A Matter of Time and Resources - Editor
TIP/TAP Series: The NIMBY Syndrome
My Attempt at Withdrawal (Follow-up Article) of 23+ year MMT Patient - Nancy Rose (DONT Secretary)
Letter to the Editor & More on the NIMBY Syndrome
NAMA Column #7 - Joycelyn Woods
Doctor's Column - More on Serum Levels
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"All neighborhoods in the United States today have witnessed or suffered the tragic effects of alcohol and other drug abuse" begins page 1 of TAP 14, Siting Drug and Alcohol Treatment Programs--Legal Challenges to the NIMBY Syndrome. While many Americans understand and worry about the extent of the growing drug problem, there is still plenty of "community opposition--commonly known as the NIMBY (not in my backyard) syndrome--" when it comes to opening a treatment center in their own neighborhood.
"The NIMBY syndrome is not new...," and along with substance abuse treatment centers, NIMBY has delayed or stopped the openings of many "health and social service facilities, including homeless shelters, group homes for the mentally ill, halfway houses for ex-offenders..." and health facilities for patients with AIDS.
TAP 14 explains that while some localities try to use zoning ordinances to stop a clinic from opening, this is discriminatory and may be unlawful. "Federal disability-based antidiscrimination laws (including the Fair Housing Act, the Rehabilitation Act and the Americans With Disabilities Act), the equal protection clause of the fourteenth amendment..., and many individual State laws have been used successfully to overturn the actions of local governments" that attempt to stop the opening of drug abuse programs. The entire TAP 14 manual concerns zoning requirements, legal challenges, review of case laws, and gives suggestions, examples, and case studies.
Community opposition to methadone treatment clinics seems to be based on the fear that clinics will draw drug pushers, thieves, and other criminals, and property values will decline. "In reality, treatment programs pose no legitimate danger to the health or welfare of residents. . .nor do they draw pushers to the area. In fact, (clinics) improve neighborhoods by helping people get well" (TAP 14, p. 1). TIP 1, State Methadone Treatment Guidelines, says "Despite more than 25 years of research and practical experience in methadone maintenance treatment of opiate addicts, the public lacks knowledge of the scientific efficacy of methadone maintenance treatment" (p. 125).
This is where community education comes in. It is important that "local decision makers and residents understand that treatment programs help communities by reducing many of the costly problems associated with active alcohol and other drug abuse and that treatment enables former users to return to productive lives" (TAP 14, p. 45). People need to learn about and understand methadone maintenance treatment (MMT): that MMT "encourages abstinence and prevents (patients) from relapsing"; that patients on MMT do not get high from their daily dose of medication, but rather are able to function normally and return to jobs; that clinics monitor "(patient) drug use through urinalysis..."; and discourage any loitering outside of the clinic by patients (TAP 14, p. 45). Additionally, MMT is "associated with substantial improvements in public health and employment and a reduction in HIV risk and criminal behavior" (TIP 1, pg. 125).
In TIP 20, Matching Treatment to Patient Needs in Opioid Substitution Therapy, there is an entire chapter on cost effectiveness of methadone treatment. It lists numerous studies that show the benefit and savings to communities of methadone maintenance treatment when compared to costs such as imprisoning drug users, hospitalizing addicts for health problems resulting from illicit drug use (like HIV/AIDS, HCV, TB, etc.), and costs due to lost productivity and illness, including paying for illicit-drug-using addicts on welfare, Medicaid, Aid to Families with Dependent Children, and for foster care of children of mothers/fathers in prison. When you add in the costs of crime resulting from illicit drug use, the cost of treatment sounds better and smarter all the time!
"Substance abuse treatment can greatly reduce health care costs. . . . For every dollar spent on treatment, more than $7 in future costs were saved." With treatment, ". . .criminal activity declined by two-thirds and hospitalizations by one-third," and use of alcohol and other drugs declined "two-fifths." Also, after treatment began, "States averaged an increase of more than 70% in the number of (patients) employed." Arrests of patients dropped dramatically, decreases ranging from "50% to 90%" in various states (pp. 97-98). Again, the TIP/TAP books cite numerous studies to back up these amazing figures. The public just needs to hear about them.
Costs of different kinds of treatment are compared too, showing that methadone maintenance treatment is the most cost effective of all of them. For example, "the treatment costs per day were residential $61.47; social model $34.41; outpatient drug free $7.87; methadone (maintenance) $6.37; and methadone (detox) $6.79." It also points out that because of the "high recidivism or relapse rates" with the chronic disease of addiction, the best cost benefits come with long-term treatment. "When patients dropped out of treatment, most relapsed to drug abuse within one year, often returning to previous criminal patterns to support the addiction. Therefore, patients should be encouraged to remain in treatment" (p. 99).
