Volume II, Issue No. II - February 1997
The Need for Medical Maintenance - Name withheld by request
Addiction in England and Beyond - Magic
Why Should I Contribute to Methadone Today? - An Advocate
Detox - Joycelyn Woods
Briefly Speaking - Short Quotes--Dates in History
Volume II, Issue No. I - January 1997
Naltrexone--Fast, Miracle Cure for Addiction? - by Beth Francisco
If the Shoe Fits - by Ken T.
Managed Care is Here--to Stay - by Beth Francisco
It's Only in Your Head - by Peter Seal
Malta's Don Seaman - Notice
Briefly Speaking - Short Quotes--Dates in History
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The Need for Medical Maintenance
Author's name withheld by request
I have been on methadone maintenance for ten long years. As I approach 40, I ask
myself if anything will be different when I reach that milestone. I worry more about
the other milestones coming up... Fifty, sixty, and even seventy. I ask myself if
I will be one of those people who spend the next three decades walking in and out
the door of methadone programs facing that barred window, handing out my money and
Today I am one of those 100 lucky who somehow, through providence and years of indignity, managed to be a medical maintenance patient. However, this choice is only good as long as I continue to live in the area that offers one of the only two medical maintenance programs in the country (NYC). Recently, when I discussed this issue with the Medical Maintenance program's physician who has been unable to get the program expanded despite a ten year successful track record, he told me this, "There are people who are in their sixties who are going to retire who want to move to Florida who are on Medical Maintenance and they have no options."
Shame, shame, shame. To the rest of the world and to those of us who sit silently by. We are the ones holding the power, whether we know it or not. For the first time, we have a National Advocacy movement (NAMA) to represent us. There is actually a strong crusade for Harm Reduction today, a movement made up of people who are well-regarded, well-funded, and willing to support our right to be treated as normal human beings. Important players" include The Lindesmith Center and DRC. But first more about my story . . .
I started using drugs in junior year of college. I started with speed and cocaine, progressing to Dilaudid and heroin. In the early l980's, heroin was also the cool drug of choice. After only a year of recreational use, which included intravenous use (somebody else had to do it for me), I heard about methadone. I knew nothing about it except that it was used to block withdrawal, which I was terrified of. At this point, I had been accepted into a prestigious graduate program and wanted very much to be able to function.
The first methadone program I found told me I was a chipper and refused to let me enroll. The second was more accommodating--for a price. I attended the clinic daily--no matter that it was sleazy and dirty or that I was treated like someone who slithered out from behind a tree to get there, despite handing over $100 a week for the privilege. All I knew was that I was able to finish college and ward off the frightening throes of withdrawal.
After a year on, I got off, mostly because my mother put me in a hospital where I was given methadone, along with enough other drugs to sink a sea faring vessel. Not long afterwards, my father died of terminal cancer. Depressed and despondent, I began my habit of trying to alleviate my misery with drugs. This time it was pain pills and tranquilizers--from Demerol to Valium.
After a year of outpatient therapy, I was again given the red carpet treatment into the psych ward. By this time, Rehab treatment had emerged. Despite good intentions and AA meetings, I ended up getting a prescription for codeine and was back to the races. After only a few months on that road, my fiance whom I'd met at the Rehab center had a brilliant idea. I'm sure you know the rest of the story.
In an entirely different state, the clinic doctor again challenged my use. However, following the three week mandatory detox, the doctor agreed to sign me up. After a few years on methadone, I grew weary of shelling out hundreds of dollars to drive to the ghetto, stand in a line, have a counselor with gold teeth and no training tell me what I had to do--or else. I began searching for alternatives. There were none.
I got married and moved to Florida. After months of searching, I found a clinic that would transfer me. I ended up moving 80 miles from a clinic. I had to spend the first few months in a hotel until I could earn enough take-outs weekly to live in the house we purchased. I ended up getting a Hardship Travel Exception" from the state. This meant I was allowed two takeouts in a row and then had to return to a clinic for another three days worth. I spent the next three years driving the required 160 miles two days a week. When I moved again within Florida, it was to a town with only one clinic. This clinic used blind dosing and refused to allow take-outs to patients on over 30 mgs. I got down below the cutoff, just to get two bottles a week. When a private clinic opened, I went there and got the requisite five bottles a week.
