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Volume II, Issue 9 (September 1997)
Special 6-Page Issue
Antagonist Drugs--A Lot Wiser - by Annette
The Good News Is. . . .Nancy R. (Detroit)
The Bad News Is. . . .Nancy R. (Detroit)
Dear Doctor Letter (Reprinted from Malta Messenger)
Beginning of the End - by Mirror
Counselors - Mark Beresky
Diversion - Odus Green
Briefly Speaking - Short items about drugs in history
Back Page - Places of interest to methadone patients on the internet
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ANTAGONIST DRUGS--A LOT WISER
I suffer from migraines, and I would say 85% of the time imitrex works. However,
I had to go to a hospital the other day when the injection did not work. I have
been using this small country hospital for years, and usually they gave me Demerol
I had been warned about Nubain, Stadol, Narcan, and others I can't think of at the moment. Because I was most often given Demerol, I did not tell them about being on 99 mgs of methadone daily. BIG MISTAKE.
The nurse told me she was giving me Nubain (10mgs). My husband and I looked at each other and quietly decided to go ahead with the shot. BIG MISTAKE. You see, what I thought about being thrown into withdrawal instantly was not in my experience. What I had experienced before was a gradual onset of withdrawal symptoms.
Never in all my years could I have imagined what was fixing to happen to me. It took about 10 minutes for the burning on my back and the vomiting to begin; five minutes later, 15 minutes after the shot, I was in full ACUTE WITHDRAWAL SYNDROME.
There are no words in our vocabulary which can describe what ensued after. Apparently (my memory is not so good after the first 15 minutes) the whole ordeal lasted only about 2.5 hours to get me semi stabilized. I was given Vistaril first. When the doctor finally came (I swear it seemed like hours, but was only minutes), he looked at me and knew this was no picnic.
He told my husband that in his 20 years of practice, he had never seen it that bad. He said he had heard of it but had not witnessed it. I was given an IV, then 2.5 mgs of valium, and a total of 22 mgs of morphine, 2 mgs at a time; then, about 10:30 p.m., he gave me Demerol. I was out cold at that time.
It started at 7:30 pm. He admitted me to the hospital until I showed no more signs of withdrawal for 4 hours. My husband and I left about 4 a.m. and, of course, went directly to the clinic at 5:00 a.m.
My God I can't tell you how horrible it was; it was as if I was a rabid, wild animal (my husband's description). I convulsed and purged out of every orifice of my body, but I was able to control my bowel because at the beginning, I could still walk and went to the toilet. I jerked, I kicked, I vomited, I screamed--I was hot, then cold, then hot. I pulled my clothes off. My back would arch, my mouth would yawn so wide, and I would jerk forward. My legs and arms would stretch and extend way out (all out of my control). I hit people (accidentally), my body was on FIRE, my eyes turned yellow, blood pressure went crazy, and my skin was ice cold to touch, yet wet (my husband said). I felt like I was on fire, and I kicked uncontrollably; in fact, everything was uncontrollable. I remember grabbing my husband and saying, "I am still in here." I didn't look like me, act like me, and I could see it in my husband's eyes. I had to tell him I was still in my body. But I must say me, myself felt very small in my body; the rest was as if I was possessed. It was hell.
If you are taking methadone, please get medic alert bracelets or necklaces, or carry a card in your wallet with an alert in case you are ever in an accident. Also, it is absolutely critical that everyone be honest and up front with hospitals, doctors, etc. . . . regardless of how you will be looked at or treated, it does not compare to the way you will be looked at if you were to be given the wrong drug. Disgust describes it best. At least the usual looks are just disapproving. I know I will be ok; it's just so fresh right now.
Everyone must tell their doctors or hospitals the truth--no matter what. But most of all, never, never, never take any antagonist medication while on methadone. This cannot be stressed enough.
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DEAR DOCTOR LETTER
(Reprinted from the MALTA Messenger)
J. Thomas Payte, M.D. is the Founder and Medical Director of Drug Dependence
Associates, an outpatient chemical dependency treatment program in San Antonio, Texas
that blends pharmacotherapies with self-help and behavioral concepts.
