Tuesday, June 29, 2010

Legislative attempt to usurp medical authority - Pennsylvania:

In a series of half dozen proposed bills, the PA. Senate is seeking to assume the role of physicians. For example: Sen. Bill 1293 would estaboish a "methadone death and incident review team" - what a label for those who desperately need help to contemplate! The team (mainly non-physicians would be charged with "determining the role that methadone played in each death ..." Isn't that the traditional responsibility of the trained/certified medical examiner? Sen. Bill 1294 would establish "eligibility criteria" (ever hear of eligibility" for a medical treatment ordered by medical doctors?), to include: "inability [of applicant] to stay drug free after at least two substantial attempts at appropriate treatment in drug-free programs." Like telling severely depressed and suicidal patients they must first have two unsuccessful suicide attempts before being "eligible" for anti-depressant medication. And the same bill demands a specific plan to achieve abstinence," imposes urine testing every two weeks forever, and prohibits patients from driving during the first two weeks treatment with methadone (but only if the methadone is given for treatment of dependence - patients getting methadone for pain would be under no constraint whatever).

Do these proposed bills reflect appalling ignorance, or merely self-serving demagoguery intended to gain votes in the next election? And which of these explanations would be more shameful for these elected officials?

Friday, June 25, 2010

ONDCP (office of national drug control) DIRECTOR: Over Half of Drug Treatment Program Patients "Are There Because of a Law Enforcement Intervention."

(Statement of Office of the Director, ONDCP (office of national drug control policy), May 18, 2010) What a sad reflection on our country's policies, priorities and practices! In NYC at the height of the tuberculosis epidemic a few years ago, roughly 3% of all patients were under legal mandate to receive directly observed treatment (source: email correspondence with NYC Health Dept Bureau of Tuberculosis).

What's being done to attract voluntary admission of those who need care? When's the last time there was a government public service message (federal, state or city) advising drug dependent individuals that treatment was available promptly, and urging them to apply? And the illogic of CJS-mandated care: judges and prosecutors determine that a defendant has a medical problem needing treatment - and generally dictate what that treatment shall (and shall not!!) be. And when the treatment is less than optimally effective - i.e., when the defendant-patient shows continuing evidence of the condition being treated (drug dependence!) - that defendant-patient faces jail, while the treatment providers merely fill the newly vacated "slot" with another court referred individual.

What a system!

Saturday, June 19, 2010

Strong Support for Methadone Maintenance - from "LA's Top Law Officials"

At a news conference 16 June LA Police Chief Beck and Sheriff Baca "decried the proposal ... to eliminate state funding for treating heroin addicts [with methadone]". Those against methadone treatment, as well as those who don't care one way or the other as long as it's provided in someone else's backyard, take note! What do top cops know that you might not? Full article: http://www.mercurynews.com/breaking-news/ci_15311225?nclick_check=1

Monday, June 14, 2010

Does Stigma Play a Role as a Barrier to Methadone in Treating Pain?

That is the question posed by a recent article in Pain Physician (13:289-293, 2010), and not surprisingly, the answer is an emphatic "yes"! The authors note that "the most socially stigmatized patients are those treated with chronic methadone." While it "is an excellent drug" for pain management, "... the lack of depth of knowledge by pain care providers about the benefits of the medication and societal stigma still play a role as a barrier to treatment." Sadly, of course, precisely the same can be said about methadone in the care of opiate dependence - even after 45 years of consistent evidence of efficacy.

NIMBY at a New High (or Rather, Low!)

A June 10 Riverdale (NY) Press article reported that for some time now 45 residents of a health care facility for elderly and disabled in the Bronx have been obliged to travel by special bus, most on a daily basis, to obtain their methadone from a maintenance facility in the neighboring town of Yonkers. It has obviously been a great inconvenience to the patients - as well as costly and disruptive (an estimated taxpayer cost of $150,000 yearly, and "loading and unloading the patients, some of whom are in wheelchairs, on the buses backs up traffic..."). So . . .the facility has proposed operating a methadone program on-site under terms that would involve a maximum of four non-facility residents receiving methadone there.

The reaction: outrage of the local residents who "just say no to methadone." There is worry over "what kind of people" would be attracted to the proposed program . . .[and] the possibility of a different breed [sic!] coming around here... "

Even with stories about NIMBY appearing from cities and towns around the nation, this one really is beyond the pale. How terribly sad!

Article can be accessed by clicking here.

Saturday, June 12, 2010

Views on Proposed Limitation of Addiciton Treatment Duration

A blog from UK on 10 June endorsed the view that it's dead wrong for government to impose limits on the duration of methadone treatment for opiate dependence. The blog is to be found at http://northerndoctor.com/2010/06/10/nutt-on-methadone-and-the-tories/. The comment below was submitted in response to this posting.

Dr. Lawson - and Prof. Nutt - are absolutely correct. It would be unprecedented and irrational to impose a time limit on medical treatment for a condition that - to date - is incurable but eminently treatable. It would be just as absurd to demand that alcoholics be urged or somehow forbidden to attend more than a given number of AA meetings. Or that diabetics be given six weeks to adapt to a rigid regimen of diet, exercise, etc. - and then be cut off from further insulin prescriptions.

We're talking about a treatment that very literally can spell the difference between life and death for those who need it. We're also talking of a treatment that yields enormous benefits to the community at large. Imposing arbitrary limits to override the judgment of doctors and needs of patients would be a catastrophe.

Thursday, June 03, 2010

More Criticism of the Cost of UK Jail Methadone Treatment.

More press coverage of criticism of the cost of UK jail methadone treatment. Once again, totally missing the underlying source of the problem: the continuing incarceration of so many drug users and the reality that drug dependence and its consequences do not end with incarceration or upon release.