And they go home to supported accommodation and evenings of AA or Narcotics Anonymous meetings. Dr McCartney, who is basing treatment on the latest breakthroughs in the science of addiction, knows exactly what to expect at each stage of recovery and believes peer support is the key. "I can't but we can" is his mantra.

12:51am Monday 26th November 2007
By DAVID LEASK

The deepest secret is that
life is not a process of discovery, but a process of
of creation. You are not
discovering yourself, but creating yourself anew.

Seek therefore not to find out who you are, seek to
determine who you want
to be.

Hello, again, it's Rozi. I wanted to introduce the next article, because it is from my home state of Wisconsin. Compared to some of the research I have done about other states, I must say that I am actually proud of our state and the methadone clinics here. I have been literally "floored" when I have heard from others what they are actually paying for services at their methadone clinics in other states. In Wisconsin, it costs you $14, ( $18 for suboxone, which is also handled there ), and that includes counseling and case management. I surely wish for all of our friends and family that all of the states would follow suit. Anyway, enough of my blabbing.....enjoy the article.

By NATHAN J. COMP Correspondent for The Capital Times Madison, WI

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 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. "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.

Two-thirds of our 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 very first 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 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 conviction. Because the sheriff's department doesn't provide methadone to incarcerated addicts, Jesse, who was hooked on OxyContin, endured horrific withdrawals during his first several 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."

27 November, 2007

With a relapse rate as high as 70 percent, it had become evident very early in
the longstanding war against the country's public enemy number one that the
regimen of cold turkey detoxification, paramilitary discipline and counseling in Pusat Serenti had been less than smashing success. However, in the absence of other proven methods, the strategy had been to build even more rehabilitation centres and incarcerate as many addicts as possible.

But with some 250,000 addicts on the official register, and with drug users making up 75 percent of the 73,000 HIV-positive cases, the point had been reached where there was a dire need for fresh directions. As a result, over the last two years, we've explored alternative methods of rehabilitation and experimented with drug-substitution therapy.

While it is too early to tell, the results of this drug-substitution method so far look promising. But like the "harm reduction" programmes to contain the spread of HIV/AIDS, where drug users exchange dirty needles for clean syringes and get free condoms, the idea of treating drug addiction with drugs appears to have run into some resistance.

While at least 2,000 of the 12,000 general practitioners in the country are required, fewer than 500 have registered for the drug-substitution programme.

The "drug pusher" label that is said to stick to those doctors who have no qualms about prescribing a patent drug seems to indicate that this is somehow deemed unethical. Although methadone and the other replacement drugs are admittedly themselves addictive, since the results of the drug-substitution therapy appear encouraging, this should put a whole new perspective on whatever moral dilemma is raised.

After all, many prescription or over-the-counter drugs are addictive, or can become so if misused. In a situation where methadone or other substitute drugs are being used to address the addiction to psychotropic drugs such as heroin and Ecstasy, they should perhaps be regarded as simply the lesser evil.

But the stigma apparently attached to drug-substitution therapy within the medical fraternity speaks volumes about the bias and prejudice that addicts face in their fight to kick the habit. They are shunned by their families and ostracised by society when what they need most is a lot of support and tender loving care.

We need to break down the medical, mental and social barriers towards addiction if we are to make any progress towards a drugs-free society.

© Copyright 2007 The New Straits Times Press (M) Berhad. All rights reserved.
Permission to print received by Medical Assisted Treatment, Incorporated.

Well, everyone, another month has gone by. I want to apologize for being late on posting this month. I must be totally honest with you and tell you we have simply been very busy helping people in need. Deborah has a great philosophy, and that is "nothing" comes before our members and others who need us. People are our main priority!

I want you to know how much I truly love gathering the news for all of you. It is important to me to keep you updated on "What's Happening?" I would love for all of you to send me feedback on any of the articles I publish because we do care at "Medical Assisted Treatment" about what you have to say. We are giving you a voice to speak and hoping you will take advantage.

I have decided, I will have to simply work more efficiently, so your news is finished in a timely manner. I just wanted to say I was sorry, and for you to keep watching, because the monthly "What's Happening" will never appear as late again. That's a promise!

