S1052832.instanturl.net

NEWS NOTES & UPDATES #1 3
A.T. Forum on the WWW NEWS NOTES & UPDATES
Submitted by Stewart Leavitt, PhD December 1996 11
Illinois State Director Urges Wider Access to Methadone 3 “Methadone Clinic Plan Tied to Advisory Board” 3 Methadone May Bring Down “Rocky Mountain High” 11 “Junkies in Mariner Park” — New Ball Field Could Strike New Heroin Addicts Need Treatment Options 11 Skip Ideology — Look At The Science Of Addiction 11 “Opponents Speak Out Against Methadone Clinic” 3 MMT Patient Input Hikes Retention 12 “Methadone: Is the Cure Worse Than the Problem?” 4 Bleak Future For Addicts Bounced From SSI/SSDI 12 “Heroin Use Growing: Recovery Takes Help, Courage And a Bill to Boost Search for Drug Abuse “Cures” 13 “Detoxification Doesn’t Cure Addicts, Doctors Say” 4 Dual Diagnosis Treatment Requires Cooperation 13 “Methadone Charge May Be 1st In State” 4 Prompt Treatment for Alcohol/Drug-Related Mood Disorders “Washington to Halt Aid to Addicts” 5 Women’s Ows Different Than Men’s 13 A.T. Forum on the WWW NEWS NOTES & UPDATES
“Speeding” Around the World 14 Submitted by Stewart B. Leavitt, Ph.D. 9/28/96 5
“Wonder Drug Methadone Is Unpopular Because It Works” A.T. Forum on the WWW NEWS NOTES & UPDATES #5
Submitted by Stewart Leavitt, PhD February 1997 14
Pharmaceutical Firm Awarded Grant to Develop Cocaine Methadone Programs Can Reduce HIV Risks For Women 14 “Couple Settles [Methadone] Suit, But Loss Devastating” 5 Methadone May Hinder Short Term Memory 14 Detox Programs Help With Withdrawal; But Not With ARF Shifts Emphasis, Expands Methadone Program In Curtailed Cocaine Use Enhances MMT 15 Urinalysis a Poor Indicator of Recovery 15 Two Reports Promote Needle Exchange Programs 15 Smack is Back: Experts Warn of Heroin Resurgence in Clinton Budget Cuts Substance Abuse Treatment 16 Second Methadone DUI Case in the News 16 DEA Says Colombian Heroin On The Rise 7 Naltrexone Helps Treat Addicts in New Haven 7 A.T. Forum on the WWW NEWS NOTES & UPDATES #6
New RAAD Treatment Offers “Quick Kick” 7 Submitted by Stewart Leavitt, PhD March 1997 16
“Methadone: Craving the Cure” 7 Record Anti-Drug Budget Falls Short, Some Say 16 NIMBY NOTES— Methadone Clinics Face Adversity Across Methadone In Jail; Three Perspectives 16 Needle-Exchanges; A Hot Potato Being Tossed Around A.T. Forum on the WWW NEWS NOTES & UPDATES
Submitted by Stewart Leavitt, PhD 11/10/96 9
“Drug Use Tops Sex As New AIDS Threat” 17 Heavy Boozing Befuddles Methadone Treatment Outcomes Buprenorphine Inferior To Methadone? 9 Vouchers Conducive to Cocaine Abstinence 18 Science Gives-in, Admits Drug Relapses Common 9 Drug Trafficking Most Rampant in Western Hemisphere 18 Methadone Users Unite On Platform 9 Beating the Bad Guys Begins At Home 18 Docs Need More Smarts About Drug Abuse, Alcoholism 10 Insurance Trends Curtail Long-term Addiction Treatment 10 “Germany Rethinks Law on Heroin” 19 Call For M.D.s To Help Convince Feds That Addiction “Liechtenstein Ruler May OK Drugs” 19 Drugging, Drinking By Women Misunderstood 10 A.T. Forum on the WWW NEWS NOTES & UPDATES #7
A.T. Forum on the WWW NEWS NOTES & UPDATES #9
Submitted by Stewart Leavitt, PhD April 1997 19
Submitted by Stewart Leavitt, PhD June 1997 24
Patient-Determined Dose Levels: UPDATE 19 Shhh… It’s A Secret… Methadone Works 24 New Journal Specifically for MMT Community 19 Urine Alcohol Test Most Effective in MMT Patients 20 Elsewhere, New MMT Clinics Meet Welcome Wagon 25 Accurate, Practical Technique for Optimizing Methadone “Heroin Habit Spreads Among The Affluent” 26 Revolutionary Change Proposed for Connecticut 20 Budget Cuts Put Bite on Baltimore Addicts 26 Connecticut Part II: “Common Sense on Drugs — You’re Canada Issues Bold Proposal to Fight HIV/AIDS 26 Pointed Doubts About Acupuncture 27 Just Saying “Da” to Drugs in Russia 21 A.T. Forum on the WWW NEWS NOTES & UPDATES #10
Methadone Treatment Expansion Needed 21 Submitted by Stewart Leavitt, PhD July 1997 27
White Collar Junkies Snort at Heroin 22 Marijuana Gateway to Harder Drugs? 27 A.T. Forum on the WWW NEWS NOTES & UPDATES #8
Submitted by Stewart Leavitt, PhD May 1997 22
Dual Bugs Bite Into California Drug Scene 28 Urine Better Than Breath To Monitor Alcohol Abuse 28 NIMPL — Not In My Parking Lot 28 Newfound Brain Chemicals Target Opiate Receptors 22 Abstinence Depends on Methadone Dose, Support Services Coke Produces High By Stalling Dopamine Reuptake 23 Clean Needles Alone Can’t Stem Tide of HIV 28 China Puts the Brakes on Addiction 23 Illegal Drugs Big Business Worldwide 29 U.S., Mexico Putting Platitudes Into Action 23 Mexican Drug Traffickers Gain Clout 29 Bid to Stop Drug Abusing Pregnant Women Faces Fight 23 Pot Penalties Softened Down Under 29 TB & Methadone Therapies Interact 24 Swiss Heroin Giveaway Touted As Success 29 Panel Sends HIV Plea to Government 24 HIV Treatment Withheld from Italian MMT Patients 24 ON THE WEB
Researched & Compiled by Stewart B. Leavitt, PhD
mostly white males and indigent. Jackson Illinois State Director Urges Wider
driven by the use of — and easier access Access to Methadone
to — Mexican black tar and China white Springfield, IL — Chicago Tribune, June heroin in the Seattle area that has led to a rise in addiction. His Evergreen clinic has clinic would correct them within 30 days a waiting list of 200 addicts; there are an Director, State of Illinois Department of or the lease could be terminated. Still, the Alcoholism and Substance abuse, “There community council. Bienstock’s previous Jackson notes that with all the licensing efforts to place the clinic at other sites last and regulatory issues, relocating a clinic users. It also provides benefits to society year were similarly rejected by township such as his is much more complicated than make methadone available to more addicts City zoning board members claimed that furniture. Just finding an appropriate site Bienstock’s proposal was the first they ahead with their stadium building plans, physicians to be innovative and use their estate consultant, testified that his survey rehabilitation and medical care to expand unofficially offered to be of assistance in methadone programs to clients they would showed that most of the patients were suit- finding another location. But, as Jackson normally refer to an approved methadone and-tie businessmen who didn’t loiter. notes, “What hurts is that this has been the “You’re talking about people who are anxious to get in there, get their dose of profile, no complaining neighbors, central methadone and get out and go to work,” and easily accessible. If there’s another Therefore a one-size-fits-all approach to place like it, I’d love to know where it is.” “Junkies in Mariner Park” — New
“Opponents Speak Out Against
Ball Field Could Strike Out
Methadone Clinic”
rehabilitation plan for the individuals and Methadone Clinic
Kingsport, TN — Kingsport Times-News, Seattle, WA — Seattle Weekly, June 5, “…. We want innovative, cost-effective 1996 (Rick Anderson) — Construction of Northeast Tennessee doesn’t need or want solutions. One is to revise regulations on relocation of several businesses, including according to elected officials, law enforcement officers, and members of the medical profession. This was in response “Methadone Clinic Plan Tied to
Advisory Board”
certificate to operate a for-profit methadone maintenance program in Greensburg, PA — Tribune-Review, June interruption in services.
“Without us, for even a short period, we’ll and drug treatment referral service at that University Professor, offered to form an everything bad that goes with it,” he says. Knoxville less than 100 miles away. DRD “They’re a pretty disenfranchised group of charges $63 a week for outpatient Pittsburgh-area industrial-zoned location. staff of 60, the methadone clinic serves rehabilitation center, which would treat 80 methadone clinic would draw addicts from crime in the city would increase due to a General Hospital, “Yes, there’s some number of patients dying of AIDS through continued heroin use has also increased.
addictive drug but, right now, it’s the best “Detoxification Doesn’t Cure
countered by pointing out that addicts are thing we have, and usually people who are Addicts, Doctors Say”
already in the area, but are forced to travel against it are not fully aware of what it “Heroin Use Growing: Recovery
Takes Help, Courage And a
Lifetime”
majority of alcoholics and drug users who Mamaroneck, NY— The Daily Times, undergo detoxification would use alcohol “methadone is a synthetic narcotic and is or drugs again unless they receive other addictive. It replaces one addiction with another.” Similarly, another mayor from a epidemic is waning, heroin is experiencing a popularity not seen since seeking help because they fear the acute the 1970s. On the streets, the drug carries names that are prophetic: “DOA,” “Instant withdrawal.
based programs. “We don’t want to just Death,” “Body Bag,” and “Silence of the Alcohol Research Center at the University heroin addicts, “there are some people $10 for a small packet. Concurrently, the measure. In the case of drug users, it could who can’t go through that, and [without a offer patients a respite in which to reflect them is incarceration, institutionalization treatment. But, he said detox should not New York City and surrounding counties.
be made a prerequisite for further help.