By now, I was fed up with the lifestyle of driving to the clinic, standing before a barred window, handing over my money and dignity. Despite my personal success, I was stripped of all my achievements when I went to my friendly neighborhood clinic. I was director of my own non-profit organization for a time, yet I spent my mornings in line at an again sleazy, threadbare methadone clinic where others were the sole determinants of my well-being--not because I had committed any crime; no, my civil rights were null and void simply because I availed myself of a medically-recommended treatment sanctioned by the federal government.
I finally got up the nerve and scoured the earth for a sympathetic doctor who would help me detox. I knew from experience that the hardest part begins below 25 mg and once you are actually off methadone. By now, I realized that methadone detoxification was infinitely worse than Dilaudid, heroin, or pain pills. After 8 years of daily use, I got off methadone despite double vision, little sleep, the loss of thirty pounds, and all kinds of neurological side effects. I stuck it out for eight months until the Darvon was stopped. The physician told me he was taking a risk to treat me this long.
I ended up walking back through the friendly doors, even though I had to start over because of my detox. I continued on methadone and after two years finally regained the five bottle a week privilege. Then, I was accepted to graduate school in NYC. I will spare you the details of my journey from a twice a week pick-up and the sleazy programs I endured to medical maintenance.
Now, I finally (almost) have a normal life. I am actually medicated by a physician who treats me like a fellow human being. Yet, I cannot forget that if I ever want to leave the state that I again have 'no alternatives." Do you believe we have the right to treatment for our chronic condition like other people with chronic illnesses? I know that I have the right to treatment with a physician like anyone else.
I also know this will never happen unless those of us on methadone along with families, friends, and supporters join together and demand it. We must push for medical maintenance programs in every state and demand that methadone be treated by physicians like any other illness.
In 1993, the Institute of Medicine studied methadone maintenance across the U.S. They determined that most treatment does not offer therapeutic dosing and interferes with rehabilitation and employment. They suggested to Donna Shalala that medical maintenance become the treatment of choice for all methadone patients stable on methadone for a year.
The next step is up to us.... I am writing to every clinic and group that has a newsletter to get the word out to you... I am counting on you to help me in this effort.
Note: NAMA is working on issues involving regulation and Medical Maintenance; they are forming a committee to promote and expand the Medical Maintenance program across the United States. If you would like to be put on the Medical Maintenance Committee, write to NAMA and ask to have your name included. Send your name, address and phone number for further information on this committee; if you have a fax, include that number, or if you are on the internet, please include your E-mail address. NAMA, 435 Second Avenue, New York, N.Y. 10010; E-mail: firstname.lastname@example.org; web site: http://www.methadone.org/ This is an urgent area we need to address.
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Addiction in England and Beyond
I am a 45-year-old opiate addict who has been on Methadone since 1969. I have
tried every form of therapy known to man to cure my addiction to opiates from every
drug ward, hospital mental unit in Portland and back-again (up to 3 visits each);
I have detoxed many, many times from Methadone also. My addiction has taken me many
directions in search of the elusive cure to find some sort of peace, freedom, and
hope to have my life back again, but I am trapped.
In 1968, with the lottery to go to Nam ever encroaching and with a raging habit of Dilaudid, (Footballs), Neu-morphans, (Blues), and street Heroin, the draft became my worse enemy, especially when friends started to return from their tour of duty. I was freaked and, of course, the country was torn apart. Since I was almost sure to go, I discovered a way out--not the best way--but a way. I became a registered narcotic addict with the federal government through the Narcotic Addict Rehabilitation Act (N.A.R.A.). On this side of the Mississippi River, you were sent to one of only two in the nation's Goverment Drug Hospitals (PRISON, For Real). . . .in Fort Worth, Texas (It was Hell on Earth). On the other side of the Mississippi, you were sent to the more heard of Lexington, Kentucky Facility. Just massive holding pens is what they were. . .no treatment of any real value. I was in Holland in 1991 for Rapid Detox--Another Hell!! In 1992, I even went down to Belize to be treated by a Shaman--No Luck!
