Thursday, October 30, 2008


A Sacramento Bee (Cal.) news story on 22 Oct read:

Drug czar John Walters claimed the proponents of this ballot measure see it as "a treatment plan for nonviolent offenders that will unclog California's overcrowded prisons." It’s tough to imagine a better reason than this to support the proposition!.

As for Walter’s lament that the bill would "weaken our capacity to help people in the criminal justice system" - get real! Does Walters really expect Californians or the nation as a whole to believe that the hundreds of thousands of people arrested on minor drug possession charges each year are "helped" by being locked up? Or that society is better off as a result?

Insanity is defined as doing the same thing and expecting different results. For sure, it's time for a change in our woefully costly and ineffective "war on drugs."


An article in an Athens paper describes the "illegal trade in the potent medicine, methadone." History and common sense teach us that black markets, whether in penicillin, silk stockings or methadone, are driven by demand rather than supply. So the question is: what is being done to ensure legal, clinically effective methadone to all in Athens who need it? For sure, making it more difficult to gain access to care within the city will only fuel the demand. Full story (English)

Wednesday, October 29, 2008


NIH has just announced (RFA-DA-09-013) the allocation of $4 million "... to stimulate investigations, using animal models or human subjects... to improve the translation of existing knowledge of the effects of exercise and physical activity into strategies for the prevention and treatment of drug abuse." And meanwhile, the overwhelming majority of those currently dependent on drugs receive no treatment.

Tuesday, October 28, 2008


Another such criticism from the UK (Times OnLine, Oct 3), castigating the head of the National Treatment Agency for Substance Misuse because he was "...absolutely unable to explain why only 3% of the 200,000-plus addicts [in UK] are cured each year." According to the reporter, Government "... policy has created a pharmacological holding pen in which the UK addicts can be coralled..." The inability after all these decades to accept the fact that addiction is a chronic, notoriously relapsing, treatable but as yet incurable medical condition is mind-boggling.


(Am J Psych 165:10. Oct 2008) While recognizing that some patients require divided doses of methadone for optimal therapeutic outcome, a physician writes that "...the most compelling obstacle in employing this strategy relates to an increase in methadone deaths in various regions of the US." It seems folks just can't accept the clear and compelling finding of a nationwide expert panel convened by SAMHSA: "methadone from clinics is not the culprit" responsible for the increase in deaths attributed to methadone in recent years (SAMHSA News, vol. 12, no. 2, 2004). Meanwhile, how many methadone maintenance patients will drop out, how many will relapse and how many will die because they are all judged likely to divert their medication and thus denied the dosage regimen that might be optimal?

Monday, October 27, 2008


From UK (Manchester Evening News, 15 Oct 08), a story of providers and recipients of drug-free treatment of addiction vilifying those who pursue other ways of easing the suffering associated with illicit drug use. The forum was a public debate entitled, "Rehabilitation is for survivors, maintenance is for quitters." How very sad!

Sunday, October 26, 2008


A resource largely ignored by addiction specialists and other psychiatrists. A just-published survey found that three years after approval of buprenorphine for office-based addiction treatment, 90% of addiction specialists were "waivered" and two-thirds prescribed it. Among psychiatrists not specializing in addiction, however, fewer than 10% prescribed buprenorphine. It is sad - but understandable - that the authors ignored non-psychiatrists because they anticipated they would be (even!) less likely "to know about and have interest in prescribing buprenorphine."
(CP Thomas and co-authors; Psych Services 59:909-916, 2008)

Friday, October 17, 2008

BANANA" Defined: "build absolutely nothing anywhere near anything"

Tusculum, TN: Town planners propose a ban on methadone maintenance treatment 1000 feet from "...any residential dwelling, a school, daycare center, park, church, synagogue, mortuary, hospital or any establishment that sells alcohol for off-premises consumption." Yes-mortuaries are a "protected" class - concern over the welfare of the undertakers, or perhaps their clients? Greeneville Sun (TN),15 Oct 08

