Volumn 2, Number 1
February 15, 2000
Organizational News
by
Joycelyn Woods
The big news as this year and the Millennium closes is that methadone
is slowly moving to being an accepted medical treatment. This is only the
beginning THE FIRST STEP – and there is still an
immense amount of work to be done. So we can not become complacent
thinking that just because everything has started moving towards something
better that it will. We must nurture and direct methadone treatment if we
want it to return to a patient caring program. This will be a long
struggle and NAMAs Mission is to insure that methadone patients have a voice.
Our main article on Vermont and New Hampshire Herald the beginning of the
end for the hold outs. The Walls are beginning to crumble. But this only
occurred because of the untiring work of Alice Diorio and New England NAMA
and her determination to make it happen. Last summer, Alice teamed up with
Mark Beresky (formerly, Southern Colorado NAMA), who moved to Vermont.
Together they make a formidable force in their advocacy work. More about him later on
Alice has been a vocal advocate of methadone for New Hampshire and Vermont
for nearly 10 years. And while it may be frustrating at times for real
advocates it is the right thing to do and because of that you know in
your heart that it will happen no matter how long it may take.
Despite the hold outsand there will always be those who will simply not listen
to reason and are influenced only by popular causes that make them look
goodmethadone will come to all of New England because of advocates like Alice Diorio.
So that said NAMA congratulates Alice Diorio for the recent Vermont
Department of Health Award that she received in December 99 in
recognition of her work in methadone advocacy and harm reduction.
Interim Board – Mission Statement
The Interim Board of Directors of NAMA was formed in June, 1999. The declining
health and diminishing participation of NAMAs officers and directors resulted in
Ms. Woods being the sole contributing officer while the organizations labor and
funding requirements were increasing proportionate with its national and international
affiliation expansion.
The Interim Boards immediate tasks are to assure adequate funding sources
are available to meet the organizational ongoing objectives and to assure
its longevity and to re-build the administrative infra-structure of the
Board of Directors/Regional Directors.
It is anticipated that the Interim Board will continue for six months to one
year, until the restructuring is complete and a board of directors can be
installed. To date, the Interim Board consists of: Joycelyn Woods, Howard Lotsof,
Herman Joseph, Lisa Mojer-Torres, Tony Scro and James DePasquale.
New Directors
NAMA is pleased to announce the appointment of James DePasquale of Long Island
NAMA as the Membership Director. In this position he will be responsible
for maintaining the membership list including: addition of new members,
communication with members and maintain the record of annual dues for each
member. NAMA will direct a membership drive in New York state where about
one quarter of the patients in treatment reside.
This drive will expand to all regions of the country and the goal
is in 5 years to have a NAMA chapter or representative at every clinic in
the US.
Mark Beresky of New England NAMA will be the new Webmaster for the website
www.Methadone.org. Our sister website, (www.methadone.net)
will be opening before too long. We will keep you informed on Marks progress.
He will also be managing editor of NAMA Talk the news communication
for chapters and affiliates, NAMAZyne the public version of NAMA Talk and
the sending out of NAMA Action Alerts.
NAMA Talk and NAMAZyne will no longer be weekly publications. NAMA Talk will be
published on the 1st and 15th of the month.
NAMAZyne will be compilation of the best of that months NAMA Talk and published
monthly. All chapters are automatically subscribed to NAMA Talk. Soon, individuals
will be able to subscribe to NAMAZyne at the website or by sending an email message to:
Mark Beresky, Webmaster [email protected]
Regional Divisions
NAMA has grown enormously in the past few years with chapters in nearly every
state with a significant number of patients. In order to insure that information
flows to the chapters and to assist new groups in forming the United States was
divided into regions, each with a directorship and one directorship for the
international groups. James DePasquale as Membership Director will also act as
Chapter Coordinator.
Here are the Regional Directors:
New England: Alice Diorio New England NAMA
Connecticut, Massachusetts, Rhode Island, New Hampshire, Vermont and Maine
Tri-State: Tony Scro Advocates for the Betterment of Addiction Treatment Education
New York, New Jersey, Pennsylvania
Atlantic Coast: Eric Peterson, Methadone Information Exchange
Maryland, Delaware, District Of Columbia, Virginia, West Virginia, North Carolina
and South Carolina
South: Carlos Franco Methadone Enabler Florida/Miami NAMA
Florida, Alabama, Arkansas, Louisiana and Mississippi
Heartland: Carmen Pearman MAG Indiana
Judith Ostergard AMMO (NE)
Ohio, Indiana, Illinois, Nebraska, Iowa, Missouri, Kansas,
Kentucky and Tennessee
North Midwest: Greg Keller Wisconsin NAMA
Wisconsin, Michigan, Minnesota, North and South Dakota, Wyoming,
Montana and Idaho
Southwest: John Finger TEXNAMA
Colorado, Nevada, Utah, New Mexico, Arizona, Oklahoma and Texas
Pacific Coast: Diane Seaman MALTA(CA)
California, Oregon, Washington, Hawaii and Alaska
International: Joergen Kjaer BrugerForeningen (Denmark)
All international affiliates.
