A New Edition of Slaying the Dragon: The History Of Addiction Treatment And Recovery In America By William L. White

Slaying the Dragon“A new edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America has just rolled off the presses. The first edition (1998) went through multiple printings and has been used as a text in collegiate addictions studies programs. Of even greater import has been how this history helped many people in recovery see themselves as “a people” and contributed to the rise of a new recovery advocacy movement in the U.S.

Multiple circumstances created the need for a new edition of Slaying the Dragon–recent seminal research on earlier periods of history, the accumulation of more than 16 years of new addiction and recovery research and, of course, events of enormous significance that have transpired since 1998. That addiction treatment has gone through significant challenges and changes in the past 16 years is self-evident, but readers may not appreciate some of the momentous and unprecedented events that have occurred within the larger history of addiction recovery. Such events include the growth and diversification of recovery mutual aid societies, the cultural and political mobilization of people in recovery, the emergence of new grassroots recovery support institutions, the rise of recovery as a potentially new organizing paradigm for national drug policy, key breakthroughs in recovery research, and rising efforts to fundamentally redesign addiction treatment.”


Source: WilliamWhitePaper.com – June 29, 2014

Blog by William White: The Language of Recovery Advocacy

RecoverySome will question why we as recovery advocates should invest valuable time debating the words used to convey alcohol and other drug (AOD) problems and their solutions when there are suffering individuals and families that need to be engaged, recovery support resources that need to be created, communities that need to be educated, and regressive, discriminatory policies that need to be changed.  We must invest this time because achieving our broader goals depends on our ability to forge a recovery-oriented vocabulary.

Words have immense power to wound or heal.  The wrong words shame people with AOD problems and drive them into the shadows of subterranean cultures.  The wrong words, by conveying that people are not worthy of recovery and not capable of recovery, fuel self-destruction and prevent or postpone help-seeking. The right words serve as catalysts of personal transformation and offer invitations to citizenship and community service.  The right words awaken processes of personal healing, family renewal, and community and cultural revitalization.  The wrong words stigmatize and disempower individuals, families and communities.

It is time people in recovery rejected imposed language and laid claim to words that adequately convey the nature of our experience, strength and hope.  We must forge a new vocabulary that humanizes AOD problems and widens the doorways of entry into recovery.  We must forever banish language that, by objectifying and demonizing addiction, sets the stage for our sequestration and punishment.  We must counter the clinical language that reduces human beings to diagnostic labels that pigeon-hole our pathologies while ignoring our strengths and resiliencies.  We must also reject the disrespectful and demeaning epithets (e.g., “retreads”, “frequent flyers”) professionals sometimes use to castigate those who need repeated treatment episodes.”


Source: WilliamWhitePapers.com – June 7, 2014

From the Publisher—Special Issue on Recovery From Opioid Addiction


For six decades methadone maintenance has been an approved treatment for opioid addiction. People who are taking methadone are no different from those who manage their diabetes by taking insulin: they are in recovery. Yet some policymakers—and even some medical, and yes, some addiction authorities—don’t believe it. Although that may change as more and more professionals buy into the scientific fact that addiction is a brain disease, and therefore it can be treated, and people can recover from it.

The federal government, from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the Office of National Drug Control Policy (ONDCP), states that medication-assisted treatment (MAT) is recovery. In this issue, we write about a comprehensive literature review funded by SAMHSA demonstrating the efficacy of MAT. And we cover an article by William L. White describing the stigma and other obstacles methadone patients face when joining 12-step groups—and the important role these groups could play in helping patients in recovery. We also interview Walter Ginter, peer, patient, and advocate, who spoke before the ONDCP in December on the topic of recovery and MAT. Mr. Ginter, a methadone patient in long-term recovery, is an articulate spokesman for methadone and for patients, helping to guide peer services across the country from his position at MARS, in New York City. We also interview Zac Talbott, based in the less-welcoming South, about his work as an advocate.

Not all of the news is good: In New Jersey, a state that strongly endorses methadone as a treatment for opioid-dependent pregnant women, a woman is facing child abuse and neglect charges simply for being in a methadone program while pregnant. The Supreme Court is due to hear the case, and legal and medical authorities are hopeful that the court will not in effect ban MAT for pregnant women. The woman was in recovery, doing the right thing for herself and her baby, yet was reported, and was held by a lower court to have committed child abuse and neglect by being on methadone while pregnant. On the bright side, the best legal and medical minds who know about MAT have filed a friend of the court brief on the mother’s behalf.