“Methadone: Is the Cure Worse
Than the Problem?”
decline in their crack cocaine business, are need not be taken off methadone before Mamaroneck, NY — The Daily Times, undergoing other therapies. “When oral a living by turning a new generation on to methadone is provided in adequate doses as part of well-run programs that aim for heroin is easier to snort, giving it a more long-term maintenance, illicit heroin use is other infectious diseases and deaths from [methadone] clinics are supposed to have switch to needles for the more immediate counseling, but what degree of counseling high that injection brings — according to “Methadone Charge May Be 1st In
John Galea, director of the street studies State”
unit in Manhattan, part of the state Office Chicago, IL — The Chicago Tribune, Narcotics Anonymous and got therapy and of Alcoholism and Substance Abuse Countering those sentiments, Dan McGill, At seven clinics in Westchester County woman may be the first person in Illinois the New York City spokesman at the state (NY) about 2,000 people receive charged with driving under the influence Abuse Services, cited studies showing that from 1,450 in 1989 and 1,965 in 1990. The state estimates there are 9,200 heroin his truck. She was arrested several hours and the needle-sharing that spreads HIV. addicts in Westchester and nearby Putnam later and charged with leaving the scene of Counties, but that figure is ten years old gives people access to social services as and needs updating. Sixty percent of the sobriety tests, police secured a warrant through IV drug use — twice the national with 8,000 of those participating for more average — and at least five times that methadone in her blood at the time of the criminal justice services. Thus, although allowed doctors to prescribe methadone as driving under the influence of methadone likely than those in methadone clinics to needed, there would be far fewer visits to and cocaine. [Further case details are not either doctors or clinics, and clinic staffs could shrink. And by having fewer patient “Washington to Halt Aid to
visits, clinics would become less scary to Addicts”
Washington, DC — reported in The Submitted by Stewart B. Leavitt, Ph.D. “In the end,” Collins concludes, “both Morning Call, Allentown, PA, June 7, addicts and citizens suffer badly from this dreary holy war which could be so easily “Wonder Drug Methadone Is
Unpopular Because It Works”
Pharmaceutical Firm Awarded
Lakeville, CT — Lakeville Journal, July Grant to Develop Cocaine Vaccine
11, 1996 (Bill Collins) — “Methadone is just as much a wonder drug as insulin, and 2, 1996 — ImmuLogic Pharmaceutical just as pure. Its ‘impurity’ is ideological, not pharmaceutical. As a substitute for the Innovation Research (SBIR) grant from being spent. Allegedly, ninety percent of ravages of heroin, it works like a charm. It the National Institute on Drug Abuse addicts were getting cash but no treatment even lacks significant side effects.” So develop its vaccine to treat cocaine abuse.
Norwalk, CT and a former state legislator.
program was started in 1974 and provides However, Collins notes, since methadone cocaine to the brain, and that treatment with cocaine-specific antibodies eliminate “deemed it wicked.” This, despite that the effect of cocaine in rats. Clinical trials facts that methadone allows heroin addicts in humans are scheduled for 1997.
to lead nearly normal lives, is the single There are over two million heavy users of best deterrent to AIDS, reduces the market cocaine in the United States, with about for drug dealers, and each year “saves thousands of us from being burglarized or year for addiction treatment. Immulogic’s approach calls for inoculating addicts with Collins points to Europe where anti-drug In 1994 Congress voted to cut off benefits theology is less entrenched and there is no anti-cocaine antibodies. These bind after three years and directed that checks go to responsible third parties, not addicts Doctors treat heroin addicts much like cocaine into the brain, thereby limiting the patient gets it filled at a pharmacy.
“Immulogic intends for this vaccine to be addictions to alcohol or drugs no longer heroin addicts on the street there are six qualify as disabilities and they will be relapse,” according to Barbara Fox, Ph.D., U.S. the ratio is 10 to 2. “That’s because January 1, 1997. Affected individuals will over here getting methadone is almost as be notified by June 18 and have until July much hassle as getting heroin.” develop similar vaccines to fight the abuse 28 to claim themselves eligible for money Collins also decries the low methadone related to their use of alcohol or drugs. “Couple Settles [Methadone] Suit,
indignities of the program, they [patients] But Loss Devastating”
Forest City, NC — The Daily Courier, August 2, 1996 (Jean Gordon) — The Advocates for the disabled agree the old treatment slots and neighborhoods that are died last year as a result of taking elimination hurts not only addicts but also leery of new clinic openings; “They [the communities, since addicts will no longer clinics] are not good for property values.” treatment or for any other medical care. For example, needle-using heroin addicts claims, by the Legislatures: “If the law It was believed that the boy, Nick Johnson 100 percent clean and sober and leading a On the LAAM in New York
age 16, was sold diverted methadone by
productive life. …I’d rather not have New York, NY — Our Town, September Greenville methadone maintenance clinic. clinic, but it [methadone] clearly saves A coroner’s toxicology report stated that Johnson’s body contained 0.04 mg [that’s recommend detoxification from volunteer basis. It is expected that the 4/100 milligram, as reported in the news long-lasting effects of the drug requiring article] of methadone at the time of his death. A pathologist, Dr. Michael Wheeler process may take six months to a year. days will render daily clinic visits and at Rutherford Hospital, said Johnson died only 20 percent of those who try to come The news article states: “The measure is secondary to ingestion of methadone. “It off methadone avoid relapses. That’s why welcomed by residents of the East 20s, clinics is especially high. In addition to opioids,” according to the report. “A the Beth Israel clinics and the Veteran’s Administration clinic on East 23rd Street, that’s down from about 340 patients last year due to the loss of a federal grant. handful of privately-owned facilities.” It is The boy’s mother, Patty, said she and her hoped that the use of LAAM will alleviate complaints of methadone patients loitering their son “who never dabbled in drugs.” 6,600 to 11,000 heroin addicts in that city. trafficking of drugs, including methadone ARF Shifts Emphasis, Expands
patients selling portions of their take home methadone distribution: “There’s no way Methadone Program In Canada
to put in a news article all the dangers of Smack is Back: Experts Warn of
Heroin Resurgence in California
government lets these clinics run,” Patty “Heroin Ensnares X’ers”
Heroin sold in the San Joaquin Valley is Denver, CO — Denver Post, August 22, emphasis to a “harm reduction” approach — a reduction in the risk of HIV and other business is booming in area emergency infections and the development of a more rooms that are seeing an average of two to officials report some disturbing tends: 1. methadone clinic, the oldest in Ontario, third of what it was a year ago, supplies clients eliminate inappropriate use of all have increased, and the purity of the drug availability of heroin — especially, the and lower priced; 3. purity of heroin is giving users alternative to needles, such as methadone treatment guidelines for related deaths have increased; 5. addiction the number of providers by training has spread from street culture to suburbia.
students and health care professionals who hepatitis C and HIV as a result of using “Fighting Drugs With Drugs”
will treat opiate-dependent clients. ARF dirty needles, and are a serious threat to public health, warns Tennant. “There is a Journal, July 29, 1996 (Jackie Jadrnak) real effort to get more programs so we can get them into treatment so they’re not out methadone clinics should be approved for The number of heroin users in Toronto is spreading their diseases,” he says. There their state, commentary varies regarding the medication’s benefits. According to Modesto by Tennant’s organization, but patients and the wait to get in can be up to rather than long-term psychological cure. more than a year for one of the 100 slots.
DEA Says Colombian Heroin On
the technique’s singular focus on the physical manifestations of addiction. “I Today, there are 35-40 patients in Yale’s can’t believe people will go through this, walk away without [further] treatment and be fine,” he says. “I worry it’s going to be percent of all heroin seized in the U.S. last in the program previously. A typical according to the DEA. In 1989, nearly all each week for at least six months and then Juergens adds that treating patients with Patients are randomly tested for drug and rates for such treatments, he notes, “are accounted for 15 percent — that increased [See related article below regarding to 32 percent in 1994, and kept rising.
naltrexone used for detox — ed.] New RAAD Treatment Offers “Quick Bedder concedes, “We’re not everything
to everybody. But we can definitely help traffickers] are positioning themselves to with the physical aspects of addiction and Seattle, WA — Seattle Weekly, July 19, then try to responsibly direct [patients] to 1996 (S. Duda) — A new treatment called them a good first chance. It’s the first step Marshall Bedder as a quick, painless way “Heroin has become more affordable and to kick the heroin habit. He boasts that “Methadone: Craving the Cure”
more glamorous,” Constantine said. “We RAAD will soon be the “absolute standard Evansville, IN — The Evansville Courier, are seeing more people snorting heroin or treatment for detoxification programs,” using heroin coupled with crack or other 14, 1996 (editorials) — In an extensive allegedly keeps addicts opiate-free about four part series of articles, the author 11th and 12th graders turning to heroin.” explores the good, the bad, and the ugly The DEA plans to spend $11 million over Although Bedder is only one of two surrounding the for-profit, 17-month-old the procedure in the U.S., RAAD has been its owner/operators. Differing points of internationally to fight heroin trafficking.
described in medical literature since the view are presented, however, the slant is Naltrexone Helps Treat Addicts in
toward bringing greater control over for- New Haven
administration of megadoses of naltrexone profit methadone clinics — to insure that only those who need methadone receive it, New Haven, CT — New Haven Register, along with the necessary support services; hastens withdrawal, and attaches itself to the newly-vacant opiate receptors in the diverted to the streets, thereby “creating like never before, a treatment first tested conscious patient, the procedure is done in Two pointed questions are raised: “Does help keep a lid on the growing epidemic.
a hospital with the patient placed under the for-profit operation actually create a Naltrexone blocks the effects of opioids like heroin, morphine and codeine, so the [methadone] to get high or resell on the user can’t get high even if he returns to using heroin during treatment — as long After six hours, the patient wakes feeling as naltrexone is continued. It is believed extreme fatigue, irritability, and suffering A former ETC patient is quoted as saying, flushed and the addict is opiate-free. Less “Ninety percent of the people are going benefits of naltrexone, since they are not down there [to ETC] to get high. They are patient is released from the hospital with a not going there to get help or because they lifestyle. The drug is effective on addicts practicality and efficacy of RAAD, citing methadone as an angel of death — telling counseling — yet, they have to be highly the tales of three deaths, two by clients of treatment and its focus solely on relieving ETC and a third who died after taking physical symptoms of drug withdrawal illegally purchased methadone. [However, in addition to methadone, there were also political leaders. In essence, legislators, circumstances associated with each death.] Clinic operator Daniel Bienstock treatment in the region and that citizens methadone clinics on a central registry to owned by a real estate firm. The area is than one; limiting the location of clinics to allows medical facilities only if they serve Janet Hassler, vice president of DRD, told cities where heroin use is well people working in the immediate area.
documented; prohibiting the dispensing of Neighbors in nearby homes feared methadone until results of patients’ urine problems with addicts loitering outside the especially from a CBS “Sixty Minutes” problems, security concerns and decreased program — had unfairly impacted properly run and effective programs. The concludes: “There seems to be a bit of programs have been widely criticized.
truth here — methadone may provide the ordinance variances were allowed, “there ALBUQUERQUE, NM — Albuquerque
Journal, June 26, 1996 (Frank Zoretich) heroin addiction. But if this treatment is application to open a new clinic by a San lure these people back to heroin.” Some Kahn, applicant and clinic operator said, importantly, a goal of becoming drug free methadone.