The Regional directors are included on the chapters listing that you can get
from the autoresponder. Send an email to: [email protected]
In a few minutes you will receive by email the listing.
Projects
This past year has been an important and exciting one for methadone maintenance
treatment and in particular methadone advocacy. The untiring work of NAMA has
resulted in patient representation on CSAT’s Accreditation and Office Based Opioid
Prescribing (OBOT) Committees. NAMA will represent patients on the New Accreditation
(New Rule) and Buprenorphine Committees that are being formed in 2000.
In addition to these accomplishments NAMA has several current projects going,
including:
Membership Drive
James DePasquale is planning a membership drive that will start in New York
state since about one-quarter of the patients are here. However,
this does not mean that those of you outside of New York will be omitted
— not at all and in fact James is making plans to work with each of you
in your area to develop strategies to increase NAMA membership.
This will be important because an increased membership means the empowerment of
NAMA. This will be the only way that NAMA will be able to achieve the goal of
having a group or representative in every clinic by 2005. So begin to think of
ways to bring in new members to NAMA and if you have any event planned contact
James so you can develop a strategy.
James DePasquale Membership Director: [email protected]
HCV Committee
This committee was formed to educate and protect the rights of patients
infected with Hepatitis C. The committee is in the planning stages but
will most certainly be assisting patients confronted with discrimination
and bias. A section on the website will contain information about hepatitis.
Chair: Michael Garrett, Long Island NAMA [email protected]
State Regulation Project
State Regulation Project will create a section on the NAMA website where
all the state regulations can be accessed or downloaded. We have about
five more states to complete the collection phase and then the scanning
and html format phases can begin.
Project Director: Terry Cox [email protected]
Project Assistant: Dianne Cox.
AMTA Conference
A number of events are being planned for the National Methadone Conference
including a special preconference meeting.
Chair: John Finger TexNAMA [email protected]
Asst. to the Chair: Michael Garrett [email protected]
Committee Members
Alice Diorio, Co-chair
James DePasquale
Becky Duarte
Barbara Finger
Carlos Franco
Greg Keller
Howard Lotsof
Judith Ostergard
Carmen Pearman
Diane Seaman
Joycelyn Woods
Preconference Meeting
How Can We Develop and Strengthen Patient Advocacy Groups?
Moderator: John Finger, TexNAMA
Presenters: Joycelyn Woods, NAMA; Diane Fleury-Seaman, MALTA; Fred Christie, AFIRM;
James DePasquale, Membership Director/Chapter Coordinator of NAMA
This special preconference meeting has been developed by the National Alliance
of Methadone Advocates (NAMA) in collaboration with other advocacy groups to present
concepts that programs can use to promote positive patient outcomes and consumer
satisfaction that will be a major focus for the new accreditation system. Ways for
providers to develop consumer satisfaction including patient recognition ceremonies,
12 step groups, patient advisory boards, patient advocacy groups and patient organizing
drives are some of the strategies that can be utilized by providers and patients to work
together and the enormous benefits that will come from this. The intended audience for
this presentation includes program directors, medical personnel, doctors, nurses, counselors,
social workers, administrative staff, patients, advocates and anyone else included in the
methadone field. This meeting will greatly enhance the ability of providers and patients
to become one community with the common goal of creating the best methadone system possible.
Supported by the Center for Substance Abuse Treatment
Conference Workshops
Planting Seeds and Watching Patients Grow
Presenters:
Alice Diorio New England NAMA
Diane Fleury-Seaman, S.D.C. MALTA
John McCarthy, M.D. Bi-Valley Medical Clinic (NAMA Advisory Board)
This interactive workshop uses harm reduction principles and sensitivity
training to improve outcomes. Presenters will give a patient’s perspective
on how to create individualized treatment based on communication and respect.
They will discuss ways to enhance a trusting, therapeutic relationship that
conveys compassion and understanding.
