NAMA Talk

Volumn 2, Number 2
March 15, 2000

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Organizational News
by Joycelyn Woods

This will be a short column since there is a lot of Reading in this issue of NAMA Talk and we are busy, busy, busy with the AMTA Conference.

Maureen Neville reports that the Patient Board had a meeting last week
and discused training for hearings. The clinic director is going to help
the group get some training. This is real positive and a good idea
for every one to sharpen their presentation skills because what
advocates say can really have a significant impact.

Deleware NAMA and Joe Neuberger are looking to change more
policy. Actually this is new policy at the clinic that says or infers that
methadone patients can not take valium because of interactions.
Joe is looking for any ideas or information about this.

Jay Clarke of Norfolk NAMA reports that they are developing a
website. By next issue I hope to be able to give you the address.

Bill Nelles called me from the UK this week and they are having
their methadone conference this month. It is a big success and
next year NAMA hopes to attend. By the way Nelles as usual
spoke of NAMA with praise and said that they are going to follow
in our foot steps in the way that NAMA has become involved with
policy issues.

Bill will also give us a report on the UK conference and a harm
reduction conference happening in the Jersey Isles.

And I am flattered as I have been invited to the European Methadone
Conference in Alezzo Italy (May 3-5, 2000) by our Italian affiliate
Gruppo SIMS. So I hope that some of our international groups will
be able to attend so that we can meet.

See — I told you it would be short!

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Feature
Article
NIDA SURVEY FINDS PRACTITIONERS WOULD TREAT
ADDICTED PATIENTS WITH OFFICE BASED METHADONE

A NIDA-supported survey of primary care physicians,
physician assistants, and nurse practitioners working in New
York City found that two-thirds of the clinicians are
willing to provide methadone maintenance treatment (MMT) in
their offices to opiate addicted patients. Seventy-one
clinicians at 11 sites in Manhattan and the Bronx took part
in the survey, which was conducted by researchers at the
Albert Einstein College of Medicine and Montefiore Medical
Center in Bronx, NY. The full report appears this month in
the “Journal of Urban Health: Bulletin of the New York
Academy of Medicine”.

“Office based methadone treatment would represent an
enormous step forward in treating heroin addiction,” said
NIDA Director Alan I. Leshner, Ph.D. “This study shows that
practitioners understand that their addicted patients are
suffering from a treatable disease, and they are willing to
provide that treatment.”

There are more than 600,000 diagnosed heroin addicts in the
U.S. but fewer than 20 percent receive treatment, notes
Ernest Drucker, Ph.D., of the Department of Epidemiology and
Social Medicine at Montefiore Medical Center, principal
author of the report. “In Europe, Australia, and Canada,
more than half of all methadone is prescribed in general
practitioner’s offices, Dr. Drucker said. “This has
dramatically expanded MMT availability and played a key
role in containing the AIDS epidemic among injection drug
users. In the U.S., however, this treatment is severely
restricted by Federal and State laws restricting MMT to
large specialized clinics.

In 1996, the Institute of Medicine of the National Academy
of Sciences recommended integrating methadone treatment into
general medical practice. In 1997, a National Institutes of
Health report recommended increased access to MMT, a
loosening of Federal and State regulation, and insurance
coverage for methadone treatment.

——————————————————-

“Methadone is a synthetic opiate, similar to heroin, that
blocks the effects of heroin and eliminates withdrawal
symptoms. It has been used effectively and safely in
addiction treatment for more than 30 years, and has been
shown to increase the retention of patients who enter
treatment, reduce rates of intravenous drug use and HIV
infection, and reduce criminal activity by allowing
patients to enhance their social productivity”.

——————————————————–

“The principal finding of our study is that these
practitioners, who are already caring for the populations
and communities most in need of more addiction treatment,
are supportive of extending methadone treatment to
mainstream medical practice,” Dr. Drucker said.
Dr. Drucker and his colleagues interviewed practitioners in
community-based primary care and HIV/AIDS clinics serving
inner city populations. Most had extensive experience in
caring for patients who are on methadone maintenance
treatment. Half of the practitioners expressed some concern
that the multiple needs of methadone patients would be
difficult to meet, but 66 percent said they would prescribe
MMT for their patients, given proper training and support.

“For these practitioners, methadone is not laden with
stereotypic fears about bringing drug addicts into their
practice,” Dr. Drucker said. “They see methadone as another
useful tool for managing the overall health of their
patients.”

Source:
NIDA PRESS RELEASE, Wednesday, March 1, 2000
Contacts: Beverly Jackson and Michelle Muth (301) 443-6245

The National Institute on Drug Abuse is a component of the
National Institutes of Health, U.S. Department of Health and
Human Services. NIDA supports more than 85 percent of the
world’s research on the health aspects of drug abuse and
addiction. The Institute carries out a large variety of
programs to ensure the rapid dissemination of research
information and its implementation in policy and practice.
Fact sheets on the health effects of drugs of abuse and
other topics can be ordered free of charge in English and
Spanish by calling NIDA Infofax at 1-888-NIH-NIDA (644-6432)
or 1-888-TTY-NIDA (889-6432) for the deaf. These fact sheets
and further information on NIDA research and other
activities can be found on the NIDA home page at
http://www.drugabuse.gov.

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Articles

 

A PRESCRIPTION FOR BEATING HEROIN

Ed Housewright, Staff Writer of The Dallas Morning News
The Dallas Morning News, February 27, 2000, Sunday
THIRD EDITION, SECTION: SUNDAY_READER; Pg. 1J
DRUGS (1937 words)

Methadone gains credibility as way to end addiction to street drug or pain-killers

Before dawn each day, they start lining up outside Dr. J. Thomas
Payte’s clinic on the edge of downtown Dallas. When the doors open
at 5:30 a.m., the doctor’s patients file in for their fix of a narcotic they say they can’t live without.

Most of these men and women, of all ages, classes and colors,
used to be addicted to heroin. Some abused prescription painkillers.
They’ve traded those drugs for a daily dose of methadone, a legal but
highly regulated substance that advocates say turns junkies into
productive citizens.

“For me, it’s the answer,” said Klyndia Smith, 45, as she waited for the clinic to open. “It enables me to maintain some semblance of a normal life.”

Methadone, which blocks the addict’s craving for heroin and kills pain without producing a high, isn’t new. It has been around for more than 35 years and has been criticized by some in the medical mainstream because it’s not a true cure. It, too, is addictive, and many patients stay on methadone for years. Some are hooked for life, as hooked as they would be on any street drug, without all the negative side effects.

But methadone, long dispensed from nondescript clinics that keep a
low profile, is gaining credibility. Prominent government officials and
scientific organizations have recently touted it as a safe, effective weapon the fight against heroin use, which is on the rise nationally.

Federal drug czar Barry McCaffrey surprised – and angered – some
drug opponents by calling for wider use of methadone. The National
Institutes of Health concur, saying methadone “significantly lowers illicit opiate drug use, reduces death and crime and enhances social
productivity.”

In Texas, the number of methadone clinics has increased from 55 to
70 in the past three years, according to the state Health Department,
which licenses clinics.

“The literature is very, very comprehensive that methadone is an
effective treatment,” said Dr. Jane Carlisle Maxwell, chief researcher
for the Texas Commission on Alcohol and Drug Abuse. “There are
an awful lot of people who are using methadone, doing well and
maintaining normal, crime-free lives.

“We want people to be abstinent, but one of the things we’re learning is that. . . for some long-term drug users, their brain chemistry has changed. They may never be able to be abstinent because their brain is telling them, ‘You’ve got to provide this chemical to me.”