“I apologize to those who are frightened. — then perhaps it creates the biggest lie of all — that people desperately in need of patients would be professional people [Editor’s note: Addiction Treatment drugs, rather than the riffraff portrayed by Albuquerque that provides methadone to Forum was interviewed by Jim Beck, the author of this series, and it was apparent get methadone from hospital clinics, not operating in that city. Applications for two that ultimately he was seeking a negative free-standing facilities in residential areas. more clinics have been approved by the slant for the articles. In our defense of UNION, NJ — Union Leader, June 27,
certain clinic practices that on the surface 1996 (Bernard Davis, Jr) — Suburban may seem unethical but do have valid Clinics filed suit against the township and application. At question is whether or not underlying rationales, we were surprised to be accurately quoted in print as saying, ordinance that prohibits a proposed “The press is always looking for some type of sensationalism. You could make a Petti said, “We feel it [expansion of the big deal out of it and make a sensational story, but you don’t have the whole story. EUGENE, OR — The Register-Guard,
Methadone as a treatment modality INDIANAPOLIS, IN — The
works. That’s been proven more so with Indianapolis News, July 17, 1996 (Robert Portland-based private, nonprofit drug methadone than any other drug you can new methadone clinic this fall in Eugene. NIMBY NOTES— Methadone
At present, about 70 addicts in the area Clinics Face Adversity Across the
was to be operated by Discovery House. A receive treatment through a county In many areas the welcome mat
stated, “…we do not see this [clinic] as a least 40 more are waiting for slots to open, continues to be pulled out from under
benefit for the neighborhood. There would which can take an average of 10 months.
the efforts of methadone clinics to
be the possibility of drug activity brought expand treatment. Here is a digest of
location for the new clinic is being fought press notices reflecting those issues…
KNOXVILLE, TN — The Knoxville
PITTSBURGH, PA — Pittsburgh Post -
News-Sentinel, June 27, 1996 (Tom leader stated, “We’ll use any means we Gazette, July 15, 1996 — South side residents were relieved that city zoning We’re concerned about he type of people officials “shot down” an attempt to locate methadone clinic in Kingsport was killed it will attract, drug dealing, and all the by a state commission after an outpouring activities that go on in a drug culture.” CODA has been in the business of treating relocate they encountered resistance due treats over 600 patients daily and is the per day in the new clinic. Dennis Donan, a largest such operation in the state.
Science Gives-in, Admits Drug
sensitive to the concerns of neighborhood unfairly blocked their attempts to sign a Relapses Common
lease by trying to change the city’s zoning Washington, DC — Comtex, October 2, code as it applies to clinics that treat drug the residents to have input. If there are addicts and the mentally ill. In a lawsuit, research into drug addiction treatments, scientists are starting to realize that there STOCKTON, CA — The Record,
order against the city’s attempts to change may not be a way to get addicts to quit their habits and never start again. Anti- claimed, “We’re not blocking their efforts, drug medications have helped treat the in fact, we’ve tried very hard to help them physiologic aspects of addiction, but even inform them he decided not to open a find a new place.” However, it seems that runs into opposition from local businesses Scientists are at a loss for how to prevent or institutions with their own development them.
priorities that exclude such a clinic.
“Drug addiction is a chronic, relapsing Health Project, said, “The uproar seems to condition and has to be viewed that way,” Submitted by Stewart Leavitt, PhD National Institute of Drug Abuse (NIDA).
Still, Tennant claims Stockton sorely need 11/10/96
“While the ultimate goal is abstinence, the a second clinic. His current operation has reasonable approach is to get addicts off Pregnant? Maybe Not
New York, NY — U.S. Pharmacist, lengths of time.” That is an important September 1996 (D. Hulisz, Pharm. D.; C. mind-shift in thinking about the nation’s FRAMINGHAM, MA — Middlesex
News, August 1, 1996 (Chris Bergeron) For the majority of addicts, their disease — Since learning that Spectrum Addiction pregnancy tests may give false-positive results among methadone users, indicating proposition, where treatment is clinic in a downtown building, residents they are pregnant when they are not. The and officials have angrily declared their cure. Scientists say that viewing the war on drugs as a win-lose proposition is like also produce false-positives. Rather than celebrating (or, perhaps, agonizing about) schizophrenia — as battles that are either those clinics had not caused problems in patients might first consult a qualified treatment clinic would attract addicts and Buprenorphine Inferior To
Methadone?
would accelerate the deterioration of the Rockville, MD — Clinical Psychiatry problems, hypertension problems, and the area and further depress property values.
News, September 1996 (from Arch. Gen. chronic physical ailments. We’re willing Psychiatry, 53:401-7, 1996) — A one to treat chronic physical ailments in ways that we’re not willing to treat chronic that buprenorphine was less effective than mental and behavioral disorders. It’s like “You don’t get people off dope by giving methadone in controlling continued opioid saying the treatment for flu is useless if use. During the trial only 57% of subjects Methadone Users Unite On
BOSTON, MA — Boston Globe, August
Platform
Oakland, CA — The Oakland Tribune, was expiring and time was running out for also reported to A.T. Forum by Diane new site for its Boston methadone clinic. public officials, business leaders, health This is of concern since, while the initial detoxification period is very important, “Methadone Consumers’ Meeting,” which leaders called upon physicians to “…learn follow-up treatment over time is even was held in conjunction with the First they know about typical medical problems Call For M.D.s To Help Convince
Feds That Addiction Treatment
reduction and diabetes.” The panel was “Substance abuse costs the nation almost $240 billion a year, including $100 billion Association’s House of Delegates, Gen. Topping the agenda was development of a in lost productivity and $13.7 billion in Barry R. McCaffrey, director of the Office “Methadone Consumer’s Platform” to Brown University, the panel’s chairman. (ONDCP), called on America’s physicians “In a climate in which cost-effectiveness to help “establish the credibility” of experience.” Among statements that were is of prime concern, the early intervention treatment programs as a major weapon in by physicians in diagnosis, referral and “You have to help me persuade legislators  “Methadone is not a ‘substitute drug,” abuse problems can save enormous and the Congress that treatment programs physicians suffer “therapeutic pessimism” in treating patients who abuse substances.
Insurance Trends Curtail Long-term At stake, he noted, are millions of federal
Addiction Treatment
dollars that can easily be diverted from Life & Health-Financial Services Edition, be convinced that treatment is a cost-  “Methadone patients have the right to October 7, 1996 (Joe Niedzielski) — Though most major employers continue to For example, the budget for SAMHSA alcohol treatment, the need to cut costs has led to inpatient drug rehabilitation and 40% last year, and $540 million for the shall be affordable to all… no patient study by Drug Strategies, a Washington- based policy research institute, about 98 to educate yourselves on drug addiction, pay attention to your patients and see the health care costs. But, behavioral health opinions on that] are unprintable. One of need not make health plans prohibitively legalizing drugs in America.” [This was prior to the November 1996 elections premiums paid to private insurance plans which liberalized the use of marijuana in Drugging, Drinking By Women
Docs Need More Smarts About
A driving force in treatment trends is the Misunderstood
Drug Abuse, Alcoholism
covered 70 percent of insured workers in alcoholism and substance abuse problems, through early intervention and prevention, abuse drugs and alcohol often escape according to a report in “The Nation’s notice and treatment because there is little Health.” A national panel of physicians, funding long-term treatment for anything. long-term medicinal treatments should not be initiated unless the patient has failed multiple previous attempts at treatment or is exhibiting potentially life-threatening and drugging to nearly the same extent as should be publicly or privately funded. An behavior with drug use, such as men; for adolescents, the gap is gone.
answer was expected to take two months.
intravenous injections with dirty needles.
analysis and evaluation for the Colorado there are strong differences between men Department of Human Services, noted that treatments to the needs of the newly addicted heroin addict, program directors reserved for daily, hard-core heroin users. and clinicians can help their patients onto The 800 addicts in Boulder, being mostly having been sexually abused as children, statewide average may not fit that profile, psychiatrist at Bellevue Hospital in New Skip Ideology — Look At The
Science Of Addiction
Washington, DC — U.S. Medicine, methadone clinic through the 1970s, but it October 1996, “NIDA Director: Just Say heroin addicts said men influenced their Science”— Alan Leshner, Ph.D., director commented, “The problem is we have had (NIDA) says scientific research has shown enough time lapse since heroin was a real that the way psychoactive drugs — heroin, alcohol, and others — travel pathways in heard of the impact of heroin. Today, kids the brain eliciting a dopamine response just don’t know the damage it can do.” has implications for treatment and relapse New Heroin Addicts Need
Treatment Options
InfoSage — Alcoholism & Drug Abuse environmental cues related to drug abuse Submitted by Stewart Leavitt, PhD Week, October 28, 1996, “Today’s Heroin can set off the same brain mechanisms.
