IN RESPONSE TO THE NY TIMES "METHADONE RISES AS A PAINKILLER WITH BIG RISKS" (Aug 17):

Here are two non-published LTEs in response to the NY Times Article on August 17th:

Erik Eckholm’s article about the increasing use and related risk of prescribing methadone for pain management was a carefully researched, balanced piece. Physicians need to be trained in the proper use of this medication as part of an effective risk management program and medical examiners need to use standardized methods in assessing methadone-associated mortality. This medication has been used safely and effectively with ancillary clinical services in treating chronic opioid addiction for more than 40 years in certified and regulated opioid treatment programs. It has helped millions of patients worldwide. Thank you for your thoughtful article.
Mark Parrino, President of the American Association for the Treatment of Opioid Dependence (AATOD)

re: "Methadone rises as a painkiller with big risks" (Aug 17), a Food and Drug Administration (FDA) official is quoted as saying that "label changes" reducing the recommended methadone dosage from 80 mg to 30 mg were instituted "as soon as we became aware of deaths due to misprescribing for pain patients . . . " This claim is difficult to reconcile with the fact, reported in your article, that as early as 2003 FDA was "alarmed by the rise in methadone-related deaths." Also, FDA had for decades called for an upper limit of 30 mg methadone for patients starting treatment for addiction, who have a tolerance to opiates that, at the outset, pain patients generally lack.

Allegations of "misprescribing" divert attention from the real issue here: How can one explain years of explicit, potentially lethal, dosage recommendations by both FDA and the manufacturers, who surely knew better?
Robert Newman, Director of Baron Edmond de Rothschild Chemical Dependency Institute, NYC

ONE IN FAVOR OF CLINIC, ONE AGAINST...

On August 23rd, two news media references to methadone clinics appeared. One was in the Courier Post (New Jersey), headlined "Methadone clinic target of new suit." It detailed latest efforts to bar the establishment of a methadone clinic. According to one resident in the area, "It is a complete aberration to bring in a methadone clinic."

The other news media reference came in the form of an editorial in the Daily Observor of Pembroke County (Ontario), with the headline, "Methadone clinic should be welcomed." It noted that "... there's a big drug problem in Pembroke ... [and] dealing with it in a progressive, straightforward way is not only the best approach for those caught in the vortex of addiction, but is also the best way for the community to begin to right itself from the problems (crime, illness, etc.) associated with drug abuse. The editorial ends: "We should welcome the clinic when it opens on Monday."

AN UNUSUAL AND THOUGHTFUL RESPONSE ABOUT A NEW METHADONE CLINIC

An unusual and thoughtful editorial supporting the locating of a methadone clinic in a town shopping center appeared in The Standard Speaker of Hazleton, PA . Editorials nearly universally take the position, "We understand the need for this type of clinic, but it doesn't belong here." This editorial shows a real understanding of how misguided the fear of crime increasing where a clinic opens is and suggests that crime may likely decrease if their town allows easy access to treatment. Read the editorial

PUBLISH . . . AND LET PERISH? (USA)

On Aug 3 the NY Times reported that CDC has known for some 10 months that it had been grossly underestimating - by some 40% - the number of HIV-positive cases in US. It kept the information from the public until it could be published in a peer reviewed journal. Meanwhile, it seems the considerably higher-than-expected prevalence has not caused CDC or other branches of federal Government to reconsider the irrational refusal to endorse - and fund - harm reduction measures proven to be effective in many countries throughout the world.

NEW YORK STATE FIRST STATE TO PROHIBIT TOBACCO IN ADDICTION TREATMENT CENTER:

Devil is in the details. The regulation “prohibits patients, family members, and other visitors from bringing tobacco products and paraphernalia to the service.” One can only hope that the state, in zealous pursuit of its goal, doesn’t intend patients to be sanctioned if a visitor opens a pocketbook and a lighter falls out.

As for staff members, no such prohibition against carrying “products or paraphernalia” is mentioned – a disparity that might reflect the fact that staff, through their unions, have vastly more clout than patients.

Precisely because it is so important and potentially beneficial, this regulations is badly in need of revision.