In the early months of 1993, I was watching the 60 Minutes show on the British Heroin Program. . .I started writing CBS for a contact address. Within two months, I became the second American accepted to the Widnes England Drug Clinic, directed by my new British Doctor, Dr. John Marks--(THE BEST). For six Wonderful months of Freedom to be able to completely have my addiction in MY CONTROL for once. I was alive--Reborn, Really. I was prescribed 400mg a day of pure Heroin (dia-cetyl Morphine) with all the Free, Sterile Water and Free Syringes I could ever use, not to mention classes I could attend for us late stage addicts with vein problems teaching us where to correctly Fix.
No Urine Analysis at all; I picked up all my Meds and everything at Gladstone's Chemist Shop--What a name, Huh?--2 x a week. And my Lady Rep at the Clinic even came by once a week to pick up my used Syringe container and to chat. I can't tell you how impressed I was to see how they treat and understand addiction in England. For many of us there really is no cure. . .I know now How true that is. . . .Plus, I also had the Free Choice to inject, snort, and/or smoke my Heroin. The trend then was trying to get people more into smoking it.
I watched a Film by the Runcorn Police that showed before and after of the main Heroin area's Traffic. This area used to have between 150-200 addicts selling and buying--after the change to Doctor prescribed Opiates, there was no one left hanging-out. There was almost 0% Drug-Related Crime. . .Interesting?
I say all this because right now as I type, we, the Methadone Patients, are being cut off and kicked off programs Nationwide (LUCKILY, I can afford the $218.00 a month--many programs are more). Oh, and I must mention--we get a five-minute-or-less doctor exam once a year to the tune of $75.00. Also, as you may know, Methadone Hydrochloride (Dolophine@-Lilly), is cheaper than Aspirin to make.
Not all addicts are MONSTERS, and Most of Us are Certainly Not STUPID. How in the Hell can a Clinic be effective in your treatment when they already run on a Conflict of Interest--on a Profit-Head-Count Basis and DEA intrusion?
Now, let's get to the meat and potatoes, of my reason, to write: I know of at least 50 people in three different Clinics around town who are actively staying away from Heroin (even though the price has dropped dramatically). How? Marijuana. Yes Good old reliable, safe, Mother Nature. It most Certainly Works for me and many, many others. I'm Clean. . . Nothing But Methadone For 3+ years now! Now these A*#@s back in Washington are testing us for THC. They give us a Powerful Narcotic from which you get no Euphoria, or at least no high, once you are stabilized, and they are worried about a little smoke?
This Government Is Completely, F*#!ing Insane! Look at The 96 propositions that passed. Look how they are handling that one. Absolutely CRIMINAL. It tells Our Children That even if you go to the trouble of Registering to Vote, Then Vote, and The Proposition that you Voted for Passed, It means Nothing, because If the Big Boys back in The White House and the legislature Decide it's not what they want, It can, and Will, OVER-RULE, the very will and wishes of the People (i.e. Present Marijuana Props). - MAGIC. . .
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Why Should I Contribute to Methadone Today?
Why should I send money for a subscription to Methadone Today when you have
a grant from the Drug Policy Foundation (DPF) to put out the newsletter?
One of the advocates said it best, "I thought because the DPF gave us a grant, I didn't have to worry about it--I figured it was free. I didn't realize all that was involved, and now I know better."
The grant was not meant to give a free ride for those who work and are able to pay. The grant does not pay for everything. We have to pay for postage, printing, software, phone bills, supplies, etc.
At the time the grant was received, printing was being donated, and the editor was (in addition to donating her time) also contributing money to pay for the remainder of the expenses. Every month, we went to press not knowing if it would be our last. We could not ask for money for subscriptions if we could not deliver the newsletter, and we had to have money from subscriptions to continue the newsletter. In other words, we were in a Catch 22 situation.
The DPF grant gave us a reprieve and time to regroup. However, if we do not receive subscription fees from those who read the newsletter, we will be in the same position we were at the end of 1996--broke and unable to ask for subscription fees because we don't know if we will be able to put out another issue of the newsletter. Every month, Methadone Today just barely makes it, but we would like to expand our mission to provide information about methadone and educate. Your contributions help do just that, i.e. sending Methadone Today to Michigan legislators, hospitals, etc.
If you are able to pay for a subscription and you enjoy reading Methadone Today, then you should contribute, at least monetarily, to DONT to help offset the cost. Not contributing is continuing with one's addictive behavior--living off others, letting others do it, and just taking advantage.