December 1996
He is very careful to note, however, that Methadone May Bring Down
M.D.) — Although still making-up a small Leshner claims research has shown that “Rocky Mountain High”
Denver — Denver Post, October 19, heroin has elicited renewed interest among fundamental ways leading to addiction — addicts and the general public because of i.e., “addiction is a condition of changed its low cost, high purity, and its apparent brains.” It’s not a question of willpower, and that is difficult for policy makers to health officials may establish a methadone Heroin-related emergency room cases as a surprise to the drug user, who actually clinic for the first time in 16 years. Over proportion of all drug-related incidents just the past three years, the number of for drug-seeking in the first place — but heroin and IV drug users have doubled in did not realize or desire that it might be young persons — age 12-17 — increased overdose deaths. And, Boulder drug users by 277%. This suggests a new, relatively “Does the brain change back? The sad are estimated to be younger than ever.
answer is, I don’t know,” he said.
“There will be no magic bullet for this Along with that, the number of new users admitted to heroin addiction programs has For these young addicts, the article nearly doubled, from 6.8 percent in 1992 ‘people, places, and things.’” Prevention efforts, he added, “must be age-specific and culturally sensitive. The advertising Stout, heroin was once deemed a relic of industry figured that one out years ago.” illness of addiction is lifelong: “The illness is very, very long lasting. We say University wrote: “…part of the the illness is chronic and relapsing, and underutilization of this (methadone) treatment is due to overregulation by the treatment episodes. We don’t have a cure DEA and the FDA, and part is due to the eligibility that goes with those benefits. for addiction in the traditional sense. The stigma attached to heroin addiction itself. Capoccia claims the answer is simple, but illness is not like a broken bone. It’s like Moreover, some politically prominent unpleasant: “People are going to end up in ideologues oppose the use of a drug as need to have maintenance and longer term part of the treatment for drug addiction. emergency rooms, or jails. In other words, Health professionals need to know the they’ll be handled the way they used to be facts, barriers, and opportunities criticized as substituting one addiction for connected with this form of addiction Drug War Won in Hospitals?
another? Leshner: “That criticism is more treatment. …. It is time that this medical Cincinnati, OH; Danbury, CT — The ideological than medical or scientific. You therapy was removed from the realm of News-Times, September 26,1996 (Irving wouldn’t say that substituting insulin for a politics.” See also, a related article on A. Beychok, M.D.) — Major hospitals are diabetic is bad. The scientific question is this: if you use this medication, can you in RESEARCH in the Winter 1997 edition lives?” Methadone is effective in treating Bleak Future For Addicts Bounced
New York City’s Metropolitan Hospital, From SSI/SSDI
Cedar Sinai in Los Angeles, University of InfoSage — Alcoholism & Drug Abuse treat the entire process of addiction as it Week, October 21, 1996, “Future Looks SSI/SSDI Rolls”— Homeless shelters and Investigation and Treatment of Addiction in Seville, Spain. Dr. Lagarda opened his MMT Patient Input Hikes Retention
overflowing in early 1997 after drug and InfoSage — Brown University Digest of alcohol addicted (DAA) beneficiaries are trials. Similar clinics are operating in Addiction Theory and Application, Great Britain, Israel, Italy, Mexico, and Puerto Rico. By the end of 1996, similar Rates in Australian Methadone Program” — When methadone maintenance patients treatment center.
have some control over their treatment — including helping to determine medication estimates that 75% to 80% of DAA significantly likely to remain in treatment supervision in an intensive care unit under Australian study in 1993 comparing three (SSDI) eligibility on January 1, 1997 will detoxification program that takes just six In all three treatment groups, methadone released within 24 hours and the detox is dosage was increased gradually during the Legislation passed by Congress last followed by six months of counseling and first weeks of treatment, until the patient Administration to notify beneficiaries by June 28 that their benefits would end on but so too did retention rates. The authors January 1st. Recipients were given either 120 days from the date of enactment or 60 silver bullet, but it shows promise of days from date of notification to request a improving the odds,” the article’s author claims. “While we are losing the war on have otherwise attended a methadone of deciding eligibility.
drugs in the field, maybe we can win it in Nationally, less than half of those notified the hospital.” of their termination filed appeals, and of [This new treatment was featured October the 100,000 appeals filed by late October, 18, 1996 on the ABC-TV news program 20/20. An earlier edition of the A.T. level of appeal. That first level consists of a face-to-face meeting or case review at described the treatment as RAAD — Rapid Anesthesia Assisted Detox — being [In an editorial comment accompanying beyond that to an administrative law judge performed in Seattle for a cost of the article, Dr. David C. Lewis of Brown and, ultimately, to a federal district court.
$9,000/patient. One-day rapid detox is also provided by the private Nutmeg Dual Diagnosis Treatment Requires the bipolar spectrum disorders —
Intensive Rehabilitation Center in Cooperation
cyclothymia [cyclic insanity], hperthymia Tolland, CT at an alleged cost of about [excess emotivity], and hpyomania — are $2,500 per patient The long term efficacy of this approach has been questioned by many in the medical and addiction recently, the mental illness and chemical treatment communities, and A.T. Forum will explore the topic further in an difficult because acute intoxications or upcoming print edition. — editor] Bill to Boost Search for Drug Abuse recognizing that many emotionally
“Cures”
InfoSage — Alcoholism & Drug Abuse both a psychiatric disorder and an alcohol disorder and reveals an inherent Week, September 23, 1996 — Senator vulnerability to depression or mania. She Joseph Biden, Jr. (D.-Del.) introduced a bill (the “Pharmacotherapy Development symptoms persist for as little as 14 days Act of 1996”) calling for a multi-million Often there have been disagreements over beyond the resolution of an acute alcohol dollar reward for firms that find a “cure” which comes first; psychiatric diagnosis or episode or other drug detoxification, there for cocaine and heroin addiction. The act would classify genuinely effective cocaine enlightened approach recognizes that both pharmacotherapy for mania or depression. and heroin medications as “orphan drugs,” must be cooperatively addressed or there It doesn’t seem to matter which came first, will be no progress in treating either.
the drug abuse or the affective disorder.
“In essence, whenever affective symptoms Companies would also receive a bounty of disorders, such as an underlying withdrawal, regardless of onset of mania independent treatment for a mood disorder But, alcohol and/or drug intoxication or sector pharmaceutical research date back psychosis in an alcoholic patient suffering which clinicians often hesitated to Williams notes that at his facility — St. concurrent substance abuse was in stable remission. She stresses that the outcome psychiatric consultations are standard for Since that time, 600 new drugs have been all patients admitted for drug or alcohol disorders are more quickly diagnosed and designated as orphans, and 100 have been detox. However, proper diagnosis cannot treated in dual-diagnosis patients.
approved by the FDA for marketing.
Women’s Ows Different Than Men’s
Biden’s bill, which was awaiting a hearing following such detoxification.
Prompt Treatment for
December 1, 1996, “Yours, mine and ows: was supported by many professionals who Alcohol/Drug-Related Mood
Study finds major differences in the way disagreed with the aversion of some in the Disorders Recommended
addiction treatment field to treating drug Medscape — 9th Annual U.S. Psychiatric — a new report suggests that women and article notes: “David Mactas, director of men experience pain very differently, and Goldberg, M.D., reporter) — “Substance simplistic to say that the use of a drug with bipolar disorder and is more likely to effectively to traditional opioid-class coexist with bipolar illness than with any painkillers, such as: morphine, codeine, addiction with another. Methadone works other Axis I psychiatric disorder [e.g., in a number of ways. Clearly, it’s humane social phobia or post-traumatic stress and cost-effective to develop a medication disorder].” Alcohol and other drug abuse respond better, reporting much longer for addictions that enables people to go to may also contribute significantly to pain relief than men, to a class of little treatment resistance and poor outcome.
opioids.” These are marketed under the alcoholics and up to 3% of cocaine abusers are at greater risk for bipolar illness than the general population. When differences between the sexes. One thing that led to the above experiment is that, the number of their IDU sexual partners." report experiencing greater pain than do amphetamines are more widely consumed Dr. Wells suggests that, for women, than heroin or cocaine in countries such methadone treatment lessens the economic Philippines, Nigeria, and Australia. The behaviors. "For many women,” she points problem is also widespread in the United out, ".sexual behavior supports their drug use." In the current study, ".more women engaging in no sexual activity during the learning skills, other contrasts between the Submitted by Stewart Leavitt, PhD prior 6 months, and none reported having
February 1997
Methadone May Hinder Short Term
Heroin Addiction Up 20 Percent
women metabolize alcohol and other RESTON, VA — Associated Press, Honolulu, HI — Honolulu Star Bulletin, Reno, heroin is more plentiful, purer, and (Helen Altonn); also reported in American less expensive than it was just a few years Medical News, November 25, 1996 — ago. “This is one of the most critical problems we face in fighting narcotics in better to antidepressant medications.
this country today,” she said. “If we do not counteract the heroin threat now, we risk repeating the terrible consequences of an MMTP with 108 control subjects. He the 1980s’ cocaine and crack epidemic.” There have been past complaints, largely Authorities estimate that heroin addiction stemming from women’s health advocates, has increased 20 percent and worldwide identity of items and an item’s position in sharply, even as other illegal drug use is One significance of this finding, Fratzke declining. “For more and more drug users, notes, is that patients’ inability to heroin is replacing crack cocaine as their rather as if they were merely short men. doors, and minds, to further explorations believe that inhaling heroin, rather than injecting it, reduces their risk of addiction treatment patients.” Among other effects, “Speeding” Around the World
patients may forget such things as phone Methadone Programs Can Reduce
Chicago Tribune, November 17, 1996, HIV Risks For Women
Counselors should be aware of this
Sec. 1, p. 9, “Amphetamine abuse a world WESTPORT — Am J Drug Alcohol potential problem, so they don’t
Abuse, 1996;22:509-521; reported Nov 18 interpret forgetfulness as a patient
(Reuters) — A University of Washington being difficult or manipulative, Fratzke
Organization, little is being done to stem a team says that methadone treatment stresses. He suggests that using techniques appears to be a particularly effective HIV to jog patients’ memories, such as having “speed” and “ecstasy.” Amphetamine-type risk intervention for female injection drug them write down important information, drugs are apparently de rigueur for the will cut down on excuses and help patients Dr. Elizabeth A. Wells and associates in Worldwide, one in 12 deaths in the early Seattle reviewed data from questionnaires According to Mike Kuhar, national ‘90s involved substance abuse of one form completed by 353 male and female IDUs University in Atlanta, “No drug is side- maintenance program. Specifically, those effect of methadone. But, in general, the when nicotine and alcohol are included.