In Philadelphia, where AT Forum attended the AATOD conference last fall, recovery transformation is happening in a solid way, moving from treating addiction as an acute episode to a continuum instead, in which someone enters recovery as a person, not a patient. Roland Lamb discusses efforts to help opioid treatment programs (OTPs) provide what is needed for recovery, with more of a focus on the person than on the dosage and the monitoring. Methadone is a way to recovery—that’s why it was created—but the person taking it is the point of recovery.

Finally, a new evidence-based document from ASAM provides guidance for safe methadone induction and stabilization in OTP patients. This is the first time this vital information has been brought together in one place. Our article by Stewart Leavitt is recommended reading for everyone interested in methadone maintenance treatment.

I hope you enjoy this issue, and we look forward to your comments and feedback.

Sue Emerson

Interview: Zac Talbott on Being a Patient and Certified Advocate for Medication-Assisted Treatment

Zac 2-9-14Patients and other individuals who are advocates are a growing force in medication-assisted treatment (MAT) for opioid dependence, providing information and support to patients as well as assistance to opioid treatment programs (OTPs). Advocates also are an essential link between patients and OTPs. They are not as well known as they should be, there aren’t enough of them, and they are in dire need of funding.

In January, Zac Talbott, a patient who is the director of the Tennessee Statewide and Northwestern Georgia chapter of the National Alliance for Medication Assisted Recovery (NAMA Recovery), shared his experiences with addiction, treatment, recovery, and patient advocacy with AT Forum.

 Getting Started in Advocacy: The CMA

Patients and others who want to be advocates need to first have a good knowledge of advocacy and the various issues surrounding MAT. Taking the CMA (Certified Medication Assisted Treatment Advocate) course and obtaining certification gives both patients and health care professionals the basic grounding for advocacy. Certification is essential to being a credible advocate. “There are patients out there who often are well-meaning, who claim to be advocates, but who can do harm,” he said. “A lot of folks without training do not realize that advocates have a code of ethics, and one of the main ethical guidelines is confidentiality. It goes to the heart of our professional credibility. There has never once been a case of a patient’s confidentiality being violated by a CMA working with NAMA-R.”

The second crucial skill that CMAs have is knowing how to communicate with OTPs on behalf of a patient. “You can make things worse for the patient you’re trying to help if you come off like an attack dog. Patients and OTPs agree on more than 90 percent of the issues, and that should always remain the primary focus. It’s also important to remember that the job of a patient advocate is to advocate for what the patient wants. We can’t take off and start a crusade without that patient wanting us to,” he said.

NAMA-R developed the CMA training course with no funding, which was a tremendous challenge. However, the course has been strongly supported by the American Association for the Treatment of Opioid Dependence (AATOD), and the federal Center for Substance Abuse Treatment (CSAT).

 Volunteering and Funding

Some NAMA-R chapters could do significantly more if their expenses were paid. Members are committed people who largely volunteer their time and give of themselves without any compensation.

NAMA Recovery chapters do need funding. NAMA-R is a 501c3 non-profit organization, so donations are tax-deductible. All other industrialized countries fund organizations like NAMA-R, said Mr. Talbott. “The United States is the exception. This leaves NAMA-R dependent on donations from patients, for-profit OTPs, and the pharmaceutical industry.”

In Tennessee—and in many other states—Medicaid won’t currently pay for MAT with methadone. “It’s all cash down here,” he said. The fee for patients is $300 to $400 a month—frequently all the money a patient has.

Mr. Talbott hopes NAMA Recovery can partner with OTPs for funding and support. “We had a wonderful meeting with Chief Operating Officer Jerry Rhodes and the regional managers of CRC Health Group during the AATOD Conference in Philadelphia this past November,” he said. “They recognize that advocacy is extremely important.”

 Insurance and the ACA

Whether the Affordable Care Act (ACA) will help fund MAT is still unclear, said Mr. Talbott. “It’s supposed to, but insurance companies are good at finding loopholes.” Implementation and enforcement are still problematic.