The increase in methadone use coincides with a spike in heroin-
related deaths. In 1998, the most recent year for which figures are
available, a record 374 people in Texas died from heroin overdoses,
according to the commission on alcohol and drug abuse. In Plano
alone, 13 teens have been killed by heroin since 1994.

McCaffrey endorses

More addicts should be persuaded to shift to methadone, according
to the Office of National Drug Control Policy, which Mr. McCaffrey, a
former Army general, heads. Currently, at least 810,000 people
nationwide chronically use heroin, and 170,000 receive methadone,
the office says.

“Only a fraction of those addicts who can benefit from methadone
treatment do so,” said a written statement from the drug office. “There
is a substantial body of knowledge and a rare scientific consensus on
both the utility of methadone treatment and its appropriateness for
many addicts. . . . Methadone treatment must be more widely available
to those who need it.”

To methadone user Tommy Romine, there’s no debate on the drug’s
merits.

“It’s been fantastic,” said Mr. Romine, 37. “It got me off dope. It’s really changed my life for the better.”

He and many other addicts tell painfully similar stories. They turned to crime to support their habit. They lost jobs and families. Their health deteriorated.

On methadone, users say, their lives stabilized. A quick swig of the cherry-flavored liquid in the morning is all it takes. No cravings. No withdrawal pains. No shooting up.

The nine Dallas-area methadone clinics open early so people can
get their fix before work. Their clientele defies stereotypes.

“We’ve got people who live under the bridge, and we’ve got people
who own the bridge,” said Rick Bingham, a counselor at D. Gonzalez
and Associates, a Garland methadone clinic.

On a recent morning at Dr. Payte’s modest, white-brick office at
Market Center and Turtle Creek boulevards, a plethora of occupations
were represented: Realtor. Cook. Architect. Painter. Waitress. Mechanic. Telecommunications manager. An attorney who is a patient wasn’t there.

Dr. Payte, who opened a methadone clinic in San Antonio 33 years
ago, has 275 patients in Dallas. Many say they have tried repeatedly
without success to kick heroin on their own.

One of the doctor’s youngest patients is 19-year-old Veronica Miles
of Waxahachie. (To get methadone, a person must be at least 18 and
have been addicted to heroin for a year or more.) She visits the clinic
with her father, Rodney Miles, also a recovering heroin addict.

“I can’t function without methadone,” said Mr. Miles, 45. “It changed my lifestyle totally. I’m productive now. It turned me into a normal person.

The oldest methadone user in Dallas County may be Lee Jackson, 77,
who has taken it for 36 years. His health prevents him from visiting a
methadone clinic, so a caseworker delivers it to his North Oak Cliff
nursing home.

“I can’t say enough about methadone,” he said. “Without it, I’d be
dead or in jail somewhere.”

USE CARRIES STIGMA

Most methadone users want to remain anonymous. They say reliance
on the drug, even though it’s legal, carries an enormous stigma.

A 40-year-old architect, the mother of two young children, hasn’t told anyone but her husband.

“I’m fearful of what people might think,” she said. “If I told my friends,I’m afraid they wouldn’t let me around their children.”

Another methadone patient is a physician who wouldn’t give his name or age. He said he became addicted to prescription painkillers four years ago, trying them out of curiosity.

“I made a horrible, horrible, horrible decision in my life, and I paid a lot for it,” he said. “It’s horribly embarrassing to talk about. It’s so hard for me to put into words what the term ‘powerless’ is until you get addicted to a substance. You will do absolutely anything to get it.”

A man who gets methadone at West Texas Counseling &
Rehabilitation in Irving recently built a $ 250,000 house in a Dallas
suburb. He hasn’t told his two young sons about his past heroin use
or his 18 years on methadone.

“Some day they’ll find out, but I want them to find out when they’re a lot older and they can deal with it,” said the 47-year-old.

“They see me as a regular dad, seemingly successful.”

SOME DISAPPOINTMENTS

But methadone is no panacea, and it doesn’t work for everyone.

Brandi Gray is an addict who has been on and off heroin many times.
In her third week of methadone treatment not long ago, she said she was
determined to succeed.

“This time I really am sick of heroin,” said Ms. Gray, 21. “Every
other time I said I was sick of it, but I really wasn’t.”

However, she acknowledged later that she continued to use heroin
sporadically and dropped out of the methadone program. She then
checked into a mental hospital to become free of all drugs and has
recently started methadone at another clinic. Again, she said she’s
optimistic she can stay off heroin.

Estranged from her parents because of her long history of drug
abuse, she’d been living with her grandparents. But they, too, kicked
her out after a recent relapse. After that, she was staying in her car.

“I screwed up everything – my whole life, my relationship with my
family. There’s no going back,” she said. “I can mend it a little bit, but not all the way.”

A walking anti-drug ad, she urged others not to get hooked.

“The high you get is not worth what you lose,” she said. “Heroin is terrible. I wouldn’t wish it on my worst enemy.”

Not only does methadone block heroin cravings, it also prevents
the excruciating withdrawal symptoms – intense cramps, sweating,
nausea and diarrhea.

Methadone was developed in Germany during World War II as an
alternative painkiller to morphine. It belongs to a class of drugs, called opiods, that includes morphine and heroin. In the early 1960s, two New York researchers discovered that methadone could be used to
treat heroin addiction.

Some people wean themselves from methadone, but many say they’re
afraid to even try. They worry that they’ll immediately revert to heroin, and their lives will again careen out of control.

Advocates maintain that giving methadone to heroin addicts is no
different from giving insulin to diabetics. The drug’s only known side
effect is minor constipation for some people.

“I don’t want to even talk about” getting off methadone, said another 47-year-old man who asked not to be identified. “I don’t think it’ll ever happen for me. I will go to my grave being a methadone addict. I’ve come to realize that I have an addictive personality.”

That many users can’t give up methadone provides ammunition
for critics. Even though it’s safe and tightly controlled, they say,
methadone is still a drug. And users are still addicts.

“I think if it’s used as a conduit from heroin with the eventual goal of getting off methadone, that’s fine,” said Ed Cinisomo, vice president of Daytop Inc., a national, abstinence-based drug treatment chain that has a facility in Dallas.

“Some people certainly need that. But I know people who are on
methadone for a very long time. It becomes a lifestyle. People deserve
better than that. You’re conditioning them that this is the only way
they can survive.

“These poor folks are like lemmings showing up at the clinic every
day. It’s a whole subculture.”

HOW IT WORKS

At most clinics, people receive drug counseling along with
methadone. They’re encouraged to participate in support groups
such as Narcotics Anonymous.

Patients usually start on a low dose, 30 milligrams. That’s about a quarter-inch in a small disposable cup.

After three months of regular visits to a clinic, most patients are allowed to take home four doses a week so that they don’t have to
come in every day. After three years of good attendance, some users
are allowed six take-home doses and visit the clinic only once a week.

Patients are given random urine tests. If they continue to fail, they can be kicked out of the program.

Methadone isn’t cheap. Most clinics charge $ 50 to $ 60 a week.
Of course, that’s a bargain compared with the $ 300 to $ 400 a day
that some junkies spend on heroin.

Heroin users typically need four to six fixes a day. By comparison, one dose of methadone stabilizes a person all day long.

Private insurance sometimes covers methadone treatment, but
many people don’t file claims because they’re afraid their employer
will find out about their addiction and fire them. Low-income patients
receiving public health-care benefits may be able to receive methadone
for a nominal charge.

One Dallas executive said methadone helped lift him, literally, out of the gutter. Hooked on heroin, he was once homeless and “damned
near selling my soul.” Now, he owns a company in the medical field.

“I have lived a very normal lifestyle for many years,” said the
50-year-old man, who wouldn’t give his name. “This is something
that should be well-accepted. It’s got a very big stigma and it’s
wrong. Methadone is not the root of all evil.