Patients and staff should have a sense of pride in Methadone Today. The newsletter is distributed extensively in the city of Detroit and surrounding area. We also have had subscription requests from California, Alabama, Illinois, Oregon, New York, Virginia, and most of the other states; we have even distributed to Canada, England, and the Czech Republic.
All time and articles are donated to us--DONT members even fold the newsletter, instead of having it done, to save money. No one receives a salary or hourly wage; if anything, we do not reimburse ourselves all that we pay out. If we did, our funds would not last until the end of our fiscal year.
Anyone who attends our meetings is welcome to look at the books. Checks received are stamped on the back, "For Deposit Only" and go immediately into a separate account--this money is not mixed with personal funds. All checks written from the account to reimburse someone or pay a bill must accompany a receipt, and only then is a paid out slip made and reimbursement made.
We have a site on the Internet which was not figured into our budget at the time we submitted the grant proposal. It is imperative that we use this medium to dispel some of the myths about methadone since the "regular" media seems to be reluctant to show anything but negative press regarding our treatment. Our newsletter can be read from our web site by those who otherwise might not see it.
We have begun extra activities--we have a great library of articles on methadone treatment, medical maintenance, dosing recommendations, etc. and any one of you has access to them just by coming to one of our meetings. The time it took to put this together was donated, but copying costs were not figured into the DPF budget. Organizational costs, such as filing for not for profit status (NFP), were not included in the DPF budget either. NFP status will allow Methadone Today and DONT to solicit not only additional funding but to expand our services to having food and clothing drives for needy patients and their children. All of these activities will benefit you whether you are a patient or staff, and we depend upon you to support our work.
All of the things we are doing are for your benefit, so when you donate the $10 for your subscription, you are getting much more than just a newsletter. You are receiving the benefit of the work of both DONT and NAMA who have your interests in mind--not the clinics' interest, but yours--although clinics do benefit when the patients are treated fairly and with dignity instead of like cattle, naughty children, and/or probationers or parolees.
Methadone Today contains timely information for patients, their families, and professionals. They receive the latest information from a variety of sources, and in addition to Methadone Today, should an article pique your interest, you can request information from our library.
Did you see the December issue of Methadone Today? Several hundred copies delivered to a clinic somehow vanished. However, if you had a subscription, your issue would have been mailed to you. Here is what you missed in that issue, which was packed with important information, including the introduction of William Read, an attorney who has offered to donate his time and services to assist patients with legal problems, or if you just have a legal question, then Bill is the one to ask. And the articles are the quality that Methadone Today has worked hard to maintain: Ken discussed "Patient Advocacy: Why It Works", Nancy talked about "My Recovery and Experience with Methadone Detox" and finally, Lesia, in our "Speak Out" column, described her fight to attend a state school when she was denied access because of methadone.
Methadone Today will not refuse any patient who cannot afford a subscription, and this is another reason why we need your support by subscribing to the newsletter. Won't you consider donating something extra to help us to continue sending Methadone Today to patients who cannot afford it.
Please check the box below that applies to your situation:
I would like a subscription to Methadone Today at $10 per year.
I enjoy Methadone Today, but I am unable to afford a subscription. Please send it free until I am able to afford it.
Won't you please make a donation to help us send Methadone Today to everyone who requests a subscription but cannot afford it. Donations of more than $10 are certainly welcome; however, even a small donation, i.e. half of a subscription ($5), can help us fulfill our mission to ensure that everyone who wants a copy of Methadone Today gets one.
Please make your check payable to: DONT/Methadone Today, P.O. Box 164, Davison, MI 48423-0164.
Methadone Today wishes to thank those of you who have contributed.
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Did you know why the word "detox" is not proper terminology when referring
to withdrawal from methadone?
Detox comes from a theory about addiction developed at the beginning of the century when medical research had just learned about bacteria, antibodies, toxins and antitoxins. This new knowledge swept medicine, and many diseases were beginning to be understood.
The theory was that morphine caused the body to create antitoxins, which caused the dependence. When the morphine was withdrawn, you were detoxinized, hence the word "detox." An attempt was made to apply this theory to addiction.
Of course, today, we know that morphine does not cause antitoxins. Rather, it mimics the natural opioids in the body which are shut down through a feedback loop--the body it tricked into thinking it is producing too many endorphins, so it stops making them.