In Tennessee, for example, the state is making it impossible for new OTPs to open, which means that facilities are opening up across the state border. “Programs in other states are treating the patients that Tennessee isn’t,” said Mr. Talbott. If Tennessee Medicaid were to say that patients had to be treated in a Tennessee facility, that might make it more attractive for programs to open in Tennessee.

Even though his organization is in Tennessee, most of Mr. Talbott’s calls come from outside the state—just because there are so many patients, especially in nearby southern states, who need help. NAMA-R has always had difficulty recruiting individuals willing to make a commitment to advocacy and start a chapter. Stigma, prejudice, and just plain fear have been barriers in southeastern states.

 From Pain Medication to Heroin

Mr. Talbott’s addiction started—as with many people—with a prescription for hydrocodone for a chronic painful condition. Most people feel sick when they take opioids, but Mr. Talbott is part of the 10 percent of the population that is susceptible to addiction. “I loved them,” he said of opioids. His addiction sent him to buying pills from a pill mill and eventually to the street, where he also bought heroin. “This was in the late 90s,” he recalled. “Within eight years I went from a couple of prescribed hydrocodone a day to 25 prescribed 30-milligram doses of oxycodone.” He became an intravenous drug user within four years of initially starting the pills.

“The opposite of the stereotypical drug user,” Mr. Talbott had two college degrees when he first became addicted to opioids, and came from a well-known and well-respected family—“church folks,” he explained.


Then, there was treatment. “I went for all the wrong reasons—I didn’t go because I was seeking recovery,” Mr. Talbott said of his treatment in an OTP. “People who are drug users think that there’s no withdrawal, and that you might even get a little buzz.” But six months after entering the OTP and starting methadone, he found that he was in recovery—by accident. “I had no craving. I stopped using the needle. I was thinking about my life again—by accident. The person I was prior to the addiction quickly started to re-emerge. That’s the beauty of methadone.”

After that, it took Mr. Talbott a year to focus on recovery and life. “There’s so much you need to do, straightening out your credit, fixing everything you did when that disease is active.” When his addiction was at its height, he was in the middle of his masters’ in clinical social work. Ultimately, the addiction took over and he left the program. But even before his addiction, he had always wanted to be in a helping profession—a mental health counselor, an Episcopal priest, or a lawyer. “I wanted to help people,” he said. “Once I was in recovery, that part of me came back quickly.”

He found NAMA Recovery because his counselor recommended it as an alternative to driving to the clinic for four group meetings during his induction period in treatment. “I had to drive more than two hours one way to the OTP because I was so rural. So my counselor said to go to the website—methadone.org—print out, read, and bring in one of the Education Series to discuss ‘and that will count as one of your groups.’” Ultimately, he wrote to the NAMA-R chapter coordinator and said a NAMA Recovery chapter was needed in Tennessee.

NAMA Recovery’s main goal is advocacy, and that is where Mr.Talbott saw his life heading. “It’s a natural fit,” he said. “To be a MAT advocate is to advocate for the patient in treatment, but we’re not patient advocates only or specifically. ‘The patient comes first,’ as Rokki [Roxanne Baker, NAMA-R president] often says.”

 Partnership With OTPs

Patient advocates can have a lot of power, not only on behalf of patients, but on behalf of providers. When onerous restrictions are imposed by states, especially states that don’t have an AATOD chapter, providers call NAMA Recovery. “We are more than just patient advocates, we are MAT advocates,” said Mr. Talbott. “We advocate for the entire modality.”

About a third of the calls he gets—Tennessee joined AATOD just last fall—are from OTPs, said Mr. Talbott. “Sometimes patients and providers don’t have the best relationship. Some OTPs view advocates as whistleblowers and troublemakers, and sometimes the OTPs get defensive as soon as advocates call them. Several of us are trying to stress to OTPs and patients that we’re all on the same team.”

Technically, the provider advocacy organization is AATOD. But when there is an issue that draws both patient and provider complaints, Mr. Talbott reaches out to consult with AATOD president Mark Parrino or the state chapter of AATOD. “We can strategize together,” he said. Sometimes the approach involves filing a complaint with the Department of Justice or SAMHSA’s CSAT, which regulates OTPs. Often, OTPs haven’t even heard of NAMA Recovery, and sometimes haven’t heard of AATOD either, he said.

“The way to go is moving away from patient advocacy specifically and toward MAT advocacy as a modality,” said Mr. Talbott. And patients who are certified advocates can be of immense help to OTPs, whether they are testifying before the legislature or making a complaint to the Department of Justice. Patients and providers aren’t always going to agree, but ultimately they’re fighting the same battles and striving for the same goals.