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About a year and a half ago, I wrote an article entitled, "My Recovery and Experience With Methadone and Detox" (December 1996 Methadone Today). I wrote about my history of using heroin, my experience with recovery with methadone (and Narcotics Anonymous), and my attempt at withdrawing from methadone. I said that I would give an update on my progress--the personal account of a long-term (23+ years) methadone patient trying to withdraw from methadone.
First, here is a recap of the article: in the early 1970s, heroin quickly ruined my life; I ended up in sad/bad shape on the streets of Detroit's Cass Corridor. During the first ten years on methadone (1975 to 1985), I continued to use heroin, then later Dilaudids because I was on various city ("free") clinics which wouldn't allow patients to go over 30 mg of methadone. That dose was nowhere near enough to take away withdrawal symptoms or drug cravings.
Then, in 1985, I found a privately-owned clinic which allowed patients individualized doses. I went up to a dose which worked for me (150 mg), and I turned my life around! I worked full-time for the next ten years as an executive secretary to the medical director of a hospital, went to college, and stopped using illicit drugs completely! So, I've been "clean" since 1985 with the proper dose (for me) of methadone.
When I was laid off from the hospital in 1995, I decided to take that time off of work to see if I could POSSIBLY withdraw from methadone. Why did I want to try to get off a medication that saved my life? Well, there were a couple of reasons. First, I thought maybe I should at least TRY since I was already 42 years old, and I thought it might be harder to do as I get older. Secondly, it is expensive. I pay $70 every week ($3,640 per year) at the methadone clinic; I wonder how I'll manage to pay the bill as a senior citizen! And, third, I was scared--scared of government interference in methadone treatment with their rules and regulations, threatening things like eliminating "take-homes" and treating patients like "criminals." The DEA actually raided a Detroit clinic in 1995, going in with their guns drawn, as if it was an illegal "dope house"! Why? Because the owner was accused of Medicaid fraud.
Anyway, I started the withdrawal: from October 1995 through April 1996, I dropped from 150 mg to 130 mg and felt OK. I decided to try going faster. Big mistake! I dropped from 130 mg to 45 mg in three months (April through June 1996). Then, I was hit with TERRIBLE withdrawals! Every day. It was impossible for me to persevere with nausea, diarrhea, sleep disturbances, aches and pains, stomach cramping, and that internal restlessness where you can't stand being in your own body. So, at the clinic doctor's suggestion, I backed up to 65 mg. I was scheduled to start going down again at a much slower pace, a few milligrams every other week when I wrote the December 1996 article. I should mention here that I had asked the clinic doctors to drop my dose at the above-mentioned speed; their advice was to do it much slower.
Well, here's the update: I decided NOT to go down in dose again after all. In fact, I went back UP, almost to the dose where I started. Maybe I'll try withdrawing again some day. Maybe not. It doesn't matter because I have accepted that I NEED this medication to correct my damaged, faulty brain chemistry. Several people told me I dropped my dose way too fast (I know, I know) and that I should try it again at a much slower pace. But, I got so sick that even today, over a year and a half later, my body hasn't yet fully recovered. My resistance is low; last winter, I caught cold after cold and flu after flu. My body is still trying to recuperate from that withdrawal attempt!
Since I joined the DONT advocacy group in June of 1995, I have read numerous medical and research articles written by the doctors who have studied methadone maintenance for the past 30 years. I now understand that for a person like me, who ingested opiates for a number of years, their brain stops producing endorphins (the body's natural morphine-like painkiller). The brain chemistry may be damaged to some degree permanently. These doctors explain that methadone corrects the opiate receptor ligand system, so we feel "normal" rather than sick. In other words, since the brain no longer produces the necessary endorphins, methadone takes the place of them.
I will continue to be an advocate for methadone maintenance treatment. I am amazed at the progress DONT and other states' advocacy groups and the national group (National Alliance of Methadone Advocates) have made. We must continue to tell our stories, about how methadone has saved our lives. How, yes, we may have been an opiate addict at one point in our lives, but WE SOUGHT TREATMENT. We tried to get well and did. Abstinence (from any medication) works for some ex-opiate addicts; methadone works for others. We should be proud that we have tried valiantly to get better in spite of sometimes tough clinic and government attitudes and rules.
My Feelings About My "Failure"
It's hard to write about my feelings regarding this, but I'll try to be honest. Despite the fact that I have not fully recuperated yet, I do NOT regret my attempt to withdraw from methadone. I always wondered how my body would react, and I learned some things that may be helpful if I ever attempt withdrawing again.