therapeutic benefit is clearly, very solidly, gathered at a health conference in Geneva, in sexual risk behaviors for HIV infection the years have found no deleterious side Switzerland. But among young people, effects. Kratske admits more research is were less likely to have used cocaine in examine rats to identify possible changes in methadone chemistry that might reduce unemployed or employed only part-time Detox Programs Help With
Withdrawal; But Not With Behavior
introduced 25 years ago. He notes that, in the early days of methadone maintenance WESTPORT — Lancet 1996;347:97-100; Urinalysis a Poor Indicator of
reported Jan 15, 1997 (Reuters) — Drug Recovery
with loss of their medical licenses. But optimism on the part of staff members and Addictions, 1996; 5:66-68, “False withdrawal, but the detox programs do not Positives in Urine Monitoring of necessarily bring about lasting changes in patterns of drug use. This latter point is Clinical Context” (Stephen L. Dilts, M.D., reinforcement" that's seen in syringe two examples of former substance-abusing Dr. De Jarlais's team analyzed factors tests while being monitored for addictive syringe exchange programs in different U.S. cities and made these substances. Urine tests are not infallible belief that detoxification treatment alone will result in changed behavior. "If we
addressed, they stress. The role of urine neither "decimate local communities" regard detoxification as a treatment to
achieve abstinence, then detoxification
patients from substance abuse is discussed programs are not especially effective,"
multiple sources of clinical input — rather appropriately regarded as a process that than just urinalysis — in assessing the withdrawal from a drug dependence. This Two Reports Promote Needle
Exchange Programs
Drs. Hall and Mattick also write that while WESTPORT — Am J Public Health detoxification can help, it is not essential for treatment, noting that methadone can 2) State laws requiring prescriptions for Curtailed Cocaine Use Enhances
hepatitis and HIV infections. One report, Addictions, 1996; 5:12-17, “Treatment significantly reduced the number of cases of hepatitis B and hepatitis C infection. Cocaine Use in Methadone Maintenance” Dr. Holly Hagan of the Seattle-King PhD, Jerome J. Platt, PhD) — The authors found that nonuse of the needle exchange patients (N = 264) reporting cocaine use was associated with a six fold higher risk of hepatitis B and a sevenfold higher risk relationship between treatment retention, occupational role, and continued cocaine applicable to HIV transmission, as well. Patients who had been in treatment longer She is an advocate of the Tacoma syringe exchange program because it ".exerts a 5) "Secondary distribution" of sterile months or less. Not surprisingly, patients charged with driving under the influence syringes do not pose a health threat to of methadone when her car was involved Commenting on both reports, Dr. Roel A. cocaine and methadone were found in her marijuana use is steadily climbing.”Coutinho of the Municipal Health Service blood, however it was the first time in the Methadone In Jail; Three
Perspectives
parallels between methadone maintenance methadone was implicated in a DUI CAMDEN, MAINE — Camden Herald,
charge. The woman was later convicted of December 5, 1996, “Methadone moving U.S. instructive, but adds that ".it will Ferrazza) — five county jails will make those opposed on other grounds that such Submitted by Stewart Leavitt, PhD an agreement with Allied Resources for
Clinton Budget Cuts Substance
March 1997
Abuse Treatment
provides health services to inmates), and Record Anti-Drug Budget Falls
Discovery House in Portland, a clinic for Short, Some Say
Tribune, Wednesday, February 26, 1997, (Reuters) — President Clinton proposed a proposed budget calls for an increase of methadone if they are sentenced to short record setting $800 million increase over the current fiscal year budget. It includes surveillance; it also includes $10 million people off to narcotics and Clinton said, million to strengthen states' efforts to Sheriff William Carter of Lincoln County motivate America’s youth to reject illegal commented, “I think it’s agreed that it’s However, prevention programs such as the drugs and substance abuse.” explained that he and others believe that Healthy People 2000 initiative and the
Besides the ad campaign, the budget calls addicted inmates might have “a couple of Substance Abuse Treatment Block Grant
received proposed cuts in their funding.
Second Methadone DUI Case in the
habit by providing the drug to inmates.” methadone is provided to heroin-addicted collision” (Steve Marlowe) — A 39 year addicts will end up in jail for that reason. “If you are now supplying the methadone inside the jail, you’re attracting the very backing out of the driveway of her home. were proposed cuts in funding for the president of Allied Resources, “The goal here is not to replace their street drugs, methadone on the front seat of the man’s therapy and maintain that therapy during brief incarceration, the idea being that if reportedly had some praise for Clinton’s they remain in therapy, they’re less likely plan, but said it did not go far enough in [methadone] while driving, but we believe education. Others, such as Eric Sterling of ALBANY, NY — The Daily Gazette
he probably has a legitimate prescription
were outwardly critical: “Everyone agrees policy cuts off methadone treatment at [In a prior report — October, 1995 — we Albany county jail” (Brian Nearing) — noted that an Illinois woman was similarly overall failure. Cocaine supplies and “Drug Use Tops Sex As New AIDS
Delaware were treated for substance abuse Threat”
Afraid this could mean methadone patient through publicly funded programs of all kinds. The primary problem for 56 percent February 6, 1997, p. 1 (Doug Fraser) — statistics continue to reflect the steady was asked to examine the new policy.
on an out-patient basis, while 60 percent claimed there is no “universal program” Needle-Exchanges; A Hot Potato
Being Tossed Around Washington
Jail Medical Director J.A. Torian said, “I March 10, 1997, Sec. 1, p. 14, “Shalala can deny a patient anything that I don’t punts on a crucial call” — this editorial see as a medical necessity.” He claimed taking other illegal drugs that might react assistance for needle exchange programs. there is still extensive sharing of needles Torian claimed he has other drugs to treat among drug users, save money, and even encourage a significant number of addicts was a friend (75 percent of the time), followed by sexual partners, followed by salivation, tearing eyes…,” he said, “but ask Congress to lift its 1992 ban on HHS friends of friends. One group showing the funding of such programs. Hence, the ban greatest rise in HIV/AIDS infection is However, one county legislator asserted, stands until the surgeon general — who “If someone can be detoxed in jail in a reports to Shalala — can assure Congress According to the article, “Massachusetts is that those program are safe and effective.
one of the few states which allows needle The editorial reports that, according to the purchase only by doctor’s prescription. DOVER, DELAWARE — The News
Journal, February 13, 1997, “Prison drug AIDS/HIV infection by injection drug use are much higher than the national average. attributable to the use of dirty needles by Local advocates say those statistics cry revolving door that returns drug offenders drug addicts doubled over the same time out for more access to clean needles.” to prison, Governor Carper promised that every drug-addicted inmate serving a year cause of death in the African-American and Hispanic communities, largely due to percent of the state’s 5,000 inmates have drug use and contaminated needles. Many Heavy Boozing Befuddles
Methadone Treatment Outcomes
mandatory drug-sentencing laws that have partners of HIV-infected addicts.
filled jail cells as fast as they can be built.
Behaviors, 1996, Vol. 22, No. 1, pp. 69- 80, “Heavy Drinking, Alcohol-Dependent which Carper wants to expand three-fold. Maintenance Clients: A Follow-up Study” treatment to 111 inmates, while the Crest (Chatham, L.R., et al — Inst. Of Behav. what it costs to treat a single HIV/AIDS Res., TCU) — treatment outcomes differ patient during the course of the disease. treatment clients and those who are not. programs, saying it is incongruous for one With heavy alcohol use estimated to affect branch of the government to “subsidize up to half of all MMT clients, the overall arrested. Of a control group of inmates not drug use,” however indirectly as with agencies wage a multi-billion dollar war managed to avoid trouble with the law.
associated with treatment failures, while also heavy users of cocaine. Those in the In this study of clients interviewed about experimental group received a voucher for Beating the Bad Guys Begins At
one year after discharge from treatment, three times a week over a 12-week period. PHILADELPHIA, PA — Philadelphia Inquirer, referenced in Chicago Tribune, Saturday, March 15, 1997, Sec. 1, p. 23, decreased opiate use (but less reduction in cocaine-free urines increased.
cocaine-free urines achieved significantly policy of dividing illicit drug-exporting improved psychological functioning. As a more weeks and longer sustained countries into “good guys and bad guys,” result of treatment, the dependent clients also had significantly fewer associations controls. Control group patients received contingent on cocaine abstinence. Overall Mexico and Peru.
group had higher anxiety scores, they did “It feeds the popular misconception that significantly higher by patients receiving the United States can solve the drug crisis Cessnas and sniffing out smuggled cargo. Drug Trafficking Most Rampant in
Victory in the drug war lies primarily on Western Hemisphere
others to kick their habits. A Rand study such cocaine addiction contributed to the in 1994 found that every $1 spent on drug treatment reduces cocaine use as much as demonstrated the feasibility and value of establishing the alcohol dependency status According to a State Department report, operations in Columbia and along the Rio of heavy-drinking clients at the time of Grande are more exciting than prevention admission so multiple drug addictions can limited to a few major routes and be identified and treated appropriately. destinations in North America and Europe World War on Drugs Failing
“For programs with adequate resources, methadone serum concentrations might be universal.” Press, February 4, 1997 (George John) — both alcohol and cocaine, since both drugs problems. In addition to well-publicized noted that, while 200,000 Americans used influence methadone metabolism and may problems with Mexico and Columbia as heroin in 1995 (“an estimate significantly corruption, Bolivia, Brazil, the Caribbean, leveled off. In Europe, the use of heroin capabilities, an option might be to institute Ecuador, Peru, and Venezuela are major and cocaine were decreasing, according to production points and/or shipping routes monitor both cocaine and alcohol use. For for cocaine, heroin, and marijuana destined for the United States and Europe. ecstasy, and LSD. Marijuana use was also extra urine tests mandated when patients test positive for cocaine. Clinics might transit country for cocaine from Columbia Overall, drug use was steady or increasing also monitor alcohol use via breathalyzers and Bolivia to the U.S. and Europe, in most parts of the world, extending into Vouchers Conducive to Cocaine
Abstinence
CHICAGO, IL — JAMA, January 15, inspect drug vessels at sea. Serious drug 1996, Vol 277, No. 3, p. 183 (abstracts), replaced their jailed members,” said the Methadone Maintenance Patients Through prosecute wealthy suspects of laundering group of experts established by the U.N. It corruption is serious; the government has bases most of its data on studies done by failed to account for $1.5 million in U.S. “Germany Rethinks Law on
injecting drug users (IDUs), rather than Heroin”
being unemployed street people, are more given a choice in determining their dose, likely to be married with children and on patients would most likely either increase or decrease it (64% total); rather than “no change” as we previously reported. For readers comments, see the Spring edition became heated as a bill was submitted to were married or had a partner; 41 percent New Journal Specifically for MMT
Germany’s federal government promoting had at least one child; 30 percent earned Community
the trial prescription of hard drugs. This over $30,000. Surprisingly, it was found that 40 percent of users shared needles, following the so-called “Swiss Model.” and a quarter tested positive for hepatitis (Vol. 1, No. 1; 1997) of the Journal of Maintenance in the Addictions focusing abused substance, followed by heroin.