“If anything, it has been many people’s saving grace. It has for me and my family and numerous associates and friends.”

GRAPHIC: PHOTO(S): (1-8 DMN: Cheryl Diaz Meyer)

1. Brandi Gray vomits after shooting up. She says she
wouldn’t wish her heroin addiction on her worst enemy.

2. Ms. Gray waits outside Timberlawn psychiatric hospital in Dallas
hoping to be accepted for drug rehabilitation and mental distress.
“I’ve tried to detox mtself off of methadone, but I couldn’t do it,”
she said. “My mom says I should feel some pain for everything
I’ve put people through. She doesn’t understand. Nobody
understands.”

3. In a fit of craving, Ms. Gray (left) sold her grandparents’ VCR,
to friend Jennifer Rickman, to support her heroin addition.

4. Brandi Gray cries while Visiting with her counselor, Mike Gardner,
at Dr. J. Thomas Payte’s methadone clinic near downtown Dallas.
She hadn’t slept much after being temporily turned outby her
grandparents two days before.

5. Ms. Gray takes a last sip of methadone before turning herself
in to Timber- lawn psychiatric hospital for drug rehabilitation and
mental distress. After about three weeks of struggling to pay for
the $ 55-a-week methadone treatment and eventually being
weaned off it by the methadone clinic, she could not bear the
withdrawal and threatened to shoot herself.

6. Ms. Gray, after melting heroin in water and “cooking” it
in a spoon over a spoon over a lighter, fills up a needle.

7. In the privacy of her granparents’ bathroom, Ms. Gray injects
heroin into her jugular vein. She said she has collapsed veins her
arms and finds injecting in the jugular more thrilling.

8. Brandi Gray, a fourth-generation heroin addict who has been
in and out of methadone clinics, cries as she leans back in her car.
“As a child, I was taught never to cry, because if you cry you’re
weak,” she said. “I was taught to take advantage of people who
are weak. And now I’m one of those weak people.”

Copyright 2000 The Dallas Morning News

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First Methadone Clinic Opens; Legislators Consider Changing Law

By The Associated Press
Foster’s Daily Democrat Monday, February 28, 2000.

HUDSON, N.H. (AP) The state’s first short-term methadone
clinic opened quietly last October, and the facility’s director says
most of his patients are people who live within a 15 to 20 minute
drive. Robert Potter says his clinic’s list of clients proves that
heroin addiction is a serious problem in New Hampshire.

“People will say, ‘We don’t have a problem here, not in our town,”‘

Potter said. “I beg to differ, and I have the zip codes to prove it.”
Right now, about 400 New Hampshire addicts travel every day to
clinics in Maine or Massachusetts to get methadone, a drug that helps
them kick the heroin habit and start leading productive lives again.

Some must travel 200 miles or more each day, a trip that
makes it hard for them to work. That’s because New Hampshire
law only allows short-term methadone treatment up to six
months, although there is an exception for pregnant women.

Potter says it takes most addicts 18 months to two years to complete
methadone treatment successfully. Now legislators are considering
two bills that would allow long-term treatment in New Hampshire,
one of only eight states that ban it.

The bills are sponsored by Sen. Katie Wheeler, D-Durham,
who believes it is time for New Hampshire to take a public health
approach to heroin addiction instead of continuing to deny a
problem exists.

“There’s a perception that we’ll be soft on crime if we do this, that
these will be places for addicts to hang out and sell the drug on the
street,” Wheeler said. “We don’t have a very grown-up, nonpolitical
view of the situation.”

One bill, approved unanimously at a Senate hearing last week,
would allow Potter’s clinic, Merrimack River Medical Services,
to offer long-term methadone treatment until the state approves a
more permanent program. The other bill, also approved, would set
guidelines for similar clinics to open on a two-year, pilot-project basis.The bills are supported by the state Department of Health and
Human Services, the New Hampshire Medical Society and various
drug treatment specialists.

They argue that methadone treatment works. Although methadone
is itself an addictive narcotic, it allows users to withdraw
from heroin and start functioning again.

Most people who use it go back to work, stop stealing money to
support their heroin habits, get counseling and get treatment for
other health problems, advocates say.

“They don’t get high, they don’t get stimulated they get
normal,” said Dr. John Dalco, who works part time at Potter’s
clinic.

The widespread availability of methadone treatment in most
states also has led to a big drop in heroin-related deaths,
authorities say.

The bill’s supporters also say heroin use is on the rise in New
Hampshire, as elsewhere, because it has become cheaper,
purer and more available.

The state’s Drug Abuse Warning Network found that mentions of
heroin use by patients in hospital emergency rooms doubled each
year from 1996 to 1998. State statistics also indicate that it has
replaced cocaine as the third most popular drug in New Hampshire,
after alcohol and marijuana.

Dr. Gerard Hevern, an Allenstown doctor who specializes in
drug treatment, said heroin use is growing rapidly among high
school students.

“Heroin is very common from about 10th grade on,” Havern said.
“It is as readily accessible as beer in any of the high schools locally
and throughout New Hampshire.”

State health officials would like to see the Legislature skip the pilot
project phase of the bill and just pass legislation that would allow
for long-term treatment, so addicts can start getting help.

“It’s not the people in treatment you’re worried about,” said Rosemary
Shannon, chief of treatment services for the state’s division of drug
abuse prevention. “It’s the people who aren’t in treatment.”

2000 Geo. J. Foster Co.

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Comments on An evaluation of community methadone services in Victoria,
Australia: results of a client survey. (1)
by
Andrew Byrne

General Practitioner, Drug and Alcohol,
New South Wales, Australia
March 7, 2000

This study reveals some interesting and important findings
regarding the treatment of heroin dependency patients in Victoria,
Australia where most patients attend pharmacies for their dosing
with accredited GPs prescribing. It is a credit to the authorities
that there has been such an expansion of treatment services to meet
the increasing numbers of dependent citizens. It is especially
important to document the functioning of methadone dispensing in
community pharmacies since this is where most of the expansion of
such treatment is occurring around the globe.

However, while changes will have occurred since 1995/6, the
authors’ positive conclusions still need to be tempered with some
reservations about the limitations of current treatment delivery.

As in other states, there is a perception by Victorian dependency
patients that pharmacy dosing sometimes lacks confidentiality (46%
said it was ‘too public’) and that there is some discrimination in
others being served first (42%). Dosing hours and location (only
66% satisfied) were also problems, especially when looking for
work (53% said it ‘interfered’).

The authors state: “Results of the study were generally
encouraging. The majority of clients surveyed stated they were
satisfied with their relationship with their prescriber and their
pharmacist, and with the methadone programme overall. Overall,
our survey indicates that the Victorian community-based
methadone service is in general an acceptable model of methadone
service delivery for clients in the metropolitan area.”

The survey of 195 patients would seem to indicate otherwise,
revealing worrying deficiencies with treatment delivery as well as
responses to that treatment. Only 72% were satisfied with their
treatment and over a third stated that they would not have
commenced treatment if they had know more about it, quoting
‘hassles’ amongst other problems.

Although the average duration of treatment was over 2 years, 40%
of patients had received no take-away or dispensed doses at the
time of the interview. Only 10% received 2 such doses weekly, and
they were more likely to be female. The reason for this uniquely
rigid regimen is not given.

The mean dose was 41mg (mode 30mg) with only 15% receiving
60mg or more. Almost half of the patients (44%) were still using
heroin regularly by self-report.

These outcomes are consistent with the literature which yields a
consensus that maintenance doses of methadone should normally
be in the range 60mg to 120mg daily with only a small proportion
of cases needing less or more than these levels. Hence up to
85% of Victorian patients may have been receiving inadequate
doses in 1995/6.