Visit the NAMA Events Website:
https://www.methadone.org/events.html
Or the AMTA Committee Website
https://www.methadone.org/amta.html
Grievance/Incidence Reporting System
A Grievance/Incidence Reporting System has been developed to collect data on
the quality care and patient treatment in clinics. With the new
accreditation changes NAMA is developing the relationships necessary to
begin to make significant changes in the system.
You can obtain a Grievance/Incident Report from our autoresponder by sending
an email message to:
In a minute you will receive as an email message your request.
Or visit our website at:
https://www.methadone.org/complain.html
You can complete the form at the website or download one in a pdf file.
We must acknowledge our chapters and affiliates whose efforts are supported
through NAMA and are/have been making significant changes and accomplishments.
Delaware NAMA
Joe Neuberger reports that his relentless search for the facts has paid off in
helping a patient. The patient had been in methadone treatment previously
and had not done well for a variety of reasons. However, upon entering treatment
this time the patient began to progress and it was the first time that she had
for any significant period not used drugs.
The patient got into a situation which was a lose — lose one for the patient
— her word against staff at a facility that was associated with the
program. While there were several witnesses they were also patients and
therefore not believable — according to the program. It was
agreed by witnesses that the patient was abused by staff and that in
retribution the staff contacted the program with the report that the
patient was violent. Within a short time the patient was detoxed and
put out on the street and homeless from the program she was in.
After Neuberger contacted nearly every upper-level staff at the program the
clinic has agreed to immediately re-instate the patient who was detoxed.
We were all concerned that she would be difficult to find since she was
put out of the shelter however Neuberger was successful in finding her
and bringing her back to the program.
Neuberger states, “So we seem to have won this one for the patient.”
But even more important the discussions with upper level management has also
enabled Delaware NAMA to open a dialogue concerning the increased use of
naltrexone and the lack of patient representation on policy-making committees.
Misc. Chapter Information
Wisconsin NAMA has developed a state grievance procedure that can be applied to
other states. When Greg Keller has completed this case — and it should be
noted that it has been nearly a year now that this case has been pending
— he will develop for other chapters a manual with guidelines on the grievance procedure.
Miami/Florida NAMA will be the host group for the 3rd National Methadone Consumers
Meeting held during the National Harm Reduction Conference in Miami (October 21-25, 2000).
A PICTURE OF NAMA
NAMA can be compared to the trunk of a tree with all the chapters
and affiliates as the limbs — each working towards their goals of
protecting the rights of methadone patients and empowering them.
For the limbs and branches to function the trunk must remain strong.
Support NAMA by joining.
You can obtain a Membership Form from our autoresponder by sending
an email message to:
In a minute you will receive as an email message your request.
Or you can visit our website at: https://www.Methadone.org
Choose Join Us or the Membership section. There is a Membership
Form at the website.
New Chapters
Now we have 2 new chapters. One in Haverhill, Massachusetts headed by Maureen Neville
and the Norfolk Chapter of NAMA in Virginia with Jay Clarke, Mike Hamilton &
Steve Carhart.
Norfolk NAMA has merged with Tidewater Advocacy Group that was started by Steve
Carhart therefore the group has some experience of the politics in the
area.
Patients Advisory Board
29 Fourth Avenue
Haverhill, MA 01830
Contact Person: M.E. Neville
Phone: (978) 374-0831
Email: [email protected]
Norfolk NAMA
2535 Bruce ST.
Norfolk, VA 23513
(757) 853-2013
Contact Persons: Jay Clarke, Mike Hamilton & Steve Carhart
Email: Jay Clark Norfolk NAMA [email protected]
Steve Carhart Norfolk NAMA [email protected]
Finally we have an established chapter that has joined us on the net. K-Zoo NAMA in Kalamazoo.
Elizabeth Meeth is using a family email right now and so I will not post it. She expects to
have her own email address within a week so it should be in the next NAMA Talk.
Welcome to the NAMA network Maureen, Jay, Mike and Elizabeth (and of course Steve
who has been with us some time).
An up to date listing of all NAMA’s chapters and affiliates can be
obtained from our autoresponder. Send an email message to: (not available)
In about a minute you will receive the listing by email.
Conclusion
As the first NAMA Talk of the year 2000 I want all of you to know how proud I
am of you, especially when I am someplace and someone mentions the help they, or
more commonly a patient they referred to us was helped by NAMA or any of the other
things that you do. Yes you are recognized by a lot of people out there — and more
important, I think, you are depended on by patients who without you feel very alone.
So we must make sure that NAMA continues and expands.