Dr. Payte has worked in both the public and private sectors of treatment since the 1960's. He developed his "Dear Doctor" letter for methadone maintenance patients who, for various reasons, must visit private physicians for medical conditions unrelated to their addictions. These patients are very often discriminated against with regard to their care and their need of pain medications for the medical problems for which they are seeking care. This is due to the ignorance of physicians in general practice about addictive disease and methadone treatment.
Dr. Payte puts it very clearly to patients, "I instruct patients to give this letter to their new doctor in their presence and ask them to read it. If the letter goes in the trash, the patient should go to the door and find a new doc." The reaction to the letter may give some clue as to the type of doctor-patient relationship that might develop.
Finally, let me add that Dr. Payte is an advocate for the development of Medical Maintenance to be made available throughout the United States. He is indeed a champion for those of us trying to recover.
If your clinic does not have a similar letter, give this to the clinic doctor to use as a guideline and have him or her sign it, furnishing your clinic's address, phone number, etc.
The bearer of this letter is a patient in a methadone maintenance treatment program. Methadone patients frequently need treatment for other medical, surgical, and dental conditions. At times the health professional is not familiar with addictive disease and the various forms of treatment, including maintenance pharmacotherapy using methadone or LAAM. The reaction to being informed about the addictive disease/methadone treatment often includes fear, anger, prejudice, disgust, and other negative subjective responses, none of which contribute to the objective delivery of quality health care. Many patients are very reluctant to provide information to the other health professional about their addiction and treatment with methadone or LAAM because of previous unpleasant experiences. The most common reaction is based on fear which is inversely proportional to the professional's level of familiarity with addiction medicine and patients with addictive diseases. The purpose of this brief letter is to touch on the most common problems encountered and to offer any assistance I might be able to provide.
Addiction is now widely accepted to be a disease or a group of diseases. Addictive disease can be characterized as a chronic, relapsing, progressive, probably incurable, and often fatal (if untreated) disorder. The principle diagnostic features are obsession, compulsion, and continued use despite adverse consequences (loss of control).
Methadone has been used in the treatment of opiod dependence for 30 years. It has been found to be both effective and safe in long-term administration. An adequate, individualized daily dose of methadone eliminates drug craving, prevents the onset of withdrawal, blocks (through complete opiate cross tolerance) the effects of other opiates, such as heroin or morphine. Efficacy of treatment is based on elimination of or reductions in illicit/inappropriate drug use, elimination or marked reduction in illegal activities, improved employment, pro-social behavior, and improved general health. Such treatment has been shown to be effective in reduction of the spread of HIV and other infections. Dramatic reductions in mortality rates are seen in methadone-maintained patients in comparison to untreated addicted populations.
The methadone-maintained patient develops complete tolerance to the analgesic, sedative, and euphoric effects of the maintenance dose of methadone. Tolerance does not develop to the effect of preventing the onset of withdrawal syndrome. Methadone has a half-life in excess of 24 hours which makes single daily dosing possible. Methadone has a relatively flat blood plasma level curve that will prevent the onset of abstinence syndrome for over 24 hours without causing any sedation, euphoria or impairment of function.
Second to discrimination, the management of pain in a methadone-maintained patient is the most common problem we encounter. Since the patient is fully tolerant to the maintenance dose of methadone, no analgesia is realized from the regular daily dose of methadone. Relief of pain depends on maintaining the established tolerance level with methadone and then providing additional analgesia. Studies have shown that exposure to adequate doses of narcotics for the relief of acute severe pain does not compromise treatment of the addiction.
Non-narcotic analgesics should be used when pain is not severe. In the event of more severe pain, the use of opiod agonist drugs, such as morphine, often needs to be increased due to the opioid cross tolerance established by the methadone. Also, the duration of analgesia may be less than usual. Doses must be individually titrated to ensure adequate analgesia. Best results are obtained with a scheduled dosing as opposed to PRN. Morphine may be required q 2-3 hours in whatever dose provides relief.
There is no justification for subjecting a maintenance patient to unnecessary pain and suffering because of their disease or its treatment. Adequate treatment of pain will ensure a more pleasant hospital stay as well as enhance healing and recuperation.