Dr Vincent P. Dole wrote “With adequate dosage of methadone,
taken daily, heroin use should be completely eliminated in 95% of
all patients.” He also recommended a minimum blood methadone
level of 0.2mg/l to prevent cravings in such patients.

The lack of dispensed doses in this study is unparalleled in the
world to my knowledge and is not based on sound scientific
grounds. Like inadequate dosing, it is known to be associated with
a significantly lower retention rates (Rhoades 1998). Dispensed
doses for the Sabbath are given in many areas and reports have
shown no differences from strict 7-day pick-ups (Gelkopf 1999).

References

1. An evaluation of community methadone services in Victoria,
Australia: results of a client survey. Ezard N, Lintzeris N, Odgers P,
Koutroulis G, Muhleisen P, Stowe A, Lanagan A. Drug and Alcohol
Review (1999) 18:417-423

 

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“Methadone deaths” (or are they?).
Comments on Methadone syrup-related deaths in New South Wales,
Australia, 1990-95 (1)
by
Dr Andrew Byrne

General Practitioner, Drug and Alcohol Specialist
New South Wales, Australia
March 10, 2000

This study identified all NSW coronial files over 5 years in which
methadone was involved, whether or not it was causally implicated by
the findings. Of approximately 1300 opioid overdose deaths, 242
involved methadone, 134 being from the syrup which is used in
methadone maintenance treatment (MMT). Methadone tablets,
which are used for pain management, were implicated in 52 cases
and the methadone was of uncertain or mixed origin in 67 cases.

These authors carefully analysed the 134 ‘certain’ methadone syrup
related deaths (MSRD) in relation to treatment status at the time of
death. Those on registered treatment at the time of death (54%) were
compared with those who were not in treatment. [if we add in the
‘uncertain’ 67 cases, this makes 202 total and *if* the same proportion
were in treatment – 54% – then this would leave 109 deaths of MMT
patients in which methadone syrup was a possible factor. This is very
close to Zador and Sunjic’s figure of 105 overdoses reported in
January ‘Addiction’ journal report covering the same period.]

In both ‘treatment’ and ‘non-treatment’ groups, about 75% were male,
40% were single, mean age about 30 (range 14 – 54) and around 80%
were unemployed.

A very worrying proportion (13% and 9%) of cases had been released
from prison in the month prior to death, demonstrating what a high-
risk period this is [see Seaman 1998]. It would be instructive to
know how many had already been on MMT on release.

It appeared that one third of the non-treatment group had previously
been registered for MMT but two thirds had never had MMT in the
state. There were 3 HIV positive cases among the 134.

The researchers confirmed the almost self evident finding that most of
the methadone in the treatment cases was from their own prescribed
doses (96%) while most of that taken by the non-MMT cases was
diverted from others and obtained on the black market (68% with
31% ‘uncertain’).

A much higher proportion of those out of treatment had injected the
methadone syrup. Around 80% died in the home environment.

In around 85% of cases in each group, two drugs in addition to
methadone were detected at autopsy. Tranquillizers, morphine and
alcohol accounted for most while only about 10% were apparently
due to methadone alone.

Like Barrett [1996] in Texas, these authors found that methadone
blood levels are of limited benefit in diagnosis. 86% of post-mortem
specimens were within the “therapeutic range” of 0.3 – 1.0mg/l.

After close examination of clinical records, only six cases of the 72
MMT cases were thought to be due to inappropriate clinical
practices. This included dosing errors, excessive take-away doses or
faulty assessment. Most of these received treatment which was
outside official treatment guidelines.

The authors’ final conclusion states: “Almost half of [the syrup
deaths] occurred in drug users not in MMT .. [who were single,
unemployed male known drug users] .. similar to cases in MMT. If
we include the 25% of cases where [the] form of methadone involved
was unknown … the total proportion of diversion-related deaths may
be as high as 63%. In some of these cases, methadone may have been
merely another drug of abuse for a group of injecting drug users who
represent a high risk group and for whom safe use messages need to
be appropriately and sensitively targeted. However, for other cases,
illicit methadone may have been used to medicate symptoms of
withdrawal, which may indicate a high unmet demand for MMT.”

Of these two possibilities, the former is probably exceptional as
methadone is rarely used as a recreational drug. This latter is
supported by the documented and continuing shortage of treatment
places in Sydney and elsewhere. Numerous patients entering
treatment state that they had purchased ‘street’ methadone in favour
of using heroin. Both of these groups should receive targetted
preventive education as recommended by the authors.

References

1. Sunjic S, Zador D. Methadone syrup-related deaths in New South
Wales, Australia, 1990-95. Drug and Alcohol Rev (1999) 18:409-415

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Lindesmith Center Files Amicus Curiae Brief
in Supreme Court Case
Challenging
Drug Testing of Pregnant Women
News Release 3/10/00

The Lindesmith Center’s Office of Legal Affairs, in conjunction
with nearly two dozen medical and public health organizations
submitted an amicus (“Friend of the Court”) brief to the US
Supreme Court in support of plaintiffs in Ferguson v. The City of
Charleston.

Ferguson v. The City of Charleston challenges a policy designed
and implemented by Charleston, South Carolina law enforcement
officials whereby pregnant women who sought obstetrical care at
the Medical University of South Carolina (“MUSC”) were subjected
to unwarranted, non-consensual drug testing designed and used to
facilitate the arrest and prosecution of mothers who tested
positive for cocaine. (MUSC is a state-funded hospital and the
only medical facility in the Charleston area to treat indigent
and Medicaid patients, a majority of whom are African-American.)
When the policy was implemented, no drug treatment was available
for pregnant or parenting women; mothers who tested positive at
MUSC were simply jailed, often moments after giving birth.

Ten women who were arrested for testing positive, including nine
women of color, challenged the policy on various constitutional
and statutory grounds and are now asking the United States
Supreme Court to overturn the Fourth Circuit’s decision to uphold
the policy. Plaintiffs believe the Fourth Circuit committed a
significant Fourth Amendment interpretation error in adjudicating
in favor of Defendants. Furthermore, this ruling, if allowed to
stand, will severely corrode the trust that is the basis of the
physician-patient relationship. Pregnant women will be deterred
from seeing doctors, from talking candidly with them, and from
consenting to medically advisable medical tests. Unfortunately,
the women who are most likely to be deterred from obtaining
medical treatment — those most likely to test positive — are
also the women who would most benefit from attentive prenatal
care. Such a policy departs from established and carefully
considered medical standards for substance abuse treatment and
prenatal care and is highly inimical to The Public Health.

The full text of the Lindesmith Center’s brief is online at
.

 

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Treatment for Opioid Dependence: Quality and Access (Editorial )
Bruce J. Rounsaville, MD; Thomas R. Kosten, MD

JAMA. March 8, 2000;283 (editorial).

A major priority in US medicine is the need to improve quality and
access while containing costs. Two articles in this issue of THE
JOURNAL address 2 important quality and access issues in opioid
stabilization treatment: primary care methadone treatment,1 which
can improve access by broadening the prescriber base, and the
abbreviation of methadone therapy,2 which might improve access by
allowing more patients per year in the available treatment slots. These
articles address 2 strategies to enhance quality: directly observed
methadone administration in primary care and intensified counseling
in brief methadone treatment.

Office-based care can clearly increase access as current methadone
maintenance delivery in specially licensed, centralized programs
reaches only an estimated 14% of patients with opioid dependence
because of limited treatment slots and geographical constraints.3, 4
Greater access is needed to cope with the recent upsurge in heroin
use5 and the increasing proportion of human immunodeficiency virus
(HIV) transmission accounted for by injecting-drug use.6 However,
increase immediate medical costs if many more heroin users are
brought into treatment. Ensuring quality while broadening access
requires compromises between simple office-based prescribing with
controls that characterize current methadone maintenance programs.