Friday, October 10, 2008


Cesar Fax (Oct 6 08) reported that the number one reason (cited by 39% of those surveyed) why those who needed - and believed they needed! - treatment didn't get it was that they were "not ready to stop using." Particularly with dependence on illicit opiates, this would seem to be a compelling reason to consider very short-term, low-cost, ambulatory detoxification aiming for therapeutic outcomes that are short-lived but nevertheless meaningful. Such treatment would be aimed at interrupting the cycle of daily drug use, at least temporarily, identifying critical concomitant medical conditions, and providing opportunity to advise patients as to available longer-term treatments they might consider in future. Over 30 years ago in NYC precisely such a program had over 22,000 admissions yearly.

Thursday, October 09, 2008


Although rigidly apolitical, we feel it's important to ensure that readers know the position of the presidential candidates re. methadone maintenance. OBAMA: can't swear to it, but I don't believe he has ever voiced an opinion. Take that for what it may be worth. MCCAIN: in May 1999 on the floor of the Senate said, among other things, that methadone maintenance was "disgusting and immoral" and introduced a bill that, in part, would limit reimbursement for methadone maintenance to six months. Check it out. Comments as always welcome. And before anyone asks: no, I do not know what position Gov. Palin has on this topic, or Senator Biden.

McCain's statement in 1999:

Tuesday, October 07, 2008

Q&A: Methadone Patient Recently Diagnosed With Cancer Asks if Methadone Can Be Used to Treat Pain

This question was submitted to our website and we thought it might be helpful for a larger audience (all names and personal references have been removed to protect confidentiality):

Q: I was taking methadone when I was recently diagnosed with Cancer. My cancer doctor wants me to stay on methadone for pain relief and I was wondering what dose would work for cancer to take the pain away. As far as I am concerned methadone is not working to relieve my pain. I was on the methadone due to my addiction before I found out about my cancer. If you could tell me if methadone can be used for pain relief of cancer patients it would be great.

A: Unfortunately many physicians think the daily methadone maintenance dose taken to treat addiction provides adequate pain relief throughout the day when it does not. Methadone is a very strong pain medication and is often used to treat cancer pain. It may be used for pain control in those also receiving methadone maintenance for addiction. If so, additional methadone is given for pain several times a day for the control of pain. The methadone maintenance treatment for addiction is continued at the usual dose and time. The methadone maintenance dose used to treat addiction usually will not provide pain relief, but if it does the pain relief will not last very long.

Whether or not methadone is used to treat your pain, the methadone maintenance dose should be continued. The medication given for pain should be started at the high end of the recommended starting dose and increased by your doctor as needed. Relatively high doses of opioid medication (for example morphine and methadone) may be required for good pain control. The only way the physician can tell if your pain is adequately treated is if you tell the physician. There is no upper dosage limit of medication which can be used as long as dangerous side effects such as drowsiness, muscle twitching or seizures do not occur. Everyone is different and different doses of the same medication for different patients with the same type of pain may be needed.

If your cancer doctor is unable to treat your pain adequately, you should request a consultation with a pain management specialist or palliative care doctor.

Monday, October 06, 2008


TimesOnline (UK) had a column Oct 3 attacking “the methadone lobby [that] has built a pharmaceutical holding pen that keeps addicts addicted” ( Same old story: critics denounce clinicians and manufacturers of medicine because they do not cure conditions that – to date – are not curable, and that (surprise!) they make money giving treatment that falls short of cure. Treatment whose goals fall short of cure define the response to all chronic medical conditions.

This critic, like many others, cites surveys showing a majority of heroin addicts and methadone patients “want to stop all drug use.” Sure - how many diabetics would say they love the idea of having to inject insulin every day for the rest of their lives? And just as some diabetics can overcome the need for insulin, some narcotic dependent people can become and remain abstinent without need for further medication. But a great many more can’t – and they presumably would be simply abandoned if critics had their way.