Short Articles
1. Program Quality Effects on Patient Outcomes during
Methadone Maintenance: A Study of 17 Clinics
2. Changes in Methadone Treatment Practices:
Results from a Panel Study, 1988 1995
3. Momentum builds for methadone treatment in Vermont.
Program Quality Effects on Patient Outcomes during Methadone Maintenance: A Study of 17 Clinics.
by
Andrew Byrne
General Practitioner, Drug and Alcohol
New South Wales Australia
This report from America has looked at a number of clinic characteristics
retrospectively to determine if they have associations with drug-use outcomes
in their patients on methadone maintenance treatment (MMT). While mirroring
the classic Ball and Ross study showing the effectiveness of MMT and the
influence of clinic factors on patient outcomes, this study used a much large
base with over 1000 patients treated in 17 different clinics.
Like the previous study, these researchers found that more frequent counselling
contacts, greater director involvement with treatment and more director experience
were associated with lower drug use by patients during treatment.
There was no correlation found between clinic hours and outcomes but the
variation in clinic hours was not as great as in Australia with mean
opening times of 36 8.6 hours per week. Most clinics in Australia are
open for shorter hours, but community pharmacies where most of the recent
expansion has occurred, are commonly open for more than 70 hours per week.
The mean dose in this series was 52mg 19mg. The two clinics with highest
average doses (60 and 66mg/day) also had the highest percentage of
patients employed (51% and 39%) and lower than average proportions of minority
(and mostly underprivileged) patients at 64% and 34% (mean was 73%). It
may be that the (mostly white) middle class patients in these clinics were
more successful in communicating their requirements to the staff in the clinics.
It is now known that the majority of opioid dependent patients require
between 60mg and 120mg daily with only a minority of cases needing more or
less than his (UK guidelines, 1999; US TIP protocols, DOH).
Clinics with mean doses under 60mg daily often have reported poor outcomes in the
past. Some reports have shown mean doses in certain groups as high as 116mg daily (Bleich, Addiction,
Oct 1999). The first ever report of this treatment by Dole in 1965 had a number of patients
taking 180mg daily.
From an international point of view the study would seem to have limited
relevance since America is unique in banning private doctors from treating
their patients under normal medical practice, preferring the strictly regulated
clinic system. This has led to a distancing of the practice of medicine from
the medical literature, most of which has paradoxically come from research
performed in that country. Given that American clinic doctors sometimes
prescribe inadequate doses [D’Aunno T, Vaughan TE. Variations
in methadone treatment prctices; results from a national study. JAMA.
1992;267:253-8] it is possible that small increments in doses or
dispensing practices might improve outcomes to such a degree as to negate the
findings presented in this paper. It is also possible that some American patients
are reluctant to take sufficient doses of methadone in the event that they are jailed since
methadone is usually terminated in American jails, (which is probably contrary to international treaties).
None of these criticisms lessen these researchers’ noble attempts to dissect
the minuti of clinical outcomes in an accepted form of treatment for heroin addiction.
References
1. Magura S, Nwakeze PC, Kang S, Demsky S. Program Quality Effects on Patient Outcomes during Methadone Maintenance: A Study of 17 Clinics. Substance Use & Misuse
(1999) 34(9):1299-1324.
Changes in Methadone Treatment Practices: Results from a Panel Study, 1988 – 1995
by
Dr Andrew Byrne
General Practitioner, Drug and Alcohol
New South Wales, Australia
This study systematically documents some modest improvements that have occurred in methadone treatment over an 8 year period in US clinics. The authors lament the slow progress in implementing best practice, even regarding the most fundamental factor of dose levels, following established therapeutic guidelines. They found that the average daily dose in 1995 was 59mg, having been 45mg in 1988. Yet one half of all clients were still receiving less than the recommended ‘minimum effective dose’ of 60mg daily.
“If we extrapolate from [other studies], the average dose increase of 14 mg/day that we found could mean that clients’ chances of relapse to heroin use have been reduced, on average, by 28%.” [could this mean that a 50mg increase would yield a 100% reduction?]
It was shown in the 1970s that patient input into dose levels was an important factor in improved outcomes (Havassy et al 1979). The proportion of clinics which reported allowing clients influence over dose levels increased from 35% in 1988 to 48% in 1995. Clinics are also waiting for longer periods before advising clients to detoxify (eg. 55% did so in 1995 for those in treatment one year or longer).
