Obituary: PCSS-Methadone

April 21, 2012 By ATForum 1 Comment

The Physicians’ Clinical Support System for Methadone (PCSS-M) died a quiet and unnoticed death last November when its grant was not renewed. Initially, when the Substance Abuse and Mental Health Services Administration (SAMHSA) launched the PCSS-M project for methadone mentoring, it was intended to bring the expertise of methadone treatment providers to opioid treatment programs (OTPs). The grant for the Physicians’ Clinical Support System for Methadone (PSCC-M) as well as PCSS-B (buprenorphine) went to the American Society of Addiction Medicine (ASAM).

OTPs were able to get telephone or e-mail responses from PCSS-M on issues such as initiating and titrating methadone, converting from other opioids, management of co-occurring conditions, and patient assessment and selection. In addition, physicians using methadone for the treatment of pain were able to access PCSS-M for clinical information and specific questions.

ASAM’s grant for PCSS-M and PCSS-B expired and was not renewed last fall. At the same time, PCSS-M was killed, and replaced by PCSS-Opioids. Both PCSS-B and the PCSS-Opioids went to the American Academy of Addiction Psychiatry (AAAP) and its partners, the American Osteopathic Academy of Addiction Medicine (AOAAM) and the American Psychiatric Association (APA). Now if you want information about methadone, you are supposed to go to http://www.pcss-o.org/. But you’ll find more information about pain. Even SAMHSA didn’t publicize that it had made this change. We found a link to it on the SAMHSA Recovery Month website (http://www.pcssmethadone.org/). The link takes us to the Social Work Leadership Institute.

Not much of a gravestone.

Filed Under: Blog, Medication-Assisted Treatment (MAT), Methadone Tagged With: ,

New Study: Methadone Clinics Don’t Bring Crime to Neighborhoods

April 6, 2012 By ATForum Leave a Comment


The NIMBY (“not in my backyard”) people are at it again. But a new study refutes their claims and shows that methadone clinics don’t attract crime.

The Good News

Crime Rates Aren’t Higher Around Methadone Clinics

In a well-designed study published online in Addiction, March 2, 2012 ahead of print, investigators compared data from a computer listing of all FBI reports of serious crimes, such as robbery, homicide, and sexual assault, in specific areas of Baltimore. The areas included 13 methadone treatment centers and three types of control locations: 13 convenience stores, 13 residential points, and 10 general medical hospitals.  The study team found no significant increase in crime around methadone treatment centers (MTCs) or general hospitals. (The study period was January 1, 1999 through December 31, 2001.  After collecting the data, the team spent several years developing the technology and analyzing the data before publishing the article.)

And—here’s something very interesting—investigators did find significantly higher crime counts close to convenience stores. Bottom line: Methadone clinic neighborhoods, unlike those of convenience stores, are not associated with a higher crime rate.

The authors note, ”Our finding that MTCs are not associated with increases in neighborhood crime addresses a major impediment to the establishment of new clinics, and should lead to greater availability of methadone maintenance treatment for the many persons who need it.”

Let’s hope the NIMBYs are paying attention.

Reference: Boyd SJ, Fang LJ, Medoff DR, Dixon LB, Gorelick DA. Use of a “microecologic technique” to study crime incidents around methadone maintenance treatment centers [published online ahead of print March 2, 2012].  Addiction.  doi: 10.1111/j.1360-0443.2012.03872.x. 

But Emotional Protests Persist

From Orange County, Florida: a methadone clinic that opened last month is the latest in a string of establishments “bringing crime to the neighborhood,” some residents complain. Locals told WFTV’s Drew Petrimoulx that pain clinics and pharmacies moving into the area are “attracting the wrong kind of people.” “There’s a lot more vagrancy.” A resident gave WFTV a photo of two people passed out at a bus stop; she said the pair had just left the new methadone clinic.

It’s not as if this was an elite section of Orange County to begin with. In fact, one resident asked why the neighborhood was picked for a new methadone clinic when the area already had so many problems. 

Readers responding on the WFTV website echoed that opinion:

“Don’t make me laugh. That area has been horrible for a decade or more.”

“That area has been called heroin run for many years.”

“ . . . one is a fool to go near there.”

(http://www.wftv.com/news/news/neighbors-say-methadone-clinic-bringing-crime/nLPyN/).

Another From Somers Point, New Jersey: Fear gripped residents when an 89-year-old woman was attacked and sexually assaulted in her home. A suspect was arrested, and the incident apparently is totally unrelated to the local methadone clinic that has been operating for 10 years. But that hasn’t calmed people. They’re upset and angry about the clinic. Staff writer Christopher Ramirez said residents are “fed up with problems in their neighborhood and are placing blame for recurring issues on a methadone clinic directly across from their homes.”