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Sound familiar today? It should--just substitute a few words.
17th Century - The prince of the petty state of Waldeck pays ten thalers
to anyone who denounces a coffee drinker (Griffith Edwards, "Psychoactive Substances"
The Listener, March 23, 1972, p. 361).
2000 B.C. - Earliest record of prohibitionist teaching by an Egyptian priest, who writes to his pupil: "I, thy superior, forbid thee [emphasis mine] to go to the taverns. Thou art degraded like beasts" (W.F. Crafts et al, Intoxicating Drinks and Drugs, p. 5).
If you feel you are not being properly dosed, you should have no trouble getting a dose increase. However, if you are at a high dose and having a difficult time getting the doctor to prescribe a dose with which you are comfortable, there is a test that will determine your methadone blood level. You may have to pay for the test yourself, but it is available. You must ask the doctor to order it for you if you think you need it.
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Naltrexone--Fast, Miracle Cure for Addiction?
by Beth Francisco
. . . Or is this the biggest ripoff since the last miracle cure? I am having a
hard time believing that anyone would fall for this one. The doctors pushing it could
have quite a racket going if they get many gullible, desperate addicts falling for
it. The line is that they will cure you simply and painlessly while you are anesthetized.
Okay--so they say, but this is what really happens:
The procedure is called Rapid Anesthesia Assisted Detox (RAAD); at least, this is one of its names. The drug naltrexone is given in megadoses and will attach to the receptor sites in the brain that the opiates previously occupied. This occurs while the patient is in the hospital and anesthetized since a conscious patient could not tolerate it, and this is what they mean when they say they will "flush" the drugs out of your system. And, since naltrexone attaches to these receptor sites and won't allow opiates to occupy them, if you do use, you won't feel anything. Now, that may prevent you from using for as long as the naltrexone is attached to these sites, but it does not give quick and painless relief from addiction.
When the patient wakes up, s/he feels extreme fatigue, irritability, and has diarrhea. That does not sound painless; in fact, it sounds like withdrawal. At this point, most addicts would head for the nearest drug dealer, but since naltrexone is in the system, you can't use--well, you could, but you would get no relief because the naltrexone is filling up those receptor sites that the opiates would normally attach to if you did use.
So, now, it's like the patient still has that broken leg, but, darn, s/he can't use any crutches; s/he's out a bundle of money in the space of 24 hours and has been discharged from the hospital with a nice prescription for the naltrexone to keep occupying those receptor sites. I don't think so! Certainly not my definition of a quick, painless way to kick and be cured.
Most people will return to opiate use as soon as they are able because it does not cure the underlying causes. The analogy I might use here is that if you want to make your lawn look pretty from a distance, you can mow it and chop off the tops of the dandelions you have growing there. They look pretty disgusting when they are going to seed, but you can make it look all nice and pretty and like good grass is growing there if you cut the ugly tops off the weeds. However, that is all you have done--underneath it all, the roots are still there, and they will return unless you kill them.
Treatment with naltrexone is nothing new. I took Trexan (a brand name, of which the generic is naltrexone) ten years ago. However, this was taken only when all opiates were out of my system for several days. If it is taken while opiates are in your system, it will throw you into immediate, harsh withdrawal. That's not exactly my idea of a painless cure even if I am knocked out (anesthetized). Also, the people I know of who have taken this cure have spent between $6,000-$9,000, and two weeks later, they are still weak, depressed and listless--not a good prognosis to stay on naltrexone and off opiates--and friends are laying odds they will be back using. The bet isn't if they will use--the bet is "when" they will use. In the A.T. Forum, "Dr. Steve Juergens, medical director of the Virginia Mason Outpatient Chemical Dependency Program, is concerned about the technique's singular focus on the physical manifestations of addiction. I can't believe people will go through this, walk away without [further] treatment and be fine. . . .And success rates for such treatments are abysmal'." Also, one girl who underwent this treatment was informed (after she completed the procedure) that two patients had died while under the anesthesia.
When people are desperate, they will try anything. But, when people are desperate, that's when others can really take them to the cleaners and feed them a bunch of cock n bull because they are so willing to believe. So, before you agree to any of these miracle cures, research the subject, and find out how your body works.