Opioid partial agonist and agonist/antagonist drugs such as Buprenex, Talwin, Stadol, and Nubaine should never be used in the methadone-tolerant individual. Severe opiate withdrawal syndrome can be precipitated by drugs of this type.
Both propoxyphene and meperidine are known to produce CNS excitatory metabolites. Due to the cross tolerance, the higher doses required to achieve analgesia could increase the risk of seizures. For this reason, propoxyphene and meperidine should be avoided in the maintenance patient.
The administration of opioid agonist drugs should be closely supervised in terms of quantities and duration. Prescribing for self administration by the patient should be carefully monitored. If it is necessary to prescribe for self administration, caution should be exercised in the amounts prescribed and refills carefully supervised.
Similar precautions are indicated in the prescribing of sedative/hypnotic and CNS stimulant drugs. The abuse potential of ALL benzodiazepines is quite high.
At times, the attending physician is tempted to treat the opioid dependence itself. This is usually attempted by doing a methadone graded reduction of dose. If successful, the graded reduction may result in a reduction or elimination of the physiologic dependence but has no effect on the disease itself. Even after the methadone is discontinued, significant signs and symptoms of abstinence may persist for several weeks and even months. The relapse rate associated with detoxification alone approaches 100%. A relapse to street/illicit drugs increases risk of overdose, hepatitis, AIDS, and a host of other biomedical, psycho-social, legal, and other complications.
Under some circumstances, some form of intervention can be accomplished during a hospital stay for other conditions when desired by the patient and in consultation with the methadone program physician. Such a process should involve experienced addiction professionals with a strong emphasis on continuity of care upon discharge.
If you have any questions or concerns about our mutual patient in relation to methadone or drug dependency, please call me. I would be delighted to hear from you.
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THE GOOD NEWS IS. . . .
Methadone and Ibogaine advocates will be both attending and demonstrating at a
National Institute on Drug Abuse (NIDA) Heroin Conference to be held Sept 29 &
30, 1997 in Washington, DC. This is the first time that methadone patients are participating
in demonstrations for the right to be treated with medical respect. We hope to bring
this message and the demand for Ibogaine availability to the persons attending the
NIDA heroin conference.
Ibogaine is an experimental medication that appears valuable in treating a broad spectrum of chemical dependence, including that to opiates, stimulants and alcohol. Ibogaine is highly effective for eliminating narcotic withdrawal for both heroin and methadone and will work for either in a two-to four-day procedure. It also has the unique ability of interrupting drug-seeking and craving behavior for periods of time, allowing a window of opportunity where former drug users may begin to put their lives in order.
You can contact Howard at: Lotsof506@aol.com or leave a message with your name, address and phone at (212) 714-7148; or Methadone Today: firstname.lastname@example.org, (810) 658-9064.
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THE BAD NEWS IS. .. .
Last month, it was mentioned that Macomb County Jail would not dose a DUI inmate/patient
even though medication was available. We did not mean to leave the impression that
alcohol and methadone would have been used together. The patient had not been drinking
at all; this was an old DUI ticket. Even if drinking had been involved, it should
be left up to medical personnel--not police officers or jailers to deny the patient
his or her medication.
Note: I said there would be an article about the KEEP Program in New York in which inmates are given their methadone while incarcerated. The article is unavailable this month but it will be in the October issue.
We are looking for good news/bad news items for this section of the newsletter. If you have something you would like to contribute, send to us at Methadone Today, P.O. Box 164, Davison, MI 48423-0164 (Please keep them short). Regular length articles and/or donations can also be sent to the same address. - Editor
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BEGINNING OF THE END
To make a long story short, when I lived in Boston (wonderful Boston), and I
was on 240 mgs. a day with take-homes, life was indeed grand. I was totally active
as a printer and graphic artist, living as they say, large--good job (printer); nice
pad (in Brighton ); no, and I mean NO, desire for opiates; driving an Austin-Healy
Roadster; beautiful relationship with a super lady; no problems--life was sweet.