NIMBY and Other Problems: Still an Uphill Battle For OTPs, But Hope Seen In Patient Advocacy

advocacyThe NIMBY (Not In My Back Yard) syndrome is one significant challenge for opioid treatment programs (OTPs), which can’t operate if they can’t get approval from municipalities. Methadone maintenance treatment has been proven effective and producing good outcomes for five decades, but that isn’t preventing politicians from pandering to prejudice and discrimination. Still, the field is forging ahead, opening new programs and providing access to treatment to needy patients.

Sally Friedman, legal director with the Legal Action Center, said that local authorities often try to zone out drug and alcohol programs in general, but it’s even more difficult to site a methadone program. “It’s challenging to site any type of facility that serves people who folks don’t want around,” she said. “I’ve seen this from examining case law—there’s NIMBY for everything, the elderly, group homes, communities want to keep out all types of social services.”

But a special place in NIMBY-land is reserved for OTPs. In 1977 the Legal Action Center won a landmark discrimination case in which a federal court prevented White Plains in New York from zoning out alcohol and drug abuse treatment programs—and while it wasn’t specific to OTPs, OTPs are included. “Stereotypes and myths” play a part in the NIMBY decisions, said Ms. Friedman.

The Americans with Disabilities Act (ADA) clearly supports OTPs and their patients, and municipalities and their lawyers can easily lose in federal court since the law is so clear. “But there’s a lot of political calculation,” said Ms. Friedman. Local politicians think they have more to gain politically from keeping the facility out, so they’re willing to risk the lawsuit and let the court tell them what they have to do.

MAT First

One point that the substance abuse treatment field in general needs to make more strongly is that medication is the first-line evidence-supported treatment for opioid addiction. “Myth and misunderstanding continue to plague not just methadone alone but medication-assisted treatment [MAT] in general,” said Michal Botticelli, deputy director of the White House Office of National Drug Control Policy [ONDCP]. For opioid dependence in particular, medication is the “first line in our arsenal,” he said. “We have to make sure people understand that this is the standard of care.”

Mr. Botticelli added that there is an opportunity to create a greater consumer voice in favor of MAT. “People have done exceedingly well on methadone maintenance.” Some people need more than medication—other social supports and the structure of an OTP—but others don’t.

As states continue to express concern about prescription drug abuse and overdoses, mainly surrounding opioids, the ONDCP is increasing its stress on the importance of access to methadone and buprenorphine, as well as social supports provided in an OTP. “If we really want to deal with overdose deaths, we need to make sure that we have adequate access to MAT.”

The same myths and stereotypes that bolster NIMBY apply to the criminal justice system, which routinely denies access to medication-assisted treatment. The biggest myth is the one that methadone and buprenorphine are “substituting one addiction for another,” which couldn’t be farther from the truth. Patients in MAT are not addicted—they are not pursuing drugs, they are in recovery, employed, productive members of society. But proponents of discrimination don’t understand how the medications work.

Lack of Negative Impact

It’s also easy to demonstrate the lack of a negative impact in NIMBY siting cases. Jerry Rhodes, chief operating officer of CRC Health Group, said it’s important to bring out studies that show crime goes down when clinics are deployed. “There is science that shows methadone treatment has good results,” he said. But here’s the problem: the issue is an emotional, not a logical, one.

The studies showing that methadone works have been ignored by many public policy makers. And while OTPs had been hoping to enlist government officials and regulators in support of MAT, that isn’t working either. “We’ve had the rug pulled out from under us,” said Mr. Rhodes. “We’re trying to get a more robust commitment.” 

Support From Patients

One thing OTPs could do better is to involve the support of patients, said Mr. Rhodes. “There are often compelling personal stories around the need for treatment, and the effectiveness of MAT.”

In general, the OTP field has done a poor job of rallying patients. But Mr. Rhodes understands that it’s hard to get patients to come forward. “You could lose your job, your neighbor could say something, there’s a fear of being seen as a patient in a clinic.”