In their comparison of office-based prescribing programs in 2 Scottish
cities, Weinrich and Stuart1 report a 3- to 5-fold increase in the
proportion of heroin injectors receiving methadone with comparable
treatment retention. Furthermore, by requiring supervised
consumption of methadone, the Glasgow program minimized
methadone diversion and reduced opioid-related deaths-admirable
achievements in quality assurance. The risks of diversion and
overdose can be reduced even further by using a recently available
medication-buprenorphine plus naloxone-that will precipitate opioid
withdrawal if diverted and taken intravenously.7 Based on safety and
equivalent efficacy to methadone,8-10 buprenorphine is currently being
evaluated for congressional approval for office-based practice.
However, quality of care entails more than simple recruitment and
retention in treatment or even reduction in opioid-related deaths.
Quality care should lead to psychosocial rehabilitation, which
medications alone cannot provide. Provision of methadone without
psychosocial supports has been shown to yield a poorer outcome
than methadone plus weekly counseling.11 However, intensive day
program treatment within a methadone program leads to no better
outcomes than once weekly counseling, supporting the greater cost
efficacy of weekly counseling.12 Weekly counseling can complement
buprenorphine stabilization in a primary care office setting and have
outcomes superior to buprenorphine provided in a methadone clinic
setting.13 In this buprenorphine study, the primary care intervention
was evaluated for only 3 months.13 However, much briefer
detoxification of 30 days or less is the most common treatment for
opioid dependence.

A critical issue for office-based treatment of opioid dependence is the
value of brief or extended detoxification vs stabilization for a year or
longer. The study by Sees et al2 in this issue of THE JOURNAL was
conducted at a methadone clinic rather than primary care sites and
demonstrates the superiority of methadone stabilization vs extended
discontinuation over 6 months. Detoxification has repeatedly shown
substantially poorer outcomes than methadone maintenance.14 In a
recent review of ultrarapid detoxification for opioids,15 the limited
efficacy of this approach even at 3-month follow-up was found to
contrast strongly with the long-term efficacy of methadone
stabilization treatment. In the study by Sees et al, patients who were
stable while receiving methadone maintenance had precipitous
declines in heroin use, needle-related HIV risk behaviors, and
drug-related crime. However, methadone stabilization is not a cure-all.
Cocaine use, sex-related HIV risk behaviors, employment problems,
and family problems persisted, and more than 50% of patients in both
groups used heroin at least once during any given month of treatment.

The study by Sees et al2 also suggests limited impact of intensifying
delivery of traditional ancillary counseling. During the first 60 to 90
days, 3 times more psychosocial treatment was offered to (and
required of) patients in the detoxification group. However, during that
time, heroin use was nearly identical in the 2 groups. Moreover,
requiring more psychosocial treatment may have been aversive, since
attrition was higher in the detoxification group even during the first
90 days of treatment, when methadone dosing was comparable. It is
particularly noteworthy that patients using cocaine were more likely to
drop out of the detoxification program, which included an additional
session of group therapy about cocaine for patients presenting with
cocaine-positive urine specimens. Hence, more hours of traditional
drug counseling did not appear to enhance efficacy. Thus, for
cost-effective office-based practice, counseling should be provided,
but the costs associated with high-intensity psychological
interventions are not justified. This finding is consistent with previous
work examining buprenorphine detoxification16 and low- vs high-cost
day program interventions12 with this population. Other work has
suggested that patients who continue to use heroin and cocaine may
respond to psychological interventions that are more focused and
manual-guided.17-19

The findings of Weinrich and Stuart and of Sees et al provide timely
input for the public policy debate over cost, quality, and access for
treating patients with opioid dependence.14, 20-22 Quick fixes for the
problem have included false starts such as detoxification followed by
“drug-free” outpatient care. This option has been examined carefully
for more than 25 years to resounding disappointment in its failure
either to prevent heroin relapse or accomplish public health aims such
as preventing the spread of HIV infection.23, 24 Moving opioid
stabilization into the mainstream of office-based medical care has
national and congressional support25 facilitated by the recent
development of buprenorphine plus naloxone treatment. If the Scottish
example1 can be followed, this new approach can provide a 3- to
5-fold increase in access. It can also reduce cost per patient,
although added access will clearly increase short-term substance
abuse treatment costs while reducing long-term costs associated
with overdose emergencies, HIV infection, and crime. The Glasgow
study also suggests that the best investment in quality should focus
on monitoring delivery of the pharmacotherapy such as supervised
consumption during the first year of treatment. Sees et al2 suggest
that quality of care does not increase with expenditures on
high-intensity psychosocial treatments exceeding routine care.

Much remains to be learned about implementing and optimizing
effectiveness of primary care treatment for heroin dependence and
other substance use disorders.1 Guidance of the development of US
primary care opioid stabilization programs requires empirically based
evidence about optimal inclusion criteria for program participation,
induction procedures for methadone and other opioid agonists,
ancillary psychosocial treatments, duration of treatment, and
dispensing strategies. However, implementation of primary care opioid
treatment should not be delayed until definitive answers are available.
While the case for primary care opioid stabilization treatment is the
most compelling, the potential value for other substance use
disorders is suggested by low treatment utilization rates for patients
with alcohol and other substance use disorders26 and the recent or
impending availability of new pharmacological treatments including
naltrexone27 and acamprosate28, 29 for alcohol dependence.
Implementation of primary care treatment for substance use disorders
offers the possibility of increased access to care for these common
and undertreated disorders. Careful study will be required to maintain
and improve the quality of that treatment.7

Source: http://jama.ama-assn.org/issues/v283n10/toc.html

 

---

Methadone Maintenance vs 180-Day Psychosocially Enriched
Detoxification for Treatment of Opioid Dependence:
A Randomized Controlled Trial
Karen L. Sees, DO; Kevin L. Delucchi, PhD; Carmen Masson, PhD;
Amy Rosen, PsyD; H. Westley Clark, MD; Helen Robillard, RN, MSN, MA;
Peter Banys, MD; Sharon M. Hall, PhD

JAMA. March 8, 2000;283:1303-1310

Context Despite evidence that methadone maintenance treatment
(MMT) is effective for opioid dependence, it remains a controversial
therapy because of its indefinite provision of a dependence-producing
medication.

Objective To compare outcomes of patients with opioid dependence
treated with MMT vs an alternative treatment, psychosocially enriched
180-day methadone-assisted detoxification.

Design Randomized controlled trial conducted from May 1995 to
April 1999.

Setting Research clinic in an established drug treatment service.

Patients Of 858 volunteers screened, 179 adults with diagnosed
opioid dependence were randomized into the study; 154 completed
12 weeks of follow-up.

Interventions Patients were randomized to MMT (n required 2 hours of psychosocial therapy per week during the first 6
months; or detoxification (n psychosocial therapy per week, 14 education sessions, and 1 hour of
cocaine group therapy, if appropriate, for 6 months, and 6 months of
(nonmethadone) aftercare services.

Main Outcome Measures Treatment retention, heroin and cocaine
abstinence (by self-report and monthly urinalysis), human
immunodeficiency virus (HIV) risk behaviors (Risk of AIDS Behavior
scale score), and function in 5 problem areas: employment, family,
psychiatric, legal, and alcohol use (Addiction Severity Index),
compared by intervention group.