mayor of Hamburg, “We must accept that we have lost the fight against drugs with practice surrounding opiate addiction and half of the addicts in Hamburg participate inadequate because it is based on in various drug rehabilitation programs, a stereotypes not supported by the survey. 140 page journal features reports of new core of long-term and heavy heroin users and original scientific investigations, book remains inaccessible.” He is proposing reviews, policy position statements, and that addicts be allowed to receive heroin education programs might not be properly Among the topics presented in this first reassess some of our particular programs increased by nearly ten percent in 1996. A survey by EU’s drug monitoring center in increasing early engagement of patients in Lisbon reported that heroin’s use is rising treatment, patient retention in treatment, particular nation’s drug policies. Only about a fifth of Germany’s 100,000 heroin Submitted by Stewart Leavitt, PhD more.
April 1997
According to Dr. Payte, future issues will address: The effects of treatment on health Patient-Determined Dose Levels:
“Liechtenstein Ruler May OK
Drugs”
Winter 1996-97 edition of Addiction Treatment Forum featured an article and of the tiny, 62 square mile principality of reader survey on the efficacy of patient- Liechtenstein, “Drugs should be legalized for adults because current policies have a follow-up report was given in the Spring done nothing but create cartels and make For further information, to subscribe, or
should be protected from the drug market, tabulated. Here are the survey questions, professionals), Haworth Press may be but from 18 or 20, a person should be free and readers responses by percent: How much input should MMT
He further suggested that heroin, cocaine, patients be allowed in determining
or ecstasy could be sold by the state well their methadone dose levels? A
only in special areas. Hans-Adam, 51, has ruled Liechtenstein for seven years since [As always, A.T. Forum will monitor this the death of his father, Franz Jesef II, the How might this affect their daily
journal, and others in the addiction field, former ruler who kept the country out of methadone dose? Increase = 46%;
to report on significant issues and trends World War II and steered it to riches.
of interest to our readers. — Ed.] Middle Class IDUs Down Under
The tabulated results are consistent with AUSTRALIA — West Australian, March 12, 1997, p3 — new research reveals that A.T.Forum, except in our final analysis a Urine Alcohol Test Most Effective in impractical because of poor venous access advertising can shape social norms and
MMT Patients
behaviors to help curb substance abuse. “I drawing blood in this patient population. believe, as he suggests, that over time it Addiction Medicine, 28th Annual Medical- To circumvent such problems, Dr. Kell’s Scientific Conference, April 17-20, 1997 (Abstracts) — Forest Tennant, MD, DrPH plasma methadone concentrations from those must be treatment,” she wrote. “In presented a paper on the “Comparison of inaccurately suggests that substance-abuse treatment doesn’t work. On the contrary: Maintenance Patients.” It is widely known samples were compared to allow the “Mr. Krathammer cites a Rand study that stated most cocaine users are still using methadone, and the recent discovery that one year after treatment,” she continued. the progression of hepatitis C in greatly “He omitted another finding from a Rand study: ‘Substance-abuse treatment is seven times more effective in reducing cocaine at first seem like trying to turn apples into “Then there is the oft-quoted CALDATA testing of a clinic population, about 40% study, which showed that for every dollar of patients had detectable concentrations spent on treatment, society gets back an of alcohol in their urine. However, only average of $7, primarily in reduced health one subject had alcohol detected by breath specific gravity, volume of distribution, testing or testing via a saliva strip method. and gender upon renal excretion of types of treatment exhibited as much as a methadone. Hence, the program allows the 12-1 return on investment. That same with 5-10 percent accuracy. The approach following treatment.” Dr. Tennant concluded that alcohol urine sampling, resulted in the optimization of patient doses, and helped disclose patient opportunity for the addict to start life renewed. “Aftercare (which nearly always Accurate, Practical Technique for
Optimizing Methadone Dose Levels
[While it is now several years since NEW YORK — J. Addictive Diseases, publication of the above article, the 1994, Vol. 13(1), pp. 5-26, “Utilization of importance of accurately determining most of all — employment are necessary methadone levels for arriving at the most prevent relapse and become a productive, Maintenance Clinics” (Kell, MJ) — The individual patients was an issue of some absence of a simple, analytical method for importance at the recent American Revolutionary Change Proposed
for Connecticut
Conference in Chicago. This will be further explored in upcoming editions of based upon evidence of continuing opioid News-Times, January 26, 1997, “Offer Addiction Treatment Forum and on this drug abusers help, report urges” (Robert patient-reported symptoms of insufficient Miller) — A report on Connecticut’s drug information relating to the above policies could make revolutionary changes techniques, Dr. Michael Kell may be in the way the state treats alcoholics and helpful in determining optimal dose, but a sizable number of patients still continue to recommends that the state coordinate its receive inadequate doses. Many clinicians Treating Addiction Works
incorrectly assume that low doses prevent CHICAGO, ILLINOIS — Chicago toxicity and favor eventual abstinence.
Tribune, March 22, 1997, Sec 1, p 23 — in a letter to the editor, Susan L. Weed, monitor plasma methadone concentrations Director, Office of Substance Abuse should be trained to screen patients for towel on heroin, switch to methadone, and parts of the country.
In a survey of 5,000 students in L.A., 40 them like dirt.” The New York Times has concluded that it’s easier to get heroin programs should be set up in state prisons than methadone.
programs. And 70 percent had a neutral or and by clinic-affiliated private physicians. Legislative committees in the state are studying bills to make both treatment and “There is not a scientifically sound study drug substitutes more readily available. using drugs,” said Joel H. Brown, one of enough they reject those messages and the incarceration. The state currently spends Researchers claimed the “Just Say No” twice as much on the criminal prosecution other relief for their ills. Whether any of of substance abuse as it does on treatment. these, and other, reforms will pass is still honest communication, and students often Just Saying “Da” to Drugs in
MOSCOW — Associated Press, April 15, marijuana, among teens is increasing.
State Rep. Arthur O’Neill, vice chairman Drugs” (Sergei Shargorodsky) — Opium sudden influx of heroin into the state, and its widespread use across different social better drug awareness programs than those classes, will present Connecticut with a Russia. The Soviet breakup proved a boon of DARE, however, claim the failure future. So now is the best time to look at to drug smugglers as once-sealed borders results more from lack of involvement by the problems and take new steps in trying Connecticut Part II: “Common
Sense on Drugs — You’re
Kidding!”
number of drug users, estimated at about 300,000 a decade ago, has mushroomed to gardening clubs, tutorial help and Press, March 27, 1977 (also in The two million. Russia’s lack of resources recreational activities in several inner-city Weston Forum, March 29, 1997) — “In America, any sensible discussion of drugs turnabout in the drug problem unlikely.
Kids Dare to Snub DARE
Methadone Treatment Expansion
That, according to columnist Bill Collins, April 16, 1997, Sec 1, p 4, “Program to a former state representative and mayor of cut drug use may do opposite” (V. Dion Hayes) — “Despite the good intentions of Dispatch, March 2, 1997, “Addicts facing waiting list for treatment” (Alice Thomas) — Business is booming at a 26-year high indicates that the efforts do not keep kids examining the issues and starting to look upon addiction as a medical problem, not a criminal problem. “Our love affair with For over 15 years, the DARE program has program director, “as long as cocaine sent uniformed police officers into schools consumption remains high, there is an devastation of inner-city neighborhoods, other narcotics. The reason is because the back-breaking prison costs, and the worst effect of the cocaine is so euphoric and so assault on African-American society since communities. Now, a long-term study brief, and the crash is so abrupt and so devastating, that heroin and other narcotic there’s always a prison bed for an addict, there’s often not a treatment bed for those among children. Other research has wanting to quit their addictions. “It’s the from a cocaine high to enjoyable music — of 146 patients at the clinic in June 1986, dopamine in this structure. However, too the climb has been steady to the current peak. The cost per patient at the clinic ranges from $3,500 to $3,800 per year.