When a person has taken opiates to the point of addiction, the body ceases manufacture of its natural painkiller. That is why we feel so horrible while going through withdrawal, and we usually can't make it until our bodies begin the remanufacture of this painkiller. At the point that we take our last dose until our bodies begin to manufacture our own endorphins, we will feel it, believe me.
Naltrexone is approved by the Food and Drug Administration (FDA) for treating opiate addiction, "However, its use has been limited because of the reluctance among heroin addicts to take the medication, [and naltrexone] should only be used after a patient has abstained from heroin use for at least 1 week." Now, if you still want to go ahead with RAAD, you have some idea of what is going to happen to you.
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If the Shoe Fits
by Ken T.
After writing such a glowing article about "our" clinic last month,
it looks like I spoke too soon about having no horror stories, as now certain things
have come to light. We like to think of our clinic as a safe haven, a place of security
where we go seeking help for our addiction. We experience many things at our clinic--conversations,
a quick, "hello, how are ya" to a friend, and also, to our clinic's disgrace,
occasionally a rude and obnoxious staff member who likes to make things as difficult
as they possibly can for the patient! Why? As addicts, we are treated badly enough
already because of the misunderstandings about methadone, our chosen form of treatment.
We surely do not need an employee of a methadone clinic being rude, obnoxious or
uncaring--not even one time!!
I usually will not say anything negative about any staff member because they are for the most part well-educated, well-trained professionals, but enough is enough! I've sat back and observed so many methadone patients be disrespected and treated so rudely that I wasn't sure that I could have dealt with the same situation as graciously. Many of these victimized people have become quite competent at ignoring these uncomfortable situations. As an advocate, I cannot ignore any staff member being rude to a methadone patient. I will not disclose names or field of expertise because you know who you are! You are supposed to be a "professional", helping people, but before you can help anyone else, you must help yourself. It is too bad when one of the clinic staff has a worse behavioral problem than the methadone patients supposedly have. It is also too bad that some patients recover in spite of clinic staff, not because of their help.
Personally, I have watched certain staff members turn their backs, totally ignore a patient, then look so disgusted because that patient needed a question answered. Even a simple "hello" was looked upon as coming from the mouth of the lowest form of humanity. I have watched certain staff make things as difficult as possible for certain patients, and look as though that just made their day to have the power to make the patient go out of his or her way--for no good reason.
And, the rules change from one patient to the next. These are not isolated incidents either! These staff members act as if they are really "doing us a favor" by gracing us with their presence. We pay good money that so many of us can ill afford and, oh yes, some of our money actually helps to pay your salary. You tell us we are accountable for our actions; so, you really should remember that you are also accountable for yours.
Why turn your back on someone when they were just being friendly? Professionals leave their personal problems at home--immature people do what they can to make things difficult for others. Methadone patients have been accused of that kind of behavior--professionals should have learned to leave it at home. You don't have to love us, but we deserve to be treated with the common courtesy and decency due any patient, due any human being.
So many of us have been to death's door, and a friendly smile or a cheery hello can be the difference between a bad day and a good day. After all that we have been through, and whether you believe it has been self-inflicted or not, we do not need, nor do we deserve anything other than treatment with dignity. When you are rude and deliberately make things difficult for a patient, what you do not realize is that you make yourself look bad. You may make the patient go out of their way, and you may get a big kick out of that, but you merely show your unprofessionalism and immaturity.
Patients should not have to accept excuses for a staff member's rude ways. And, they should not have to accept excuses from those staff member's peers or supervisors either. No one deserves to be treated badly in a methadone clinic--no one. If one of us has done something to offend you, please let someone know. Don't take it out on everyone.
We come to you for help, so please help us--do not hinder us. Do not criticize us--share your knowledge. We count on you to be a positive part of our lives--so, share a smile. We need you to guide us, we don't need you to be a factor in causing a relapse. Take time to extend a helping hand, for it can be the beginning of a positive patient-staff relationship and maybe even a friendship.
Peace, and Happy New Year!
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Managed Care is Here--to Stay
by Beth Francisco
I wrote about managed health care in the December 1995 issue of Methadone
Today--it has arrived! It has been sneaking up on us, and some of you may
have been switched to an HMO not realizing it or at least not realizing the implications.