Results Methadone maintenance therapy resulted in greater
treatment retention (median, 438.5 vs 174.0 days) and lower heroin
use rates than did detoxification. Cocaine use was more closely
related to study dropout in detoxification than in MMT. Methadone
maintenance therapy resulted in a lower rate of drug-related (mean
[SD] at 12 months, 2.17 [3.88] vs 3.73 [6.86]) but not sex-related HIV
risk behaviors and in a lower severity score for legal status (mean
[SD] at 12 months, 0.05 [0.13] vs 0.13 [0.19]). There were no
differences between groups in employment or family functioning or
alcohol use. In both groups, monthly heroin use rates were 50% or
greater, but days of use per month dropped markedly from baseline.

Conclusions Our results confirm the usefulness of MMT in reducing
heroin use and HIV risk behaviors. Illicit opioid use continued in both
groups, but frequency was reduced. Results do not provide support for
diverting resources from MMT into long-term detoxification.

Source: http://jama.ama-assn.org/issues/v283n10/toc.html

 

---

Provision of Methadone Treatment in Primary Care Medical Practices:
Review of the Scottish Experience and Implications for
US Policy Policy Perspective
Michael Weinrich, MD; Mary Stuart, ScD

JAMA March 8, 2000;283:1343-1348

Context Under new proposed regulations, US physicians outside of
traditional methadone clinics could prescribe methadone to patients
with opioid dependence. No large-scale evaluations of US programs in
which methadone maintenance is provided by primary care
physicians are available, but primary care physicians in Scotland
have participated in such programs on a large scale.

Objective To review the history, operation, and outcome data on the
efficacy and safety of 2 Scottish primary care-based opioid agonist
treatment programs to derive lessons for the US context.

Design and Setting Naturalistic study of programs in Edinburgh and
Glasgow, Scotland, with data obtained through site visits and
interviews conducted in 1996 and 1998, as well as from published
reports and retrospective analysis of electronic databases.

Main Outcome Measures Proportions of injection drug users who
were enrolled in the methadone maintenance programs, average
methadone doses in the programs, and methadone-related deaths.

Results A total of 60% to 80% of injection drug users in Edinburgh
and 41% to 73% of those in Glasgow were enrolled in methadone
maintenance in 1998-1999. Dose levels are consistent with US
recommendations (for Edinburgh in 1998, 61 mg; for Glasgow in
1994-1996, 54 mg). The Glasgow program required supervised
consumption of methadone in community pharmacies for the first year
and experienced significantly fewer methadone-related deaths than
Edinburgh in 1997 (17 vs 30 deaths; P<.0001). Programs in both
Edinburgh and Glasgow provided support to primary care physicians
and achieved levels of general practitioner participation of 59% (1998)
and 30% (1999), respectively.

Conclusions The Scottish experience indicates that prescription of
methadone in office-based settings can expand access to an
important treatment modality. Primary care physicians safely
prescribed methadone for maintenance treatment when provided with
adequate support. Diversion of methadone was minimized by requiring
supervised consumption in community pharmacies.

Source: http://jama.ama-assn.org/issues/v283n10/toc.html

 

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ORGANIZATIONAL INFORMATION, FUNDING AND FUND RAISING

1. 1. The SearchZone – new from The Foundation Center
      http://fdncenter.org/searchzone/

Tired of sifting through irrelevant search results returned by standard
search engines? Then visit the SearchZone, where the new Grantmaker
Web Search engine lets you to search more than 1,000 grantmaker Web
sites and tens of thousands of documents related to grantmakers and
their grantmaking. Just follow the link below and look for the “powered
by Ultraseek server” logo at the top of the page.”

Please note: other search features on The Foundation Center’s website
can also be accessed from the SearchZone page.)

Source: “THE INTERNET INSIDER – For Grantseekers & Fundraisers”
Issue #12 – March 1, 2000

1. 1. The Philanthropy News Network (PNN)
      http://www.pnnonline.org

The Philanthropy News Network (PNN) produces a Web site that delivers
informative, relevant news about the nonprofit sector as a whole and the
role technology is playing in reshaping philanthropy in America and
throughout the world.

This free site — updated every business day — features a wide range of
topics and PNN’s original feature stories.

Visit PNN Online at: http://www.pnnonline.org

1. 1. CharityVillage.Com Named As Best Site for Email Discussion Lists
      http://www.charityvillage.com/charityvillage/stand1.html

Phoenix – March 6 – Arizona State University’s Nonprofit Management
Institute announced today that it is ranking CharityVillage.Com as the
nonprofit sector’s best website for its comprehensive listing of email
discussion listservs that focus on issues affecting the nonprofit sector.
While there are a number of websites that maintain listerv information on
the nonprofit sector there is none as comprehensive as this.
CharityVillage’s listing of listservs can be found at
http://www.charityvillage.com/charityvillage/stand1.html

NAMA recommends this site for any group that needs information about
nonprofit and organizational issues. There are over 20 lists at this sitethat include topices from starting a non-profit to board of directors to
fund raising.

Fundraising? Hunting for products or services? Organization building?
Looking for program ideas, discussion forums, online publications,
how-to advice, current trends?

3,000 pages of news, ideas, resources, and services for fundraisers and
nonprofit managers. It’s at: http://www.charityvillage.com

The ASU Nonprofit Management Institute
Enhancing Organizational Effectiveness Through Training,
Research and Management Assistance Since 1993
http://www.asu.edu/xed/npmi

Source: Starting Non-profit List, March 05, 2000

1. 1. “SNAPSHOT”: SAMHSA PROVIDES A FREEZE-FRAME OF UPCOMING EXTRAMURAL Grant OPPORTUNITIES

The Substance Abuse and Mental Health Services Administration
(SAMHSA) today announced the availability of the first issue of
Snapshot a new series dedicated to simplifying and amplifying
information about SAMHSA’s Grant programs. Service providers,
state and local substance abuse and mental health administrators,
educators, consumers and family organizations will find that
Snapshot provides all the information they need about SAMHSA’s
grant programs in one readable and compact source.

This issue of Snapshot gives potential grant applicants a
preliminary view of funding opportunities in substance
abuse prevention, addiction treatment, and mental health
services for Fiscal Year 2000. The volume provides a brief
overview of just how SAMHSA’s grant review process works,
providing suggestions about how to get started in grant writing,
identification of what an application packet should contain, and
tips about “what works” in the development and presentation
of applications.

Snapshot details all of SAMHSA’s planned FY 2000 Guidance
for Applications (GFAs) from the Center for Mental Health
Services, the Center for Substance Abuse Prevention, and
the Center for Substance Abuse Treatment. In addition to
eligibility criteria, project descriptions, and funding priorities,
readers will find information about anticipated announcement,
receipt and award dates for each GFA. The volume also
provides contact information for the SAMHSA program staff for
the particular GFA, and an application to attend one of three
scheduled Technical Assistance Workshops.

While some changes may occur in the scope and emphasis
of some of the grant announcements between today and their
publication in the Federal Register and on line at the SAMHSA
web site, the Agency hopes that this installment of Snapshot
will stimulate the field, encourage new grant applicants, and
build stronger and more competitive applications.

Snapshot is available at no cost from SAMHSA. Send an e-mail to
[email protected]; a copy will be mailed to you or check the
SAMHSA web site www.samhsa.gov for a copy.

Alternatively, call or fax SAMHSA’s Division of Extramural Activities,
Policy, and Review (301/443-4266; 301/443-1587-Fax)

Source: Press Release 2/29/00

1. 1. CyberGrants
      http://www.cybergrants.com/

CyberGrants.com is a new venture which brings together the needs and the
communications of grantseeker AND foundation or corporate grantmaker.
Grantseekers can research grant guidelines and develop on-line proposals,while, member foundations can review proposals — right online.