Pogue said the county would ideally have Submitted by Stewart Leavitt, PhD only part of the puzzle in taming
slots for 650 to 700 methadone patients, and memory affect the addictive process is Addicts Hooked on Dopamine
with shorter stays, more people could be served for the same amount of money, the pp. 69-76; cover feature story (J. critics reason. Poor and uninsured people Experiencing similar sensations at a later — the majority — pay $30 a week; tax times triggers craving, much as Pavlov’s dogs salivated uncontrollably in response addictions — heroin, cocaine, alcohol, to a conditioned stimulus. The mere sight participation in the program. “By the time nicotine, etc. — although the precise a patient hits the doorstep of a program mystery. Dopamine is a neurotransmitter, years or decades. To think that they can ferrying messages from one neuron in the have six to 12 months to fully recover is a brain to another, and is associated with feelings of pleasure and elation. Research White Collar Junkies Snort at
suggests that, more than just transmitting The Providence Journal Bulletin, March 7, 1997, “Snort, don’t shoot” (Bob Kerr) “Close to half of recovering addicts fail to — One of the most eagerly embraced drug addiction — a half dozen maintain complete abstinence after a year neurotransmitters have been identified and — about the same proportion of patients implicated to date — it may be a common with diabetes and hypertension who fail to dangers of heroin. Most shocking is that end point of all other pathways leading to younger people are trying it, according to medication regimens,” the article noted.
sensations. This controversial hypothesis Recovery Institute. “They think it’s just another drug… but heroin has a 90-to-95- how a genetically encoded trait — e.g., a NIDA, the treatment of drug abuse should not necessarily strive for a cure, as much influences to create behavioral disorders progress of the disease and alleviates its treatment “thought it might be a giggle to and/or addiction. The notion is that a great worst symptoms. “The occasional relapse do heroin, but not do it like those grubby, many substances can become addictive by is normal,” he says, “and just an indication 90-pound, disease-spreading junkies with needle tracks up and down their arms and legs and between their toes.” They did it Newfound Brain Chemicals Target
the “safe way” by snorting, until they Opiate Receptors
started getting wretchedly sick when they The recognition of dopamine’s potential Health News, April 3, 1997 — Scientists As a result of such practices, these middle reporting in the journal Nature (4/3/97 class junkies did much to encourage drug effective therapies and supports the belief they believe may lead to new painkillers that maintained abstinence not only halts inflicted by drugs, but may also reverse markets offering nearly unlimited profit act by binding to specific sites in the brain potential, a stronger grade of heroin was found two other brain chemicals that also bind to these sites, at least in mice. Led by extravagance. The gene also plays a role in the dopamine neurotransmitter/receptor methadone treatment, if needed.
system in the brain that’s implicated in U.S., Mexico Putting Platitudes Into
addiction. According to this new research, Action
addiction, like methadone, are also aimed the gene instructs cells how to make one “Mexico, U.S. Must Act in Drug War,” the newfound substances, which target mu gene is found in possibly 30 percent of President Clinton’s early may visit to the blame for the illegal drug problem in Coke Produces High By Stalling
the U.S. As the world’s largest consumer Dopamine Reuptake
Researcher Richard Ebstein admitted they of illegal narcotics, the United States need to look for more genes that might admitted that demand is a big part of the affect a person’s vulnerability to heroin News, “Cocaine-Induced Euphoria Linked addiction. Plus, genes alone aren’t the do more to stem the trafficking that feeds only reason for addiction, stressed Alan April 24, 1997 — Researchers have used their platitudes and paper promises into China Puts the Brakes on Addiction Clinton and Mexican President Ernesto
FANGSHAN, China — Associated Press, Zedillo signed a pact to devise by year’s Chinese government this spring ordered a rising drug addiction problems; including wanted in the U.S. While some drug abuse transporter sites. And the magnitude of the harsher penalties, public trials, and forced in the U.S. is declining, Americans still self-reported euphoria was correlated with drug treatment. According to Chinese consume nearly $50 billion in illicit drugs the degree of site occupancy; at least 47% propaganda, the population of registered of the transporters had to be blocked for subject to perceive cocaine’s effects.
youth between ages 12 and 21 is rising.
Blocking of the dopamine transporter sites number of addicts is believed to be drug abuse problems in the world, Mexico brain cells that release it. This allows Heroin is the biggest scourge, due to the has grown to be among the world’s most country’s shared border with the opium remain available in brain synapses longer countries. During Clinton’s visit, the U.S. than normal. This study provided the first Methamphetamines and the designer drug offered to pay $6 million for the training Ecstasy, known locally as “head-rocking between cocaine’s blockade of dopamine pills,” are popular among urban youth.
China’s drug problems are unremarkable. [See Nature 1997;386:827-833 for a Officially, about 47,000 pounds of heroin was seized nationwide in six years. In the Bid to Stop Drug Abusing Pregnant
Gene May Raise Heroin Risk
Women Faces Fight
been confiscated by police since 1992.
preliminary work, scientists at the Sarah Cocaine Babies,” May 5, 1997, Sec1, p1 have identified a gene that might raise a was arrested for using an illegal substance, based upon the presence of cocaine in her heroin. It could be a step toward giving body and that of her stillborn child. It treatment on addicts, virtually eliminating marks the first time in Illinois that prosecutors are attempting to press a drug At treatment centers, addicts are given a strict three-month regimen of lectures and The death of the infant was the woman’s physical exercise. Each addict must pay March 1997, p. 3 (Jerry Gottlick) — An Presumably, there is an erroneous concern “When you’ve got someone giving birth to convened by the National Institutes of that drug interactions between methadone multiple cocaine babies, and you see the Health has criticized the U.S. government and HIV medications (e.g., retroviral agents) would preclude such therapy.
However, legal experts claim it is not a professionals (including J. Thomas Payte, crime in Illinois or anywhere else in the Washington University Medical Center in MD, Co-Chair of the American Society of while pregnant. Attempt to introduce such significant evidence of a gap between decried the practice, stressing that there is abortion opponents arguing that addicted however, that similar panels have reached no scientific clinical evidence of similar conclusion and had minimal effect significant interactions between from getting proper prenatal care and drug on government policy, going back to the counseling if such penalties were enacted. Reagan administration.
contraindicate the conjunctive use of such Those at highest risk for HIV infection are pharmacotherapies. In some cases, dosage adjustments of the drugs in question are Forcing a patient to first withdraw from criminally punished for the harm they do to their fetuses, even in the later stages of using behaviors that might contribute to children to be removed from the homes of Daniel Single, AIDS Action Council the further spread of HIV. Added to that, the stress of methadone withdrawal might During 1996, over 2,500 babies were born prioritize science and the public health exposed to drugs in Illinois, most in Cook above moralist and timid politics. Dramatic increases in federal, state and premature death. Those patients unable to local funding for drug treatment are also and remaining in MMT without the benefit of HIV therapy could also TB & Methadone Therapies Interact
The panel urged that the substantial declines in funding for drug abuse BETHESDA, MD — American Journal of Health-System Pharmacy, April 1, Payte and others urged the Italian Minister to re-examine the current policy in that it seriously jeopardizes both the treatment of detoxification not only decrease drug use but also substantially reduce the frequency addiction.
[The Italian Minister may be contacted users.” The panel also noted that needle at: Onorevole Maria Rosaria Bindi; dell’Industria, 20; 00144 Roma, Italy; remove its current ban on such programs.
dosage to 150 mg/d led to suppression of HIV Treatment Withheld from Italian
Submitted by Stewart Leavitt, PhD
MMT Patients
June 1997
CHICAGO, IL — via e-mail to A.T. Forum — according to reports coming Shhh… It’s A Secret… Methadone
combination TB therapy with methadone.
from the American Methadone Treatment Works
Panel Sends HIV Plea to
Government
April in Chicago, Italian physicians have York Times, “One of Medicine’s Best- allegedly made it a practice to withhold Kept Secrets: Methadone Works,” June 3, HIV treatment from addicts in methadone 1997 (Christopher S. Wren) — In a well- “HIV Interventions Held Inadequate,” of our Web update deadline the bill — the legislature is a lifetime to people with SB1182 — only required governor Don the disease of addiction.” -Ed.] highlights the successful experiences of Elsewhere, New MMT Clinics Meet
The bill was in response to a proposal for Welcome Wagon
ERIE, PA — Erie Daily Times,
intense community opposition. Two other “Methadone Center to Open in Erie,” May methadone regularly, Wren notes, and it is and Bristol also created an uproar of accepted as the closest thing to a heroin headquartered in Pittsburgh received state cure, only about five to twenty percent of exemptions allowed by the bill are for a users stay on it for more than ten years.
center in Erie. This is the firm’s first relocate within three miles of its current operation, another is being developed in medication. Others relapse into drug use. wanting to relocate within 1.5 miles of its The Erie center will only accept private- often petty bureaucracy that administers paying patients, since under federal and It is felt that the one year ban will allow state law new treatment facilities cannot accept medical assistance patients for one insidious social stigma that by equating entire issue of methadone treatment in the year. The operation, intended to serve an methadone with illicit drugs, forces users state. Some believe that this could bring a eight county surrounding area in day when methadone is administered only northwestern Pennsylvania, will eventually have a capacity of 500 patients.
According to Dr. Edwin Salsitz, director of the methadone maintenance program at Wallace Center in Nashville — currently Beth Israel Medical Center, “Methadone Critics of the for-profit clinics claim they very heavy on the counseling. Our belief is that methadone serves as an adjunct to counseling to encourage heroin addicts to the treatment process and not a trade-off programming or social rehabilitation.” Ron Ramsey, “clinics with a profit motive The center’s goal is to create a drug-free abstinence: “Methadone is a very useful drug for a limited number of people. It has methadone treatment. I think there is a proper place for methadone, but it should be considered on an individual basis.
be in a clinical setting where the goal is to WARWICK, RI — Warwick Beacon,
multiple drugs and have limited education get people off heroin and other opioids.” “Methadone Clinic Opens, Need Seen,” and job skills, “they are not going to be happen after the year [of the moratorium] associated with large metropolitan areas, Salsitz conceded that, “Methadone can’t new for-profit methadone treatment clinic you literate.” But for healing the medical symptoms of heroin addiction, he equates [A.T. Forum has been following this complicated issue for several months, and operator of the clinic, has another diabetics and other medicines are for high the above reported outcomes might have treatment facility in Pawtucket, RI.
changed since we last checked into the After being open for but a few weeks the Tennessee Curbs Methadone
matter. Also, in a letter by Robin Robinette of the Tennessee Methadone Courier, May 23, 1997 (Rick Wagner); Sundquist, she stated, “It would be a Kingsport Times-News, May 25, 1997 (Matthew Franck); Newport Plain Talk, Disabilities Act for the state to impose outstanding in its ability to listen to us and reprehensible when so many addicts are traditionally has a ‘can do’ attitude.” having such a difficult time getting into HILO, Hawaii — Honolulu Star
treatment with the restrictions that Bulletin, “Drug Treatment Bound for currently exist. HIV is not going away, two clinics currently being developed. [As and heroin in everywhere. …. One year to — Drug Addiction Services of Hawaii (DASH) based in Honolulu is expected to there’s no longer the threat of getting publicly funded drug treatment centers in Baltimore will either be forced to close or There are already 25 patients in that locale 550,000 true heroin addicts in the U.S. The state will no longer pay $4.8 million in subsidies to the centers, affecting nearly each day to a clinic in Hilo for methadone. 700,000.
