METHADONE ISSUE NEEDS REAL UNDERSTANDING:

Below is a good comprehensive Letter to the Editor responding to atrocious comments from a judge and prosecutor in New Hampshire.

Nov. 10 - To the Editor:
I am writing to express an alternative opinion to those expressed by both Judge Sawako Gardner and county jail superintendent Al Wright in the Nov. 9 Herald article by Elizabeth Dinan about the request of a "jail-bound woman" to continue her treatment for opiate dependence at an area methadone clinic.

Firstly, I would like to extend my thanks to both Gardner and Wright for their service to the community. As a fellow community member, however, I would like to offer some more accurate information about both addiction and the medically-based treatment of addiction.

As I am sure both Mr. Wright and Judge Gardner are aware, New Hampshire has a significant and rapidly increasing rate of opiate dependence. The cost to the community of any disease is high, but can be ameliorated with accurate information and appropriate services.

As scientific advances have been made regarding addiction, the stigma under which persons with addictions live has begun to lift. However, many misunderstandings still abound. Though there are other ways to treat opiate dependency, methadone therapy has been proven to be one of the most efficacious. Methadone treatment for opiate dependence has been used since the 1940s. Like the disease of addiction, methadone treatment has been stigmatized and misunderstood for decades. In conjunction with a daily dose of medication, methadone therapy, by law, includes participation in counseling for all patients. The medication treats the damage inflicted upon the brain by the abuse of opiates and keeps the patient stable (i.e., free of acute withdrawal symptoms and cravings) while, in counseling, they make the changes in their lives they need to make to live a life free of illicit use.
Because the abuse of opiates has such a profound impact on the brain, recovery is a long process. It is possible that the brains and bodies some opiate dependent persons will repair themselves in time. However, there is a percentage of patients who will need to be maintained on opiate replacement therapy for long periods of time - sometimes for life. When a patient decides to taper from his or her stable methadone dosage, it is done slowly and in conjunction with a physician and his or her counselor to lessen the chances of relapse and the return of withdrawal symptoms. Treatment is individualized and, therefore, it is both impossible and unfair to the patient to determine a length of time in treatment without accounting for individual situations and needs. Though both Judge Gardner and Mr. Wright posit that "long-term use is not recommended," studies of the efficacy of methadone treatment have proven the opposite (see Gerstein, et al. Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessment (CALDATA): General Report. 1994; National Institute of Health (NIH). Effective Medical Treatment of Opiate Addiction. 1997).

Methadone treatment, therefore, is not a "legal addiction," but a replacement therapy for persons with the disease of addiction that allows them to live healthy, drug-free lives. Much like people with diabetes use insulin, methadone is used to make up deficits in the body's physiology. Though I understand that providing treatment to inmates is a "burden" when viewed in a certain light, I believe it is our duty as a community to increase our understanding of the problems we are facing - and viable solutions to those problems. Though the immediate cost of facilitating one inmate's continuation in methadone treatment might seem high, supporting treatment for addiction has been proven to lessen the costs to the community in the long run.

Lisa Feldman
Portsmouth