Monday, March 4, 2013

Methadone links

I am working on a series of papers on methadone. Methadone's transition from obscure synthetic narcotic first synthesized in Nazi Germany to the front line treatment for the "disease" of opioid addiction is a story that deserves to be told in full. Unfortunately like most things I write it is taking forever, so I'm posting some links I have come across in my research.

Government Sources:

Methadone Maintenance Treatment (MMT) Facts Center for Disease Control
Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) National Institute of Drug Abuse

About Methadone a blog by "Grey Rider"
A site about methadone, methadone maintenance, buprenorphine, medication assisted treatment and drug policy, as seen through the eyes of a current methadone maintenance patient.

"Grey Rider" is an attorney and methadone activist. He has written a three part series on methadone for the blog Points: The Blog of the Alcohol and Drugs Historical Society 
Links to the three point series:
Introduction to Methadone
Better Living Through Methadone
The Anti-Methadone Movement: Just Say "Yes" to Heroin

Opinion and analysis by Maia Szalavitz

Methadone: A Major Driver of Prescription Painkiller Overdose Deaths
Heroin Cheaper, More Effective than Methadone For Hard Cases: Study
How I learned to Stop Worrying and Love Methadone
The Wire V. the Baltimore Sun: Which Covers Addiction Better?
Wire v The Media on Drugs II: You're Right, David Simon, We Suck

On Limiting Access to Methadone

An Unavoidable Reality: Methadone Works, Bloomberg Businessweek. Commentary by John Carey
Methadone for MaineCare patients capped at two years under bill Bangor Daily Mail. By Jackie Farwell

Methadone Overdoses and Deaths:

Don't Blame Clinics for Methadone ODs, SAMHSA Says
As Methadone Deaths Increase, Where is it Coming From, and Why?

See also this Pulitzer Prize winning series Methadone and the Politics of Pain by the Seattle Sun Times.
To cut costs, Washington steers Medicaid patients to a narcotic that costs less than a dollar a dose. The state insists methadone is safe. But hundreds die from it each year — and more than anyone else, it's the poor who pay the price.

StopMethadoneDeaths An Anti-Methadone Site. Full of ignorant prohibitionists and hurting family members of people who have overdosed on methadone. I can understand someone who has lost a spouse, child, parent or family member to a methadone overdose; these people are in pain and looking for someone or something to blame. Methadone clinics and their clients (junkies) provide an easy scapegoat. Here's some of their ideas to solve methadone overdose deaths:

The methadone clinics that are being run like “pill mills” need to be shut down. The doctors and clinic owners need to be prosecuted for these deaths. They are “legal” drug dealers. The agencies that could do something about this are not acting fast enough, if at all. (FDA, SAMHSA, DEA , STATE AGENCIES that are responsible for enforcing state and federal regulations and State Methadone Authorities) We need to contact them on a regular basis and force them to do their job. We pay their salary! 
Contact your Representative and ask them to co-sponsor HR672 or to suggest any ideas you may have.  Click HERE to contact.  This is the National Drug Control Strategy for 2012 from the White House-National Drug Control Strategy 2012 Policy Focus: Preventing Prescription Drug Abuse begins on Page 47.
(National Drug Control Strategy for 2012 from the White House-National Drug Control Strategy 2012
Pharmaceutical Companies need to pay for all cost for inpatient drug treatment (Abstinence Based) due to prescription drug addiction. 
Require physcians to have training on prescribing opiates before they are assigned a DEA number.

Responding to these Suggestions:
1. The fact of the matter is that methadone maintenance (clinics for addiction) is already over-regulated, there are no clinics operating like "pill mills." The more methadone access is restricted, the more addicts turn to the black market, which means more overdoses, crime, death and disease. It is absurd to hold the clinic owners responsible for people using diverted methadone in ways neither intended nor authorized by the clinic. Going on by degrees, we would then have to hold accountable every alcohol manufacturer responsible for each case of alcohol poisoning, tobacco companies would be accountable for every case of death due to chronic use of their product and every automobile manufacturer responsible for automobile fatalities. Where does personal responsibility factor in? The true intent is to make the insurance costs due to diversion risk so high that the clinics eliminate all take-home dosing, if not close altogether.

2. The National Drug Control Strategy is just a rehashing of the same prohibitionist policies that have failed for the past 40+ years (or even further back to the Harrison Narcotics Act), there is absolutely no evidence they will work differently today. 12-Step groups define insanity, as it relates to addiction, as doing the same thing over and over again while expecting different results. Perhaps the US government is addicted to waging a war on (some) drug users.

3. This is absurd because drugs do not cause addiction, drugs are no more intrinsically addictive than many other activities like alcohol, gambling or eating food. Furthermore suppose a company does not manufacture drugs of so-called abuse, but merely vaccines and antibiotics. Why should they have to pay for drug treatment? Again going on by degrees, alcohol producers would be responsible for treating alcoholics, casinos for gambling addicts, food manufacturers for food addiction, ect.

Note how they single out "abstinence based." Not science-based, or evidence-based, which both clearly indicate opioid substitution as a safe, effective and valid treatment for opioid addiction. While I have my issues with how these programs are run, some of which I laid out here, the fact remains that opioid substitution is the best treatment available for the "disease" of opioid addiction.

4. I have often heard people say such-and-such should be part of a physician's mandatory training, if all these suggestions were implemented physicians would have no time to practice medicine since they would be spending all their time in training! Now requiring physicians to have training on prescribing opioids may not be a bad idea, but the devil is in the details. If the training is nothing more than opiophobic propaganda it will do more harm than good. More training will not change the fact that opioids are indespensible for pain relief, and opioid substitution the best treatment for opioid addicts. On these points the science in unequivocal.

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