The City Council got creative and found a novel way to spur the methadone clinic to move: it introduced an ordinance to prohibit parking on the street bordering the clinic.

(http://www.pressofatlanticcity.com/news/top_three/article_68980e70-bee0-11df-be4a-001cc4c03286.html.)

And lastly from Salem, Florida: the Zoning Board of Appeals last month unanimously rejected a permit request for a methadone clinic. SalemPatch.com says Community Substance Abuse Centers (CSAC) plans to appeal, raising alarm among residents.

The ZBA’s stated reasons for rejection: traffic concerns and the residential character of the area, which includes Witchcraft Heights. [The Salem name is linked with a rumored ghost population; some say Salem is “bursting with struggling spirits just waiting to spook you.” Maybe that’s part of the problem. www.ghostsofamerica.com.]

Any evidence of a rise in crime around existing clinics? Not that Salem Police Chief Paul Tucker is aware of. He should know, and he supports having a methadone clinic in Salem.

http://salem.patch.com/articles/area-police-chiefs-meth-clinics-dont-up-crime

Sometimes Good Sense Prevails

As reported on the AT Forum website last November, a Warren, Maine methadone clinic won a NIMBY battle after a yearlong fight. Education, mediation, and lawsuit considerations triumphed over a classic NIMBY response based on emotions, and the community finally granted permits for an opioid treatment program.

http://atforum.com/news/2011/11/methadone-clinic-wins-nimby-battle/OTP Patients

(All sites accessed March 30, 2012.)

 Tell us about your OTP NIMBY experiences and how you overcame them. You
 can post your comments by clicking the comment link at the top of this page.

 

Filed Under: Blog, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), Methadone Tagged With: , , ,

15-Minute Methadone in Baltimore – Police and Public Health vs. the Regulators

August 10, 2011 By ATForum Leave a Comment

Baltimore is on the verge of a showdown over methadone. It’s not the usual NIMBY battle – Baltimore has embraced medication-assisted treatment for opioid addiction since the days of the well-informed and visionary Mayor Kurt Schmoke. Instead, it’s about something called “open-access” methadone, in which someone can come in for a quick assessment and get the medication within 15 minutes.

Waiting lists for treatment in Baltimore, where heroin addiction is a long-time problem, mean that many people are turned away for treatment when they most need it and are most likely to benefit. What are they supposed to do for a month while they are waiting to be admitted? Most go back to their dealers.

Now, one program is vowing to tackle the regulatory apparatus preventing methadone treatment from expanding and is just going to do it – at least that’s what the operator says.  In late June, Rev. Milton Williams, pastor of the New Life Evangelical Baptist Church in Northeast Baltimore, who already operates a traditional opioid treatment program “Turning Point”, said he would start offering “open access” methadone – treatment within 15 minutes – on July 5.

No, it’s not endorsed by the Maryland Alcohol and Drug Abuse Administration or the state’s health department, which has not given approval for the scheme. But Williams said his church is going to go forward with it anyway, adding that he would be able to treat 100-150 more patients a day.

And Williams has a well-placed and powerful supporter: the Baltimore Police Department. Even the police department is in favor of Williams’ plan.

The Baltimore Sun published stark statements from the police department saying that arresting addicts was not going to happen anymore. Detective Donny Moses, spokesman for the department, said he “had a change of heart” about arresting addicts after five years in the narcotics division. “I must have arrested a million and one people addicted to heroin, and I thought there had to be a better way,” he said. “I was thinking this was someone’s daughter or son and someone was praying for you.” Moses added: “The Police Department is no longer interested in locking up all the addicts.”

And Lt. Col. Ross Buzzuro from the police commissioner’s office said: “We can’t arrest ourselves out of this problem.”

Some critics rightly point out that counseling and other services are important, as well as methadone, to treatment. But in the absence of any funding for extra treatment, giving out the medication will at least give patients a safe option to street use of heroin or other drugs.

Like so many people who are passionate about treatment, Williams has personal reasons for being involved. His daughter was shot in a drug deal in 2002. She left three children behind.

On one side a pastor who is a zealous advocate, a community which is infested with drug deals, a police department that knows what drugs are doing to the neighborhood, and a drug that has been the single most successful treatment for opioid addiction for more than half a decade – and on the other bureaucrats who may not step far outside their well-appointed offices and who see no problem with waiting lists lasting a month, not to mention rulemakings lasting years – and it’s not hard to decide which side has the moral imperative in this showdown.

Which will win is another story.

Filed Under: Blog, Medication-Assisted Treatment (MAT) Tagged With: , , , ,

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