Source: “THE INTERNET INSIDER – For Grantseekers & Fundraisers”
Issue #10 – January 30, 2000

1. 1. Fundraising for Small NonProfits
      http://www.resolveinc.com/NEWS.htm

Fundraising for Small NonProfit – It’s Right There in the Palm of Your
Hand!(c) – by Hildy Gottlieb – ReSolve, Inc.
(Problem-solving and Strategy for NonProfits and Tribes)
A good “de-mystification” of the fundraising process!

Source: “THE INTERNET INSIDER – For Grantseekers & Fundraisers”
Issue #12 – March 1, 2000

1. 1. Techportal.org
      http://www.techportal.org

Search for funding and grants, in-kind donations, training,
volunteers, or more. for nonprofits with needs in technology.
From TeamTech in San Francisco (a program from AmeriCorps)

Source: “THE INTERNET INSIDER – For Grantseekers & Fundraisers”
Issue #12 – March 1, 2000

1. 1. The People Tab InfoPieces, Requests… People!
      http://www.infostry.com

The People tab, Infostry.com’s latest feature, allows you
to find a person to ask a question, or to post your
credentials into a particular category to make your
expertise known to potential buyers.

The People tab is the fastest way to find an expert capable
of answering your particular information needs. You can
check each person’s qualifications and rating before
placing a request. After you place a request, you will be
notified via email when the person answers it.

The People tab is also an excellent means to offer your
Online Consulting Services. Buyers can view your
credentials and directly enter into Negotiations with you
by clicking “Place a Request”. It is in your interest to
be as accurate and compelling in your Personal Description
as possible.

To place your Identity under the People tab in a particular
Category, you will need to log in and fill out “Areas of
Expertise” located under My Identity on the left hand tool
bar under Profiles. Click Update My Identity and then
scroll down to select a Category in which you would like
your Areas of Expertise to appear. Finalize the process by
clicking Update Category Selections and your Areas of
Expertise will appear in the proper categories on the site.

---

ANNOUNCEMENTS CONFERENCES AND MEETINGS

1. 1. Sessions from Preventing Heroin Overdose: Pragmatic
      Approaches are Available on the Internet

“Preventing Heroin Overdose: Pragmatic Approaches”
on January 13 and 14, 2000 in Seattle, Washington
and sponsored by the University of Washington Alcohol
and Drug Abuse Institute and The Lindesmith Center.
You can now hear (with the proper hardware and software installed on
your computer) recordings of these sessions online. Please point your
browser to: http://www.lindesmith.org/library/ODconferenceaudio.html

This two day conference brought together leading experts from around the
world — scholars, service providers, outreach workers and others who deal
with and are affected by heroin overdoses — to present and discuss a
wide range of topics including heroin overdose risk factors, naloxone
distribution, the epidemiology of overdose deaths, outreach and education,
and international innovations in heroin overdose prevention.

1. 1. Free Charles Garrett Campaign at Critical Juncture
      http://www.drcnet.org/wol/127.html#garrettcampaign

In 1970, Charles Edward Garrett, an African American man from
Texas, was sentenced to life in prison for possession of two
grams of heroin. Garrett, at the time addicted, anticipated an
unjust sentence from the all-white jury, fled. Starting a new
life, Garrett beat his addiction, joined the working world and
started a family.

In 1998, Garrett was arrested by Texas authorities. Though
current law does not provide for this harsh a sentence for the
offense, prosecuting attorneys refused to go along with a defense
motion that would have allowed Garrett to serve a term of
community service instead of incarceration. Garrett began to
serve his life sentence, leaving behind his wife and two year old
daughter, Ernestine.

Texas governor and presidential candidate George W. Bush may or
may not have used illegal drugs during his youth at the time
Garrett was originally sentenced; he has only guaranteed his
abstinence as far back as 1974, and refuses to answer regarding
the years before. Bush, who has increased drug penalties during
his tenure as governor, has the power to grant Garrett clemency.
Garrett’s lawyers have filed an appeal with the Texas Board of
Pardons and Paroles, which could be ruled on at any time.

Please visit http://www.freecharlesgarrett.org/ to sign an
electronic petition calling for his release, and/or write to:
Texas Board of Pardons and Paroles
Attn: Mr. Gerald Garrett, Chairman
P.O. Box 13401
Austin, TX 78711-3401

Remember, you are writing an appeal for an individual case of
clemency, so please limit the content of your letter to calling
for basic justice. Don’t talk about the drug war, Gov. Bush’s
history, racism or other issues; the board members to whom you
are writing couldn’t do anything about those things if they
wanted. There will be plenty of time to discuss those issues in
the larger venue of the media once he is freed. Most of all,
please make your letters polite; the board members and the
governor hold Charles Garrett’s fate in their hands.

1. 1. Is Our Drug Policy Effective? Are There Alternatives?,”
      New York March 17-18, 2000

Sponsored by the Assn of the Bar of the City of New York,
NY Academy of Medicine and NY Academy of Sciences

A two-day multidisciplinary conference. Featured speakers
will include
Nicholas de B. Katzenbach, former US Attorney General
Kurt L. Schmoke, former Mayor of Baltimore
Robert Sweet, US District Court Judge
Edward H. Jurith, General Counsel ONDCP
Sally Satel, Psychiatrist
David Musto, Yale University
Robert Newman, Continuum Health Partners
and many others.

Early registration (3/13) $30 or $20/day on site $20/day, includes lunch
Send check made out to NYAS to:
Henry Moss, NYAS 2 E. 63rd Street New York NY 10021

March 17 will be held at 1216 5th Ave. at 103rd St.,
March 18 will be held at 42 W. 44th St.

For further information, contact Henry Moss at (212) 838-0230 ext. 410.

1. 1. ORGANIZE! AN ACTIVIST-ACADEMIC CONFERENCE ON
      SOCIAL MOVEMENTS AND ORGANIZING

New York City, Columbia UNIVERSITY APRIL 8-9th, 2000

What kinds of insights can organizers lend to academics?

What kinds of insights can academics provide on questions
about organization that are relevant for activists?

****** REGISTRATION FORM******

PLEASE EMAIL TO: [email protected]
or mail/fax to address above:
Name:
Address:
Phone:
E-mail:
Affiliation (if relevant):

REGISTRATION FEE IS $10, CHECKS PAYABLE TO ORGANIZE!
(Scholarships available by advance request)

Please indicate if you will send your check by mail or pay at the
Door (the former is encouraged).

1. 1. Conference 2000 National Methadone Conference
      American Methadone Treatment Association

April 9-12, 2000 San Francisco

NAMA Events and Activities

NAMA Preconference Meeting

How Can We Develop and Strengthen Patient Advocacy Groups?

Day: Sunday
Date: April 9, 2000
Time: 1 – 5 PM

Moderator: John Finger, TexNAMA
Presenters:
Joycelyn Woods, NAMA
Diane Fleury-Seaman, MALTA
Fred Christie, AFIRM
Chris Kelly, ARM
Howard Lotsof, NAMA
Lisa Torres, NAMA
James DePasquale,NAMA

This special preconference meeting was 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 Facilitated by NAMA

D4 Planting the Seeds and Watching the Patients Grow

Day: Tuesday
Date: April 11 2000
Time: 1 – 2:30 PM

Presenters:
Alice Diorio New England NAMA
Diane Fleury-Seaman, S.D.C., MALTA
John McCarthy, M.D., Bi-Valley Medical Clinic (and 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 NAMA at the Consumer Advocacy Booth during the
conference. NAMA would like to thank AFIRM for the
donation of the booth.

Booth Manager: Greg Keller, WI NAMA

NAMA Organization Meeting
To be determined.