At first, when I decided to go back up in dose, I was afraid that I would disappoint some people, especially my husband. Although he is NOT an addict and has never used any illicit drugs or even alcohol, he is very understanding. He saw how sick I got from trying to withdraw, and he is totally understanding and accepting that I may need this medication for life. He knew me during my active addiction to "street" drugs, and he KNOWS methadone saved my LIFE, literally.
Also, when I decided to go back up in dose, I sometimes experienced feelings of embarrassment that I had "failed." But, my friends in the advocacy group said I should be proud for even having attempted it. That made me feel better! You see, I know now I need this medication, and I am not ashamed of it (would I be ashamed of needing insulin?). But, I just want everyone else to understand that, too!
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DONT had hoped to be more self-supporting by now. That hasn't happened, largely because while people are happy to read Methadone Today, they don't pay for it. As noted, that is going to have to change.
DONT has recently been deluged with e-mail, faxes and letters requesting its assistance as an advocacy organization. We are not unsympathetic, but unfortunately, we are going to have to make changes in that area as well.
For the time being, DONT will only be able to provide advocacy services--whether that's writing a letter to or calling a clinic, or searching for information and providing it to those requesting it--to those people who have paid for a membership (see coupon on back page).
Accordingly, when you contact DONT, you should provide information (i.e. name, address, etc.) and that you have a paid membership at the time you request assistance. While other requests will be considered based upon the nature of the situation and individual need, those who are not members will either receive no response or a form referral to another group which may or may not be in a position to help you.
Please realize it is not a question of DONT or Methadone Today desiring to avoid involvement or make money. It is not a question of DONT being unwilling to provide advocacy for patients with legitimate needs or an unwillingness to distribute Methadone Today free to anyone who might desire it or benefit from it. It is a case of DONT and Methadone Today being unable to do these things anymore except for paid subscribers and members of DONT.
No one at DONT has ever been paid a dime for any advocacy work. DONT and Methadone Today are completely non-profit, with every cent coming in going toward the substantial costs involved in printing and distributing Methadone Today, as well as other patient advocacy efforts.
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There are several coalitions working to protect patients in various
ways. Dr. Dole has also been trying to get the assurance that patients
who want to remain in treatment will continue to receive it.
In a city of about 125 programs, it is difficult to imagine that patients will be put out into the streets, but the Mayor's remarks are having far-reaching impact in a variety of ways. Patients are naturally frightened and are being made to feel ashamed of the one thing of which they should be proud. The Mayor has continued to attack methadone treatment by threatening to cancel the leases of several programs who rent space from the city. This would cause additional hardships since programs would be forced to closed because it is virtually impossible for any program to find another site in the city.
In case you think that this will not affect you because you don't live in New York City, it is time to wake up. The Mayor has high aspirations politically. During the past month, he has visited the cities of Des Moines and Philadelphia and attempted to get officials to do the same thing. He has even said that this is a perfect issue for the Republican Party.
Not only does the Mayor not understand the system, he apparently does not know the history. It was the Republican Party that started methadone. To the policy makers of the time, it made good business sense because methadone treatment reduced crime and all the costs associated with illicit drug use.
As Methadone Today is preparing to go to press, NAMA also plans to participate in several press conferences hoping to reach out to the community. Tentative dates are September 15 and 23. DONT has signed on to be listed as a member of the Coalition for Methadone Choice for their full-page ad in the September 23, 1998 New York Times. When the National Methadone Conference convenes in New York, there will no doubt be more said.
New York still needs you to write letters. Write a letter to Mayor Guiliani; hand-written letters are fine. Send them to: Mayor Rudolph W. Guiliani, City Hall, New York, NY 10007
This is also important: NAMA needs copies of your letter
so that we can show several federal agencies, including General McCaffery
of the Office of National Drug Control Policy and Donna Shalala of Health
and Human Services how the Mayor's callous remarks have impacted the lives
of patients. Send a copy of your letter to: National Alliance
of Methadone Advocates, 435 Second Avenue, New York, NY 10010, Attn.: Letter
to NYC Mayor Project
Patient Records Seized in Fairfax VA
On August 14, the Fairfax Police seized the records of 79 methadone patients using a search warrant approved by County Magistrate, James McCarthy. The records were seized in connection with an investigation about a car theft, because the clinic they attended was 200 yards from where the vehicle disappeared. The affidavit written by a Detective Garrett Broderick in requesting to seize the records stated, "It is common for people who have addictions of various narcotics. . . to engage in these kinds of criminal activities to support drug addiction."