In the past year, more and more physicians moved to HMOs, so it looks like we are
not going to be able to dodge it much longer. After the first of the year, it doesn't
look like there will be a choice, and everyone will be going to HMOs. If you want
to have your methadone maintenance treatment covered, you will have to do some work.
You may have to do some leg work, and you will probably have to make some phone calls; for sure you will have to make some decisions and take action. Part of recovery is taking responsibility and becoming informed. If you don't do the work, don't blame your clinic if you end up having to pay out of your own pocket. If you are not already enrolled in an HMO, find out what kind of policy the available HMOs have regarding methadone maintenance treatment before you sign up. Will they pay for treatment? Will they allow you to stay at the clinic at which you are enrolled? Or, will you have to switch clinics? Do you have to make an appointment with a doctor in order to receive authorization for methadone treatment? Or, do you merely have to make a phone call?
When you receive notification from Medicaid, read it! Do not skim over it and throw it aside and assume that your methadone treatment will be paid for. Do not automatically assume your clinic will tell you what needs to be done, but if they do offer suggestions, use the suggestions. You can also find out from your clinic with which HMOs they have contracted. If you want to remain at your present clinic, this may be valuable information--check it out.
When you call your HMO or see an HMO representative, you will have to tell them that you are a methadone patient. If you do not inform them of that fact and just tell them that you are receiving substance abuse services, they may authorize payment to an abstinence-oriented treatment center. Then you will not receive methadone maintenance. So, be very specific, do your homework preferably before you sign with a particular HMO, and do not assume anything--find out for sure.
If this is taken care of early, clinics should be paid on time, and that may save you, the patient, from having to pay out of your own pocket or losing your take homes due to unpaid balances. Ask your clinic what their policy will be.
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It's Only in Your Head
by Peter T. Seal
How many times have you heard that before?!
Little did we know! It seems the world is full of Freudian Slips - we often know more than we know we know! Thoroughly confused?
What I'm talking about is that it really is "ALL IN YOUR HEAD"!
Think about it - how for years we've all been told "It's only in your head", and "You've just got to get your head together." All that time, all those people (your parents, friends, treatment professionals, etc.) were talking about the correct general area, but thinking in terms of psychological issues, instead of chemical issues. The brain chemistry IS where the problem lies. Their overall understanding was far off base! Your addiction/disease has nothing to do with beliefs, morals or attitudes. It is the BRAIN CHEMISTRY -the metabolic processes that are deranged, and NOT the psychological condition in our heads. It is this lack of understanding that prevents nearly all of us from achieving success in recovery.
Think about it - have you read any research articles on neurotransmitters? The reason that drugs make us feel better or normal is because of their chemical action in the brain. Does it not make sense that the daily use of a substance whose chemical action is in the brain would eventually change the way the brain works? For example, lets say that for 2 years a person injected insulin every day. Eventually the body would say, "I've got all this extra insulin floating around I guess I'm making too much. Better cut back on the insulin manufacturing." That is what happens to your brain when you put drugs into it daily. From some drugs we can recover and eventually the brain will return to normal. Unfortunately, for heroin use this does not seem to be the case - the damage is permanent for some people. For others who have been dependent on heroin the damage is a matter of degree. They may feel fine under normal circumstances, but should a crisis occur - whether physical as in a medical condition, or psychological as in the death of a close friend or family member, change/loss of job, divorce, or any life crisis - they are unable to respond within the normal range. This eventually leads to relapse. So, does not heroin, cocaine, alcohol or any other drug usage change a person's BRAIN CHEMISTRY??
Isn't that what Drs. Vincent Dole, Marie Nyswander, and Mary Jeanne Kreek said before and after discovering methadone maintenance treatment thirty years ago, back in 1963?! When are we going to get it?? What the hell is "rebound effect", "protracted withdrawal" and relapse in general? The first two are nothing but the fact that your brain chemistry is still expecting extra drugs. The last one is your brain may never be normal and you just can't take it anymore, so you relapse. And, in fact, your brain may never have been normal to start with, but that is for genetics and science to answer. However, it is looking more and more like some individuals are predisposed to drug use in general and heroin addiction in particular.