Unfortunately, my boss wanted to promote me to the sales staff. This would require me to travel beyond my once-a-week pickups. It was the beginning of the end. Trying to handle on a less than therapeutic dose, I stupidly gave in to pressure to ``detox and become totally successful." As I detoxed, my migraine seizures became totally intolerable, sometimes causing me to stay in a darkened room for days on end! Needless to say, next stop back in the bag up to my shoulders, dealing (the job died at about 50 mils.), had to liquidate the ride (Austin-Healy Roadster), the stereos, the wonderful penthouse in Brighton (certainly no more grand meals at Jack and Marion`s Gourmet Restaurant in Brighton). And, yes, I know, those pleasures of the flesh aren't good for us anyway.
The point is that at an effective dose of methadone cannot be beat for shoring up those failing or absent endorphins, preventing or relieving migraine, and therefore granting access to the land of the `normal` person. Right!! Twenty-five years later, I still haven`t recovered from that detox. I`m now back on maintenance at a hundred a day--not enough, but these regs, you know......
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by Odus Green
There has been a lot said by various law enforcement agencies and others about
the "diversion" of methadone. I submit that diversion, while certainly
not non-existent, is such a small percentage of the total that it does not justify
the negating of our civil rights and liberties as is now the norm.
I also daresay that the predominant means of illegal mass distribution of the substance is granted by the very agencies that are charged with its proper dispersal. The only way that methadone could possibly become available on the streets in such quantities as to affect any serious number of people would be through what patients call "the back door."
Patients, who could not be admitted to a clinic were they not addicted, are not capable of selling enough of the meager supply with which they are trusted. To maintain their own dosing requirements and that of another person would be an almost impossible feat, whereas a nurse could easily steal enough of the drug to addict a sizable number of people.
This being the case, it would seem wise to use the more common method of utilizing prescriptions with a pharmacy actually dispensing the drug at a 2 week or 1-month supply at a time. This would not be a great enough amount to add to the numbers of opiate addicted persons, whereas the current clinic system is actually conducive to hoarding enough of the drug to be introduced into the community in quantities great enough to add to the overall drug addicted population.
Let's look at the numbers and see why the current system, under even minimal scrutiny, is only serving to add greater amounts of methadone to the underground market. An individual, even on a high dose of 100 mgs, must first take care of themselves before they can think of selling any part of their prescription. So, even if a person were to wean themselves down to 50 mgs per day, which is the bottom end of a decent dose, they would be able to sell only one dose a day, and this is presuming that one is selling a substance he knows to be pure and of a verifiable amount, to get money to buy much the same substance, only heavily-adulterated and no way to know exactly how much actual drug he is getting. Not only does this defy logic, it is greatly exaggerated in size and scope by the anti-drug forces, and this is purely an economic motive. The bigger they can make the problem seem, the more money they can ask for, and get, from Congress.
Now, an underpaid LPN who makes up 250 doses a day and who wants to make a little side money is certainly in a better position to add to the overall drug problem than is the person who is there to get away from just that kind of life. If s/he takes just 5 mgs. From each dose (which would be impossible to detect by the majority of patients) she has 1250 mgs to add to the "street" each day. That is enough to supply 25 people with 50 mgs each day.
Clearly, this is a much bigger "threat" than the patient who is made to attend the clinic each and every day in most cases because it is thought he is the danger to the public. Yet, all the resources are expended on the patient as the source of illegal methadone. This is illogical from the beginning. The patient should be trusted more, and the clinic workers should be under the majority of scrutiny.
Actually, the whole system should be abolished--the patients should be treated by their family doctors and go to the pharmacy for their medication. But, then the government agencies who make millions by running this convoluted, silly system we currently have would be without a job, wouldn't they?
It is certainly in their best interests to demonize the patient and scare the public into thinking that methadone patients themselves are a danger to society. Without these government agencies to guard "Them" against "Us", we (the patients) would rape, pillage, and plunder society at large. Hence, the "protests" each time a clinic is trying to locate in a new city.