Visit the AMTA website at
http://www.assnmethworks.org

Visit the NAMA Events Page

NAMA Talk-1

1. 1. 11th International Conference on the Reduction
      of Drug Related Harm

April 9-13, 2000 Jersey Channel Islands, British Isles

NAMA will not be attending this conference however many of
our international affiliates will be participating in the conference
and the Users Meeting held during the conference and report back.

1. 1. Drug Use, HIV and Hepatitis: Bringing It All Together

Baltimore May 7-10, 2000
Sponsored by NIDA, CSAT, and CDC

This conference on drug use, HIV, and hepatitis will unite
researchers and practitioners from across the country to
address these inter-related and urgent public health issues.
The goal of this conference is to reduce the incidence of
chronic infectious diseases among drug users, to facilitate
entry of drug users into drug treatment, and to link them to
appropriate medical care.

The conference has the overall goal of advancing the
integration of best practices in prevention, outreach,
assessment, case management, medical treatment,
and monitoring to ensure that people with drug problems,
who are at risk for or have contracted chronic infections,
will receive timely, coordinated, and comprehensive services.

“Drug Use, HIV and Hepatitis: Bringing It All Together” is
designed to provide and produce practical strategies for
implementing an integrated approach to prevention,
treatment, and policy issues.

Hotel, travel and registration information is available online
(www.chhatt.net) or call toll-free 800-937-8728.

1. 1. 13th International Conference on Drug Policy Reform

Washington, DC May 17-20, 2000
Sponsored by the Drug Policy Foundation.

Visit http://www.dpf.org or call (202) 537-5005 for further information.

The deadline for scholarship requests is Monday, April 3.

Communities Respond to Drug Related Harm

3rd National Harm Reduction Conference
Miami October 21-25, 2000

Harm Reduction Coalition
Communities Respond to Drug Related Harm
AIDS, Hepatitis, Prison, Overdose & Beyond
Wyndham Hotel Miami-Biscayne Bay

For Information Contact: (212) 213-6376
Fax: (212) 213-6582
Email: [email protected]
Website: http://www.harmreduction.org

*Deadlines
Abstracts: May 15, 2000
Scholarships: July 3, 2000

NAMA is a sponsor of this conference.

*Conference Meetings

3rd Annual National Methadone Consumer’s Meeting
From this meeting have come vanguard declarations
and ideas such as the Methadone Consumer’s Platform
and the Dedication for the New Millenium. For our third
meeting NAMA expects nothing less as the methadone
community begins the change to an accreditation system.

Sponsored by: NAMA and MALTA

Committee Chair: Carlos Franco [email protected]

Visit NAMA’s Events Website at:

NAMA Talk-1

1. 1. Lindesmith Seminars

Lindesmith Center Seminars are held at the Open Society Inst
400 West 59th Street (between 9th and 10th Avenues), 3rd Floor.

March 14, 4:00-6:00pm

“Let’s Get Real: New Directions in Drug Education.”
Marsha Rosenbaum, PhD and Lynn Zimmer, PhD.

March 30, 4:00-6:00pm

“MDMA (‘Ecstasy’) Research: When Science and Politics Collide.”
Julie Holland, MD, John P. Morgan, MD and Rick Doblin.

Call (212)548-0695 to reserve a place
or e-mail [email protected]

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INTERNET RESOURCES

• KnowX
  http://www.knowx.com/

“The Most Comprehensive Source of Public Records on the Web”
“Search public records, such as business records, or locate a friend. Most
searches are free, although registration is required for some.”

Source: “THE INTERNET INSIDER – For Grantseekers & Fundraisers”
Issue #12 – March 1, 2000

• The Ultimate People Finder Search (from KnowX)
  http://kf.knowx.com/infoam.exe?form=pf/search.htm

“Locate people via a residence directory, death records, and databases of
home buyers and sellers.”

Source: “THE INTERNET INSIDER – For Grantseekers & Fundraisers”
Issue #12 – March 1, 2000

• REFDESK.COM
  http://www.refdesk.com

Best Source for Facts on the Net and a great website for everything!
It’s a virtual reference desk! A collection of you-name-it references.
You’ll find website links for everything from area code finder, 260
search engines, Bartlett’s Quotes, Find a Lawyer, Geneology, Learn
to do Anything, How Stuff Works, Daily Almanac, etc! etc! etc!

Source: “THE INTERNET INSIDER – For Grantseekers & Fundraisers”
Issue #12 – March 1, 2000

• Website AcronymFinderCom
  http://www.acronymfinder.com/

The Acronym Finder is a world wide web searchable database of
more than 131,000 common abbreviations and acronyms about
computers, technology, telecommunications, and military
acronyms and abbreviations.

The Acronym Finder is not a glossary of terms, web search engine,
dictionary, or a thesaurus — it is only designed to search for and
expand acronyms and abbreviations.

• HANDSNET
  http://www.handsnet.org

HandsNet has been helping busy Human Services Professionals use
online networking to access the information they need since 1987.
WebClipper is the easiest, fastest way to keep up with developments
in your field and take advantage of all the Internet has to offer with
personalized clippings, custom searches, job bank, events calendar,
funding information, discussions, professional directory, networking,
and more!

• Contacting Congress
  http://www.visi.com/juan/congress/

This is a wonderful nationwide tool. “Contacting the Congress !!”
just click on a state on the map, and do it!

Source: DrugSense Weekly, March 3, 2000, #139

• Physician Leadership on National Drug Policy
  http://www.caas.brown.edu/plndp/

Physician Leadership on National Drug Policy has a web site
at http://www.caas.brown.edu/plndp/ where physicians can
register as PLNDP Associates, endorse PLNDP’s consensus
statement and receive updates on the organization’s
activities and the issue.

Physician Leadership on National Drug Policy is comprised of
a broad range of national leaders in the fields of medicine
and public health, including high-ranking officials from the
Reagan, Bush and Clinton administrations.

Members include Louis Sullivan, M.D., Secretary of Health
and Human Services under President Bush, Edward Brandt, MD,
Assistant Secretary of HHS under President Reagan, and David
Kessler, MD, former Commissioner of the Food and Drug
Administration under President Clinton. The group also
includes a former Surgeon General, a Nobel laureate, and the
editors of the New England Journal of Medicine and the
Journal of The American Medical Association.

• List of Journals & Publications

American Psychological Assoc. Div.50 (Addictive Behaviors) (Full text).
http://www.kumc.edu/addictions_newsletter

American Journal of Drug and Alcohol Abuse (TOC with Abstracts)
http://www.dekker.com/e/p.pl/0095-2990

International Journal of Drug Testing (Online Journal, Full Text)
http://www.criminology.fsu.edu/journal/

The Journal, Addiction Research Foundation (Full Text Select Articles)
(Replaced by The Journal of Addicton and Mental Health)
Http://www.arf.org/Intropage.html

Journal of Addiction and Mental Health (Full Text)
Centre for Addiction and Mental Health.
(Formerly The Journal, published by Addiction Research Foundation)
http://www.camh.net/journal/

Journal of Addictive Diseases (TOC, Abstracts)
Official journal of ASAM
http://www.haworthpressinc.com/
http://www.asam.org/jol/journal.htm

NIDA Notes National Institute on Drug Abuse (Full Text)
http://www.nida.nih.gov/NIDA_Notes/NNindex.html

Self-Help and Psychology Magazine (Full Text Articles)
http://www.shpm.com/

Drugs, Brains and Behavior (Book, Full Text)
By C. R. Timmons & L. W. Hamilton
(Previously published as Principles of Behavioral Pharmacology)
http://www-rci.rutgers.edu/~lwh/drugs/

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NAMA Talk is published exclusively for the chapters and affiliates of the National Alliance of Methadone Advocates.

Staff

Mark Beresky, Editor

[email protected]

If you see an article or publication of interest send it to
Mark Beresky at [email protected]

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