But even all the experts who know these things, along with the self-righteous "recovering" people, can not believe in 30 years of scientific research, documentation, evidence and facts. Hell, addicts themselves/ourselves do not want to admit it really is only in our heads'! We are told and sold all these psychological, emotional and spiritual things to do to achieve recovery, but they have such minimal success that more of us are dead, incarcerated or still strung out. Yet, the one thing that is missing from the picture - the BRAIN CHEMISTRY of an addict - is rarely addressed, with the rare exception of "quality" methadone treatment.
Most addiction professionals' are behaviorists and know zero about the brain or pharmacology. They do not believe in giving a "drug" to an addict. Because of this, they usually sabotage methadone treatment by doing it incorrectly. The medical profession and medical treatment are the only hope that addicts have!
It's so simple - if it IS "only in your head" - then you must address the problem in the only way that will address the CHEMICALS in your head. I know this so very well. When I detoxed from methadone, it was the "right" thing to do after all. So for 13 years I lived in a state of protracted withdrawal! I never felt normal the entire 13 years -- not one day. You can't even go to sleep and forget about it -- first it's hard to get to sleep and even harder to stay that way. And it affected my feelings too because I had to put up a wall of protection. I dared not feel or it I might be overcome by my own emotions. I have learned the hard way, that denial is a powerful thing! Until, finally I got damn tired of it and I addressed the chemicals in my head. I will never again be "drug free" at such a cost. THANK YOU Drs. Dole, Nyswander, Kreek, Joseph and other younger researchers such as Payte, Zweben and others. You have given me the power of knowing that my addiction is truly a disease. With this knowledge I have regained the humanity that I lost as an addict. Without it I would have never had the confidence to learn that "the power of one addict helping another cannot be equaled"- NOT! It can be surpassed by going to the cause of the problem! I can firmly say as a drug therapist that going to therapy and spirituality never did a thing for me, except to side track me and waste 13 years of MY LIFE!. I denied myself my own humanity, as we all do to "stay clean at all costs."
So please learn about your disease --join an advocacy group learn about methadone, find out if you have ever had proper treatment or correct doses. And then demand quality methadone maintenance treatment with dignity, not psycho-babble! When given in the correct therapeutic dose, methadone can normalize your brain chemistry, so that you can normalize your life! NAMA is right. - Methadone really does save lives! (Reprinted from NAMA Ombudsman - Fall/Winter) 1994)
Peter T. Seal is President of the Southern Colorado Alliance of the National Alliance of Methadone Advocates (SCA-NAMA) in Colorado Springs, CO. He has worked in the field of methadone as a counselor and trainer for over 15 years.
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Malta's Don Seaman
We are sorry to have to bring you the news of another advocate's death. Don Seaman,
of California's M.A.L.T.A., died Monday, December 9 of pneumonia. He had been sick
with what he thought was a cold, but he put off going to see a doctor. His wife,
Diane Fleury-Seaman, finally insisted that he go. They put him in the hospital but
he never made it home.
His death was a real shock. It is my understanding that the hospital called Diane, and she had no idea that it was to inform her that he had died. He just didn't seem to be that ill.
This is probably a good lesson to all of us because many of us suffer from the effects of our previous drug and alcohol use. Some of us have weakened hearts, and many of us have Hepatitis C, some not even realizing that they do. There is supposed to be a flu going around this winter that could be quite deadly to older people, those who have abused their bodies, and those who aren't in the best of shape. It might be wise to get a flu shot and/or a checkup. We all think it can't happen to us, but here it is among one of our own again.
I never met Don, although I did correspond with him a few times regarding advocacy and the newsletters. He was always ready to help us out with things they had already been through--to help smooth our way, and he was always ready with a word of encouragement. We will miss him.
If anyone would like to make a donation to Diane or M.A.L.T.A., or send a card with their condolences, the address is: Diane Fleury-Seaman, M.A.L.T.A., P.O. Box 1716, Marysville, CA 95901.
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1901 - The Senate adopts a resolution, introduced by Henry Cabot Lodge,
to forbid the sale by American traders of opium and alcohol "to aboriginal tribes
and uncivilized races." These provisions are later extended to include "uncivilized
elements in America itself and in its territories, such as Indians, Alaskans, the
inhabitants of Hawaii, railroad workers, and immigrants at ports of entry" (Andrew
Sinclair, Era of Excess, p. 33).
Sound Familiar? It should--discrimination is the basis of our drug laws.
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