It is time we are treated fairly and morally by the medical profession. It is certainly their place to step up and tell the public the truth and end the lies that are perpetuated by those who stand to lose their jobs if the current system is abolished. These include the government agencies as well as the entire abstinence-based treatment business. I have personally seen these places spread lies and stir up a whole community because they are worried, not about patients, but about their "bottom lines." I am simply a normal person who needs a particular medicine to make my life the best it can be--just like millions of other people. Why is it that I am made to be evil simply because the medicine I need is called methadone?
Note: In California, DEA officials said at least 95,000 mg of methadone were unaccounted for by the clinics. Diane Fleury-Seaman of MALTA is concerned the allegations will give added ammunition to those critics who believe methadone merely substitutes one addiction for another, and that will only make the patients suffer more. - Editor
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by Mark Beresky
My current counselor once told me, "Don't you think we all would like to
use methadone?" Like I wouldn't do anything to be able to live a normal life
without the constant interference and rule setting dictated by the clinics?
I get the impression from some counselors that they think we are in some type of euphoric state. And they seem to resent the fact that they can't have any. To me, this is akin to wanting some of a cancer patient's chemo. It smacks of a complete misunderstanding of the etiology of this disease and the function of its only effective medication. This may have something to do with many counselors' efforts to lower doses. A jealousy thing, maybe?
There are other possibilities, too. I am reasonably certain that many counselors took that course in their careers simply because it was easy and reasonably well paid. Prior to 1986 (correct me if i'm wrong), there were no requirements to become a drug and alcohol counselor, at least not in this state. All who were in the field at that point were "grandfathered" in to certification. Those who wanted to become counselors after '86 were required to go to some type of schooling and pass certification requirements. To those searching for a career it doesn't look too bad. A couple a years of school and making a decent starting salary is assured. You get to work in air-conditioning, make decisions about other people's lives, and tell yourself that you're doing it all for the good of the society. The problem is that most never study the disease or related research and developments after they get their first paycheck.
Most also never shake the myths, misinformation, prejudice, sophism and outright lies peddled by this country's religious right to the world in the earlier part of the century. And this is the tragedy. I can take an outright mercenary, but I object to indifference and prejudice when making decisions about the lives of others. Let's just say that I think a lot of "counselors" are there for the paycheck and don't know a lot about this disease that they doubt IS a disease.
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1948 - "Opium and morphine are certainly dangerous, habit forming
drugs. But once the principle is admitted that it is the duty of the government
to protect the individual against his own foolishness, no serious objections can
be advanced against further encroachments. A good case could be made out in favor
of the prohibition of alcohol and nicotine. And why limit the government's benevolent
providence to the protection of the individual's body only? Is not the harm a man
can inflict on his mind and soul even more disastrous than any bodily evils? Why
not prevent him from reading bad books and seeing bad plays, from looking at bad
paintings and statues and listening to bad music? The mischief done by bad ideologies,
surely, is much more pernicious, both for the individual and for the whole society,
than that done by narcotic drugs" (Ludwig von Mises. Human Action,
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NET WEB SITES
There is a new methadone web site at: http://www.aparker.org/r_bob/index.html
World's Largest Online Library of Drug Policy: Before it is put through the propaganda mill. Check it out at http://www.druglibrary.org/
Methadone Information Exchange - This site allows methadone patients to post their ideas, suggestions, and frustrations: http://www.mindspring.com/~methinfex/
A.T. Forum - This is an excellent quarterly publication which deals with issues surrounding methadone: http://www.atforum.com/index.html
NAMA - National Alliance of Methadone Advocates' Education Series, NAMA position papers, & much more: http://www.methadone.org
Chemical Dependency Working Group - Go to this site to get the "must have" Methadone Treatment Works Compendium: http://www.users.interport.net/~nama/cdrwgpub.htm
New Methadone Chat Channel for Methadone List Participants: - This is located at irc.calyx.net; Port 6667; Channel #methadone. It was set up by Nick Merrill, who has generously given us the methadone list. Thanks, Nick.
Methadone Awareness Newsletter - Katharine Bolton's web site is down right now; however, ask for a sample of, or subscribe to, the newsletter ($10 per year). Contact information: 617 Pine St. #2, Philadelphia, PA 19106
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