Police spent several hours in the clinic, and when the nursing supervisor objected to their presence and search, they threatened to arrest her for obstruction of justice. Another police office hung up on the clinic's lawyer.
Legal professionals and civil rights advocates say that this is a clear violation of the Fourth Amendment which prohibits illegal search and seizures. Search warrants are supposed to be narrowly tailored, and this warrant clearly was not. Professor Bacigal of the University of Richmond, who trains magistrates, said that he was embarrassed about it and added, "I hope I didn't train this particular magistrate."
In addition to violating the Fourth Amendment, the action also violates a federal law that protects all patients in drug treatment. For such records to be seized, the interest of pursuing the case must outweigh the privacy rights of all the patients. The clinic has hired a lawyer to get the records returned.
National Methadone Conference
This year, at the National Methadone Conference, about 15-20 chapters of NAMA will be in attendance. Prior to the conference, we will have our own special meeting--the First National Methadone Conference. There are several important meetings planned during the conference, including one between NAMA and CSAT regarding the new regulations and physician prescribing. Presently, Robin Robinette of TMAC and Diane Seaman of MALTA are working on a Methadone Patients Platform for the New Millennium. The Platform will be presented to CSAT, and NAMA will continue to work with CSAT and other federal agencies so that this time patients will have a voice in the guidelines that impact their lives.
Second National Harm Reduction Conference
October 7-10, 1998
During the conference will be the Methadone Consumer's Meeting sponsored by NAMA and MALTA.
Place: Cleveland Convention Center, Cleveland, Ohio
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I have learned and grown from your publication. The ignorance and prejudice that surrounds methadone within the so-called professional treatment field is disappointing and incredible.
I also thought I would enclose some information about a recovery residence that I recently opened. I am not seeking any publicity and am not asking you to put this in the newsletter. There are more important things to discuss in it. Through word of mouth, the beds fill as they become available.
We have an agreement with a local methadone clinic to provide
(withdrawal) from opiates at a comfortable pace set by the patient. Methadone
maintenance would also be an option should the patient choose it. If maintenance
was the patient's choice, even if their initial goal was detox, we would
support and facilitate stabilizing them in recovery.
I view a methadone maintenance patient who is not using illicit drugs as in recovery. I believe that outlook is unique among programs in Michigan.
David C. Kintigh, B.A., B. Ph., C.A.C.
President, Burton Heights Wecovery Residence
We felt that it was important to print Mr. Kintigh's letter. His outlook regarding (MMT) is unique among treatment programs, and we are pleased that Methadone Today may have contributed to it.
As you may be aware, most recovery residences and even many mental health facilities are prejudiced against MMT patients and therefore discriminate against them by refusing entrance and/or therapy. However, this may be changing slowly.
Through Methadone Today's web site, I was contacted by another new residential program who was considering allowing MMT patients admittance. Unfortunately, they decided against it but simply because they already had some residents enrolled and did not feel they should "change horses in midstream." The program's representative stated that this decision does not preclude MMT patients' admission to another program in which he may be involved that has not accepted patients already.
Update--The NIMBY Syndrome
In July of 1998, someone from the Burton Heights neighborhood complained to the Grand Rapids Housing Inspectors. Similar residences all over the country have had problems being accepted. Congress has passed legislation to protect them from discrimination. Opponents always chorus the same rhetoric, "It's a good idea, by not in my back yard!"
The city Housing Inspectors responded to the complainant. They toured the building and cited numerous code violations. They also claimed the building was not properly zoned to be used as apartments.
At the insistence of city inspectors, the residence was shut down on July 10, 1998. Twelve addicts were forced out of their homes and onto the streets, twelve addicts who were staying off drugs, holding jobs, and trying to put their lives and families back together. None had supportive, drug-free homes to move into. All but four relapsed and returned to drug use.
Those who relapsed became predators, shoplifters, parasites on society. They did whatever they had to do to get that next high.
One woman returned to prostitution to earn the money to move into an apartment. She had been drug free for over seven months. After earning enough money for an apartment, she used it to get high.
Society had invested thousands of dollars in providing her drug treatment, but she had no place to live after she was put on the streets. Her new-found, but fragile, self-esteem was destroyed when she returned to selling her body.
The Burton Heights Wecovery Residence is expected to be open in a month (less by the time this month's issue of the newsletter is distributed). For more information, call Burton Heights Wecovery, (616) 243-6453 or Methadone Today, (810) 658-9064.
Note: Individuals seeking, or participating in, detoxification from opiates or who are in maintenance using prescribed methadone will be eligible for admission and will be evaluated using the same standards as apply to other applicants.
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