Until December, which is in just a few days, I will be seeing you. Please, remember to tell anyone you think we could help in some way just where we are. Because we are never too busy to help someone. THAT is what Medical Assisted Treatment is all about. Sending you Smiles.......Rozi

Happy Halloween to everyone!! I'm not sure about the rest of you, but Fall is my favorite time of the year. It's a combination of things, including the cool air, the beautiful leaves turning colors, and knowing that the holidays are just around the corner. I am somewhat sad to say goodbye to Summer, but by now I've truly had enough of the hot weather. We've already have the yard decorated for Halloween, and we are the family in your neighborhood that always has the yard that looks like an airport for Christmas, so compared to that, our decorations now are pretty toned down.

One thing that never changes, no matter what time of the year it happens to be, is that news continues to be a part of our daily lives. I bring to you the articles that you may not see in your daily newspaper, articles that may change the way some of us live our lives. I will bring you stories of addiction, stories of survival, and of course, stories of those who just simply have given up. There are times when I get so excited about articles ... and I can"t wait to share them. There are other times when I feel very hesitant and this is one of those times. We need to hear about all that is happening. Right?

Tuesday, October 8 New Zealand Herald

A mother high on methadone was found slumped in her car on a Tauranga street with her five-year-old daughter on the roof and her four-year-old son was on the bonnet, a court has been told.

Other motorists had earlier taken evasive action to avoid the car, The Bay of Plenty Times reports.

The mother, 30, a sickness beneficiary, pleaded guilty in Tauranga District Court yesterday to a charge of driving under the influence of drugs. She was granted interim name suppression.

The court was told the woman went to a pharmacy at about 9.30am on September 28 where she took her prescription dose of methadone. - She was also given two extra daily doses to be consumed over the next two days.

Methadone is a substitute drug for opiates, prescribed by doctors, but dispensed by pharmacies.

The woman drove off with her two unrestrained children and took one of the extra doses.

As a result of taking the extra methadone, she passed out for about 30 minutes at a service station, leaving her children unsupervised and all the windows open.

The car was then seen being driven on a nearby road where it mounted the curb and footpath outside Mount Maunganui College.

The woman carried on, the car weaving from side to side before coming to a stop on Maunganui Rd. She was found slumped over the wheel and the children had climbed out the car windows and onto the roof and bonnet.

When officers spoke to her, her speech was slurred and she passed out frequently.

A GP certified that she was under the influence of drugs and incapable of driving any vehicle.

The children were taken into the custody of Child, Youth and Family.

The woman's lawyer, Glenn Dixon, told Judge Peter Rollo that his client was at a risk of imprisonment and a pre-sentence report should be called for.

Judge Rollo agreed.

Mr Dixon said his client denied that she took a second dose of methadone. She denied injecting herself in the neck but admitted she had taken another pill which gave rise to her offending.

The woman was remanded on bail for sentence.

Reference: New Zealand Herald Published: October 2007

Reference: http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10468825

"GRATITUDE can turn a negative into a positive.

Find a way to be thankful for your troubles

and they can become your blessings."

~ Anonymous ~

Illegal Drug Use May Be Tracked With Toilet Waste

By Amy Flashenberg

There's an old saying that one man's trash can be another man's treasure. Now, researchers have taken that philosophy and applied it to toilet waste -- finding a way to use the excess as a helpful resource for monitoring communities' patterns of illegal drug use.

But the research is still in its beginning stages, and State College is not, as yet considering using it.

In the past year, researchers have been working to develop a quicker and efficient method of analyzing wastewater to detect traces of illicit drugs, said Jennifer Field, lead researcher and professor in the department of environmental and molecular toxicology at Oregon State University. The purpose of the analysis is to monitor drug-use trends in communities, she said.

The findings of the research were reported at the American Chemical Society last month at their meeting in Boston.

"The ultimate goal is to provide information [about drug-use trends] over time and space and across different municipalities," Field said.

Wastewater from 10 U.S. cities was tested. The names of the cities are not being released because the researchers' focus was on evaluating the effectiveness of the method itself, and the testing is "only preliminary," Field said. The outcomes were "definitely a proof of concept," she added.

The screening process Field and her research team has been developing is an old adaptation of a method currently used for similar testing of drug traces and also of metabolites, she said.

According to a press release issued by the American Chemical Society, the current method identifies byproducts of drugs by determining their molecular weights. But the process -- tandem mass spectrometry - - is one that requires concentrating the samples to be able to detect any drug they might contain, according to the release.