representing 17 percent of the city’s drug people reported using heroin during a one director of the Addictions Recovery activity in 1995. Meanwhile, the federal claim heroin use has increased because the government’s Drug Abuse Warning type of drug has changed from injectable “Asian White” to smokable “Black Tar room visits escalated from 63,200 in 1993 habits.” in how the state will pay for treatment for Swift Deaths For Drug Dealers
the poor. Patients whose bills are paid by BEIJING, China — Chicago Tribune,
getting tough on drug dealers, executing at something to lose by staying addicted,” a least 38 people just a day after 27 others drug called naltrexone often is ideal. It patients are treated. Because many of the blocks the narcotic effect of heroin and city’s treatment centers are not under southwestern narcotics trafficking region. works well for addicts with social support contract by the six managed-care Immediate executions of the drug dealers Vietnam Proffers Drug Cure
patients and the Medicaid funding they’ve UNITED NATIONS — Reuters, June 12, been receiving. Some directors said their JIDDAH, Saudi Arabia — Associated
clinics would have to close, leaving whole reportedly stepping up testing of an herbal to get help.
bringing to 20 the total number of people medicine that Vietnamese doctors believe Canada Issues Bold Proposal to
Fight HIV/AIDS
month. The medicine, called “Heantos,” VANCOUVER, British Columbia — The HANOI, Vietnam — Associated Press,
contains 13 traditional herbs and has been Vancouver Sun, “Legalize Cocaine and tested on 3,000 Vietnamese addicts. It is Heroin to Fight AIDS, Study Says,” May taken in liquid doses for three to five days, 23, 1997 (Stewart Bell) — “A National selling more than 1.8 kilos (3.9 pounds) of and then in tablet form for another month.
Action Plan” is the title of a bold report heroin was sentenced to die before a firing issued by the Task Force on HIV, AIDS & [More complete data on research results were not available in the press report. - “Heroin Habit Spreads Among The
Ed.] Side effects have allegedly been Affluent”
minimal. Full testing will require another The eleven member Task Force panel was coordinated through a partnership ARLINGTON, Virginia — USA Today, May 21, 1997 (Marilyn Elias) — A panel Substance Abuse; about 80 groups in total affluent, well-educated heroin addicts are Budget Cuts Put Bite on Baltimore
The report said, “The illegal status of drugs makes the user afraid to go to health allowing it to be sniffed or smoked, rather essential education on safer use of drugs for fear of being seen to condone use.” Matthews) — Facing state budget cuts, 41 Weiss found animals suddenly taken off a surge of corticotropin-releasing factor in chemical/behavior relationships were seen amounts of narcotics for personal use. intense craving for drugs. It is an ancient heroin-related opioids, and alcohol.
nervous system, triggering the release of A second study in Science, by Italian the body’s internal system in balance.
Seventeen states, including over half of Provide treatment options that do not America’s 200 drug courts, use acupuncture as part of drug court-offered but they may not relate to humans. “When states where doctors must administer the you study drug abuse, you have to look at AIDS among drug users, costing $100,000 treatment.
a lot of social issues, which you can’t do per HIV case, is a public health crisis not well understood by the public, the report Drugs of Abuse Booming in U.S.
every four intravenous drug users has the AIDS virus, and the city has the highest diarrhea, nausea, accelerated heart beat, HIV infection rate among drug addicts in and insomnia. However, there seems to be Publication - Annual Report for 1996: a lack of controlled clinical studies on acupuncture’s success as a stand-alone increasing in popularity with most users addiction treatment modality. Often it is “an important issue to look at because it used as an adjunct to other therapies.
suburban residents are entering the fold of Submitted by Stewart Leavitt, PhD users.
Pointed Doubts About Acupuncture
July 1997
Heroin’s high purity and low prices are DAYTON, Ohio — Dayton Daily News, Marijuana Gateway to Harder
“Pointed Debate: Experts on Both Sides acupuncture say it’s more effective in Availability of cocaine and crack is high According to a study using laboratory rats in most areas, but use has stabilized and and reported in the journal Science, chronic use of marijuana causes chemical large number of outpatients. Drug courts in states like Florida offer the therapy as chemistry changes caused by smoking pot Marijuana use is increasing and readily available everywhere but in parts of the offenders volunteer for the treatments.
verboten in Ohio’s drug courts since 1992, “Chronic drug abuse often enhances the effects of stress,” said Friedbert Weiss of Addiction and Alcohol Services doesn’t Marijuana joints laced with crack or PCP treatment for drug abuse, citing the lack of are young users who usually do not deal in “Any drug that an individual comes across controlled research studies. The Ohio ban might provide relief. Once the relief is experienced, then the use of that drug in most popular form is “crystals” which are snorted or injected, and often used as a doctors had to amputate the entire arm and patients to park.
shoulder from one side of his body to save Abstinence Depends on Methadone
Dose, Support Services
Urine Better Than Breath To
ROCKVILLE, MD — Clinical Psychiatry becoming more prevalent in the Southwest Monitor Alcohol Abuse
ROCKVILLE, MD — Internal Medicine News, “Urine Test Picks Up Alcohol Use Diego, Dr. Richard Schottenfeld noted the There is growing interest in “natural” many containing ephedrine that reportedly researchers said urine testing is far more opioids ranges from less than 10 percent mimics methamphetamine. They are often effective at detecting alcohol abuse in variation is largely due to the program’s Dr. Forest Tennant, executive director of addicts who also have a diagnosed mental Group, West Covina, said urine testing Shottenfeld, of Yale University School of Dual Bugs Bite Into California Drug that occurred 12-24 hours prior to testing. good evidence to show that 30-40 mg/day
Scene
Breath testing only detects acute alcohol less than 35 mg/d continue to use heroin.
News & Review, “Double Plague,” June associates gave urine and breath alcohol tests to 187 MMT patients. They found 75 produce opiate tolerance. In one study patients tested positive on the urine test, mentioned, only five percent of patients continued to use heroin when their daily alcohol concentrations via breath testing.
necrotizing fascitis caused by flesh-eating “It’s [urine testing] been an excellent are highly unlikely to be using heroin if bacteria that destroy human tissue at the therapeutic tool,” said Tennant. “We the dosage is more than 80 mg/d, although NIMPL — Not In My Parking Lot
QUINCY, MA — The Patriot Ledger, [It should be noted that the dosage levels “Find a place for methadone clinic,” June 90 percent of the 460 IV drug users tested reported as optimal by Shottenfeld are 19, 1997 — For years, clinics have faced effective vaccines for hepatitis A and B, presented by experts in Addiction there isn’t one for the deadly HCV.
Treatment Forum. Further, reported clinical experiences indicate that dosage parking lot in which to provide services must be individually tailored to patients and some patients may need well in excess die yearly from complications related to The Boston suburb of Weymouth wants to of 100 mg/d to achieve abstinence. — ed.] estimates, that number could increase to Clean Needles Alone Can’t Stem
within its town borders, suggesting that it Tide of HIV
clinic has been bounced around from a car dealership parking lot, to a state park, to a least half the cases were linked to IV drug shopping mall. All that’s needed is a place use, with some victims dying within hours programs alone are not enough to curb the after getting infected via injection. One Marijuana is the most widely abused drug, Pot Penalties Softened Down Under
SYDNEY, Australia — Sydney Morning percent incidence rate [of HIV infection in percent of the world population. Use of Herald, July 12, 1997 (forwarded by injection drug users, which] is the highest that I’ve seen recorded anywhere, and it doesn’t seem to be getting any better,” and 1994. The average age at first use of testing the electorate’s reaction to drug Why aren’t the availability of sterile Mexican Drug Traffickers Gain
law reform with proposals to remove jail needles enough to stem the tide? “Cocaine Clout
users are injecting more frequently,” he The possession for personal use of up to said, “[but] the other issue is that when they’re high on cocaine their judgment is Snow) — Once they were “mules” for cannabis leaf, two grams of cannabis oil, extremely impaired… so that in a sense Columbia’s powerful cocaine cartels, but many of them don’t care about anything Mexico’s narcotics traffickers have now incur only fines or no penalties at all.
grown into drug lords in their own right. thousand clean needles in the next room, but that doesn’t matter, they just want the shifted from Andean jungles to America’s South Wales prisons, the marijuana reforms will also provide the Government crucial for sterile syringe provision,” he distribution networks in the U.S., and they attitudes on drugs. Officials said they continued, “they should be considered one produce most of the amphetamine used would monitor the reaction as a guide to bypassed the Colombians several times to heroin, such as providing safe injection Illegal Drugs Big Business
Worldwide
for the cultivation, possession, and supply Administration, “These sophisticated drug of large quantities of marijuana. An official of the National Drug and Research billion-a-year business worldwide, equal Centre said removing the threat of jail for to eight percent of all trade, according to a Colombia as the premier law enforcement minor marijuana offenses would mean the report by the United Nations International threat facing the United States today.” debate over the drug’s use would become Because of the power shift, drug-related one based on health grounds rather than a violence and corruption regularly spills automobiles and about equal to the global over the U.S.-Mexico border, threatening quickest way to turn minor offenders into historically sensitive relations between the hardened criminals is to put them in jail.
Seizures of drugs have been rising and the two countries.
Swiss Heroin Giveaway Touted As
U.N. estimates 30 percent of all cocaine Further, Mexico’s drug gangs have tainted Success
and 10-15 percent of heroin shipments are high government posts in a developing intercepted. But demand and profits are so nation of some 93 million people that has high that interdiction has barely dented the recently teetered on the edge of political Medical Prescription of Narcotics: Final business and drug traffickers simply find and economic crisis. American lawmakers Report of the Research Representatives”

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