Monday, September 26, 2005

Different Strokes...

different strokes . . . Why, when it coms to methadone treatment for addiction. do folks feel compelled to badmouth the treatment and those that receive and provide it? Does the breast cancer patient treated by surgery plus chemotherapy feel obliged to express venomous comments against radiation therapy? Do "recovering smokers" who quit with hypnosis vilify those who stopped (or tried to stop) with the assistance of nicotine gum, or patches, or acupuncture? What's with some folks? Why can't they be happy and take pride in what they've achieved - without expressing hostility to those who seek to overcome their problem of opiate addiction through other means. Folks shoud be respectful. They should be humble. They should count their blessings, and wish others well - regardless if they seek their salvation through means different than their own. The contempt expressed for methadone maintenance may lead some to give up that care - and die as a consequence; does anyone want to live with that? What does the damnation of others, and the course they've chosen, say about the critics?

Thursday, September 22, 2005

Relevant Questions Regarding Methadone Treatment

A colleague recently posed several relevant questions that many in the addiction treatment field face. I would be interested in hearing other opinions on these questions as well.

Q: We have had a few requests from clients to stop methadone therapy. What can we do in this case - how will we decrease the dosage?

A: Patients will almost always express the desire at some point to leave treatment - it is a major burden the frequency of visits, inteference with life and travels, constant reminder that one has a problem that requires meds, pressure from family and/or friends/employers, etc. The most one can do - and the least one must do - is to ensure that patients know there's a very high likelihood of relapse to illicit opiates when methadone is discontinued. Sure- a few make it and achieve and maintain abstinence, but they are the small exception. So . . . they should be well informed. If they insist, I'd encourage them to proceed as slowly as possible - maybe 5 mg each week - and tell them that any time they say the word you're prepared to discontinue further decrease in doses and to go back up. No shame - no problem. And finally, I'd make sure they know that if they do relapse at any time you will welcome them back with open arms.

Q: We also have a few clients that started the MMT, but after two-three days they leave, and after one week they come back for methadone. Should we admit them again?

A: Patients who "drop out" for longer or shorter periods, after just a few days or after many months - they're a problem. Ordinarily I'd say of course, take them back. They obviously need the help you provide. But you also have an obligation to thousands of other local residents who need help and are on the waiting list. I would probably suggest a four-week wait before permitting return to treatment - but it's no easy answer (if that person dies during the 4 weeks: horrible; if a patient dies on the waiting list who was denied admission because the former patient came first - also horrible. Tough business.

Thursday, September 15, 2005

U.S. Prisons - Evidence-Based Medicine is Irrelevant!

A paper on "attitudes and practices regarding the use of methadone in US state and federal prisons" (J of Urb Health vol 82, #3)reports on a nationwide survey finding that 48% of responding prisons in the US use methadone - "predominantly for pregnant inmates of for short-term detoxification." Compounding their
refusal to provide treatment to inmates is the overwhelming failure to refer to methadone programs when drug-dependent inmates are released; only 8% did so. What a terrible tragedy! Anyone have ideas on how to get the prison system to acknowledge and employ
treatment that works?

Wednesday, September 14, 2005


Twice within the past week community leaders who clearly should know better have revealed their ignorance of addiction and its treatment, and their strong – indeed, venomous - personal bias against patients receiving methadone maintenance. A South Boston representative, who sits on the Legislature’s Committee on Substance Abuse and Mental Health, Brian Wallace, was quoted in he Spt. 8 Boston Herald as saying, “Methadone scares the hell out of me. . . . [Patients] think it’s going to help them get better and it doesn’t. They become methadone junkies.” On the other side of the world a former Scottish Solicitor General (whose initial claim to fame was getting Beatle Paul McCartney off on a cannabis charge), buttressed his call for heroin maintenance by saying, “. . . methadone is just as bad as heroin, except it can tend to create methadone zombies” (Daily Record, Scotland, 14 Sept). After 40 years the hostility towards methadone and the lack of knowledge that breed that hostility is as bad as ever. What are we doing wrong?

Monday, September 12, 2005

Special Disaster Associated with Katrina for Opiate Dependent Residents

At last one major newspaper has commented on the special disaster associated with Katrina for opiate dependent residents (Chicago Tribune, Sept. 9). It sure would be nice if some newspaper were to editorialize on this aspect and note that in treatment or out, opiate dependent persons have a medical condition for which treatment availability should be given precisely the same priority as diabetes, epilepsy, hypertension, etc. Instead, the only reference I've seen to this segment of the affected population was a quote by New Orleans Mayor regarding hordes of marauding addicts roaming the street searching for their "fixes."

ALSO, can't help commenting on the Betty Ford price tag for its services - $20,000 for 30 days care! Wow - and at the same time we're told here that waiting lists for methadone treatment in Louisiana (PRE-flood!!) numbered 1,800. The socioeconomic divide among Americans that the storm highlighted clearly extends to treatment access as well. No surprise about any of this, but still…

Friday, September 09, 2005


It's an ill wind . . . There appears to be a lot of activity at the federal and state governmental levels, in conjunction with provider organizations and concerned individuals, to respond to the special needs of hurricane victims who in addition to all else have an opiate dependence - both those who have been receiving opiate agonist maintenance and those out of treatment. One can only hope this is being carefully monitored so we can learn from the experience. And if it turns out that those involved were indeed able to mobilize forces, waive constraining regulations, and get treatment promptly to large numbers in need - then perhaps it will prove a model for future responses to catastrophe. Furthermore, the steps today that effectively make treatment available to those who desperately need it in the affected Gulf states may perhaps be applied to the roughly 80% of opiate dependent Americans who currently have no access even in the best of times.