The new method has modified the existing process, which originated in Italy last year for similar screening processes, and involves the ability to use samples with lower concentrations to complete the testing in just 25 minutes, Field said.

A variety of illicit drugs -- including methamphetamine, cocaine, LSD and ecstasy -- can be detected using the new method, and "legitimate drugs" like methadone and caffeine are also detected as a means of comparison, Field said.

The State College Police Department has not used wastewater screening methods to track drug use trends, but instead has evaluated the community's drug use by analyzing data obtained from crime reports, said State College Police Lt. Tom Hart, a criminal investigation division commander.

"We're constantly evaluating [instances of drug activity] to keep a handle on what we believe is a drug problem in the community," Hart said.

According to data from the State College police,instances of drug arrest increased about 28 percent from January 1997 to December 2006. The second most common drug charge during the 10-year span was for possession of only small amounts of marijuana. The first most common charge was possession of paraphernalia.

Because Penn State students comprise a large portion of the State College, they are considered temporary residents and are factored into the evaluations of drug activity in the area, Hart said.

I believe in Recovery, and I believe that as a role model I have the responsibility to

let young people know that they can make a mistake and come back from it.

~ Ann Richards

I would like to take the time to offer a very special welcome to all the members in "Everything Coming Up Methadone." We appreciate your faithfulness through the years. We would like to invite all of you to come visit us. If you are new to taking
methadone then it is defintely where you belong. We promise to treat you and not trick you if you join us in October. (LOL) ...... Some of you will be needing extra support with Thanksgiving and Christmas around the corner. We are waiting on you. There is absolutely no reason any of you need to be alone. Come and learn about methadone and meet new friends. There is absolutely no reason any of you should be alone during Christmas Holidays. We are here to share them with you.

JANNETTE PIPPIN

October 4, 2007 - 10:07PM

DAILY NEWS STAFF

BEAUFORT — A Carteret County man with a history of charges for illegally selling prescription medication was in jail Thursday under a $1 million bond following his latest arrest on similar charges, authorities said.

Walton “Walt” Gillikin Sr., 64, 588 Harkers Island Road, Otway, was charged by two agencies with a combined seven counts of trafficking methadone pills and three counts of maintaining a dwelling or vehicle for controlled substances, according to the Carteret County Sheriff’s Office.

The charges filed Wednesday night followed a joint operation by the Sheriff’s Office and Morehead City Police Department.

Methadone tablets and around $500 cash were seized from Gillikin, accused of selling the prescription medication on the street.“He has a prescription and gets well over 100 pills every month, and we think he sells a majority of that,” said Carteret County Sheriff Asa Buck. Gillikin is suspected of diverting thousands of prescription pills for illegal sale over the last several years, the sheriff’s department said.

Buck said the fact that he may have obtained the drug by a proper prescription doesn't make his actions legal. "To turn around and sell (the pills ) is illegal and makes him a drug dealer like anyone else." he said. Buck said methadone is a dangerous drug that should only be used by an individual as prescribed by their doctor.

The Carteret County Sheriff’s Office has arrested Gillikin on several occasions in recent years for similar activity. He recently spent time in prison after violating probation on a 2001 conviction. He was admitted to the prison in January 2004 and was released in February 2005, according to North Carolina Department of Correction records. Gillikin was also on probation at the time of his latest arrest, authorities said.

“He has had a number of opportunities to stop dealing and he hasn’t,” Buck said. “If convicted, I hope the court will give him the full force of the law this time.”

Since the mid-1960s, methadone maintenance treatment has been highly valued for helping to reduce the ravages of heroin and other opioid addiction. Yet, during this past decade, overdoses and deaths associated with methadone have gained it a reputation as being “widely abused and dangerous.” This came largely from sensational news stories claiming inherently harmful effects of methadone, rather than more accurately stressing that most tragedies were the result of methadone being either misprescribed, misused, or abused in some way.

However, methadone is indeed a very potent opioid medication, and fatal over-doses have been reported ever since it was first used, as a pain-reliever, in the 1940s. At that time, the most severe risks of death were associated with excessive amounts of methadone being prescribed.