Despite these improvements, the authors state: “..many methadone treatment units continue to use treatment practices that do not meet desired standards. The 116 units participating in the 1995 survey report treating 46,108 clients. Based on the percentages reported ….. approximately 24,000 of these 46,108 clients received average doses of methadone that most researchers consider to be ineffective(ie. <60mg/day) and approximately 9000 were in treatment for less that 1 year. In addition almost 21,000 clients were encouraged to detoxify from methadone in less than 1 year, and approximately 4200 clients (9%) influenced their dosage levels only to ‘some’ or ‘little’ extent.”
Other findings were that clinics in the mid-west gave treatment which on average was of shorter duration with lower doses than elsewhere. Clinics with higher proportions of socially disadvantaged patients used lower dose levels. Also clinics which employed numbers of ex-addicts were more likely to prescribe lower doses, a situation which the authors state calls for more education.
Despite small improvements in most general trends, the authors state: ‘Nonetheless, the results do not indicate only “good news”.’ They go on to recommend more training for staff and continued research into anomalous treatment practices.
Few Australian methadone prescribing units still adhere to these poor practices. Despite increased regulation in some States concerning high doses, there should be no discouragement to the use of safe and effective doses in dependent patients. Those of us involved in prescribing are all ‘on notice’ following publication of this ground-breaking paper.
References
1. D’Aunno T, Folz-Murphy N, Lin X. Changes in Methadone
Treatment Practices: Results from a Panel Study, 1988 – 1995.
American Journal of Drug and Alcohol Abuse 1999 25;4:681-700.
Momentum builds for methadone treatment in Vermont.
Alcoholism & Drug Abuse Weekly January 17, 2000
No. 3, Vol. 12; Pg. 3 (634 words)
A report released last week by a Vermont legislative study committee could lend critical support to efforts in that state to provide methadone treatment to heroin addicts. Vermont is one of eight states that do not allow heroin addicts to receive methadone.
The 1999 Report of the Pharmacological Treatment of Opiate Addiction Study Committee recommends that Vermont’s General Assembly pass legislation directing the state health department to work with a newly established opiate addiction advisory committee to develop guidelines for a regional system of care combining behavioral therapies and pharmacological treatments.
These treatments would include methadone, levo-alpha-acetyl-methadol (LAAM) and any other federally approved treatment.
The report recommends that the opiate advisory committee be made up of seven members, including providers, a representative from the state provider association, a law enforcement official, and a representative from a harm reduction coalition, and that the treatment guidelines be issued by the end of this year.
There are hurdles to passing this legislation, however.
Vermont Gov. Howard Dean has said he strongly objects to any legislation that would allow methadone treatment in Vermont. Ironically, Dean last year supported and signed legislation allowing a needle exchange program in the state (see ADAW, March 1, 1999)
Dean is said to base his objection to methadone treatment on a fear that making it available would draw heroin addicts into the state. The legislative committee’s report counters this by indicating that with 42 states already offering methadone treatment, an immigration of addicts into Vermont would seem unlikely.
Legislation based on the report was introduced last week. To override a veto, each chamber of the legislature would have to support the bill by a majority of two-thirds plus one vote. The Vermont legislative session winds down in mid-to-late April.
“The prospects of passing the Senate are very good and the prospects in the House are probably favorable,” State
Sen. James Leddy, who chaired the committee that produced the report, told ADAW.
The study committee’s report will be the focal point for garnering support for the legislation. State legislators are expected to review the report’s conclusions carefully.
The report, which looked at federal and state data on heroin addiction and methadone treatment, found that about 2,000 Vermont residents use heroin or opiates, though this number does not account for use among the homeless.
According to the Vermont Office of Alcohol and Drug Abuse Programs, about 184 people who sought addiction treatment at state-funded programs cited heroin as their primary substance of abuse. The largest increase in heroin use is among teenagers and young adults under 25.
The report cites studies stating that the best approach to treating heroin addiction involves an integration of behavioral and pharmacological treatments. It cites national statistics that more than 115,000 Americans lead stable lives as a result of methadone treatment.
The committee also heard testimony that up to 80 percent of heroin addicts return to using the drug within a year if treatment is ended.
The committee’s report noted that the state’s comprehensive HIV prevention plan calls for immediate implementation of pharmacological treatment for people addicted to heroin, and that the Office of Alcohol and Drug Abuse Programs found that for each dollar spent on methadone treatment, an estimated $ 12 to $ 14 in health care and social costs are saved.
The report also pointed to the operation of a clinic in neighboring Greenfield, Mass., where there have been no reports of negative incidents in the several years since the program’s inception.
Copyright 2000 Manisses Communications Group, Inc.
© Copyright 2000 National Alliance of Methadone Advocates
www.methadone.org Last Update: September 23, 2003