According to all recent accounts, methadone-associated emergencies, overdoses, and deaths have steadily increased. While the evidence suggests that methadone prescribed outside of Methadone Maintenance Treatment clinics as a pain reliever is the greatest source of problems, methadone in general is being portrayed as a threat to individual and public health.

Yet, when prescribed and used properly, methadone has been consumed safely by millions of patients worldwide during its more than 40-year history in Methadone Maintenance Treatment. And, increasing numbers of individual patients have now been maintained on methadone for several decades or more without incident or physical harm.

All cause mortality in Methadone Maintenance Treatment patients is typically many-fold lower – as much as 15 times lower – than in untreated opioid addicts in the community. Some researchers have observed that the all-cause fatality rate among Methadone Maintenance Treatment patients is around 1%; whereas, the rate increases to 10% or greater in those who are discharged or voluntarily discontinue methadone maintenance for addiction. Other studies have found that the death rates in addicts who are merely detoxified from opioids can be 22 times greater than in Methadone Maintenance Treatment patients.

Within the controlled and regulated environments of MMT programs, most if not all of the overdoses related to methadone can be prevented. And, if opioid over-doses do occur, they need not be fatal if proper training and safety procedures have been implemented.

There are three primary reasons why methadone overdose may occur during Methadone Maintenance Treatment:

1. A new patient who is not sufficiently accustomed to opioids (tolerant) is prescribed an excessive amount of methadone, or the person supplements safely prescribed methadone with illicit methadone outside the clinic.

2. Once started on methadone, the amount is increased too rapidly, leading to a harmful build-up of the drug.

3. There is a methadone-drug interaction resulting in an unexpectedly excessive level of methadone, or methadone is combined with other drugs that harmfully affect the patient’s breathing, nervous system, and/or heart function.

Opioid-related overdose deaths with long-acting opioids like methadone, rarely occur immediately and there usually are warning signs of overmedication. Some-times, Methadone Maintenance Treatment clinic staff, and patients, refer to this as being “loaded” on methadone.

In overdose, the primary mechanism of death is suffocation –– breathing slows (respiratory depression), resulting in a lack of oxygen (hypoxia), until breathing stops completely and the victim lapses into a coma. Along the way, depressed breathing may cause fluid to fill the lungs (pulmonary edema), or the victim may inhale their own vomit or saliva (aspiration pneumonia), which further inhibits lung function.

Excessive methadone can slow heart rate and lower blood pressure, but breathing is most typically affected first and causes the death. . . . Patients with a history of breathing problems – sleep apnea, asthma, emphysema, congestive obstructive pulmonary disease – or heart problems can be at special risk.

Methadone overdose rarely is seen right in the Methadone Maintenance Treatment Clinic; rather, it typically occurs many hours after dosing when methadone levels have peaked and the patient is asleep, or has passed out, at home. Patients do not die from opioid-induced respiratory failure while they are awake and alert.

Methadone patients, as well as family members or friends, need to know the warning signs and symptoms of overmedication or overdose to take action before it is too late. By knowing what to watch for patients themselves can be alerted to seek help before they become ill or lose consciousness.

But, if this happens, others must seek emergency help as necessary and care for the patient until help arrives.

What to Watch For – Signs/Symptoms of Overmedication/Overdose

Unusual sleepiness, grogginess, drowsiness (oversedation, somnolence).
Mental confusion, slurred speech, intoxicated behavior.
Slow or shallow breathing.
Pinpoint pupils (miosis).
Slow heartbeat, lowered blood pressure.
Unusual snoring while asleep.
Difficulty arousing the person from sleep.

Face extremely pale, clammy.
Fingernails, lips turning blue/purple.
Body is limp.
Vomiting or gurgling noises.
Cannot be aroused or unable to talk.
Very little or stopped breathing.
Very slow or stopped heartbeat.

*An unrecognized symptom of methadone over-medication is unusual feelings of excess energy with or without euphoria. As methadone levels drop the other signs/ symptoms may emerge.

AT Forum Summer 2007 Volume 16 #3

Well, my friends, another chapter comes to an end, and as usual, I have so many more things I want to include, but you'll have to wait until next time to see them. And until then, this is Rozi, sending smiles to everyone....and reminding you that I am as close as your e-mail. Please don't ever be afraid to call if you need anything at all. rozi.director@MedicalAssistedTreatment.org