The field is beginning to recognize that OTP patients, like other people in recovery, can be a significant voting bloc. For example, there are 5,000 to 6,000 OTP patients in West Virginia. In a small state like West Virginia, 5,000 votes—in some places, even 1,000 votes—can swing an election. When there is no access to MAT, patients—and prospective patients, who also vote—suffer. “This is a job for the National Alliance for Medication Assisted Recovery  (NAMA),” Mr. Rhodes said.


Another good advocacy tactic involves collaborating with other groups. Mr. Rhodes cited the effectiveness of the autism advocacy movement, which is spearheaded by parents who are fierce advocates for their children. Drug addicts, alcoholics, people with mental illness need the same kind of advocates, but have always been treated as marginal populations, which is what drives the stigma. “We can do a better job of working with other constituents,” he said.

Even as a field, various types of treatment are fragmented—medication, no medication, alcohol, drugs—and OTPs could benefit by these groups working together and bringing OTPs into the tent.

Back to NIMBY

The bottom line is, OTPs need facilities, and that means they need certificates of occupancy. Mr. Rhodes warns clinics against going into a community to develop a clinic and not garnering support first. “You can’t do this and not deal with NIMBY, but you can do a better job of trying to support these efforts.”

Here are some of the things you can expect to hear when you try to site a program. “This isn’t our problem.” That’s pretty easy to refute, because an OTP usually has done research and knows that there is an opioid problem. For example, at one meeting, someone stood up and said, “I don’t want this town becoming a methadone mecca.” A physician who was there then said, “You don’t understand, this town is already a heroin mecca.”

The OD Bandwagon

Despite the many newspaper articles about prescription opioid abuse and overdoses, there are rarely any discussions of the cure—treatment. “People don’t understand how prescription opioid abuse relates to methadone treatment,” said Mr. Rhodes. “We rarely address the cure, we just talk about the magnitude of the problem.”

“Education is key,” agreed Ms. Friedman. “We need to explain how the disease works, how the treatments work, and how we produce successful outcomes.”

Bob Newman is Retiring, But You Haven’t Heard the Last From Him

BobNewmanphotoLegendary methadone treatment advocate Robert G. Newman, MD, is retiring. But, he hastens to add, he is not leaving the field. “What I’m leaving,” he told AT Forum in February, “is the office.”

Dr. Newman announced via a January 26 e-mail that he would be giving up his “formal role” as director of Beth Israel’s Baron Edmond de Rothschild Chemical Dependency Institute. He will continue to work through June, but Hindy Bernstein, his assistant of the past 25 years, will be leaving in April. “Hindy is leaving me for Florida,” he said. Although he will no longer have the financial support of Beth Israel, he will continue advocacy efforts.

An Advocate

“The challenges are at least as great today as they were 40 years ago when I started my advocacy work,” Dr. Newman said. He will continue to be a fly in the ointment, but he does want to see more “noise” from the rest of the opioid treatment program (OTP) community.

His days will continue to begin and end the way they have for years, he told AT Forum. “I go to the Internet, I get the Google alerts, which very often have some particularly horrendous feature that I’m obliged to respond to.”

There is a lot of “bad news” for Dr. Newman to blog, write letters to the editor, and send e-mails about. And he does so very articulately. For example, some states are cutting off methadone treatment arbitrarily, trying to limit it to one or two years. Regulators are confounding addiction and dependence, not recognizing that maintenance medication is treatment, not a “substitute” for heroin. Unbelievable as it is that this non-science is going on today, some 50 years after medication-assisted treatment (MAT) has been proven effective, and in the face of federal officials, Dr. Newman sees it happening. And he isn’t going to be quiet about it.


NIMBY—the “not in my back yard” phenomenon in which even people who claim to support MAT don’t want programs in their neighborhoods—is illegal, violating the Americans with Disabilities Act (ADA). But despite the various ADA wins that OTPs have achieved, they are never “precedent-setting,” and therefore need to be fought over and over again. “This is terribly frustrating to me,” said Dr. Newman.

Dr. Newman said the opioid-treatment field can help with this fight. “There are many reasons for NIMBY, and some of those reasons have to do with the field, how we have allowed our treatment, our patients, our services to be viewed,” he said. “It isn’t just misperception on the part of communities and politicians. Some of the anti-methadone- patient bias reflects the way the field has chosen to isolate itself and adopt and embrace unique practices that make this treatment separate.”

 Office-based Methadone

 Dr. Newman is glad that buprenorphine has been made available to OTPs and to office-based opioid treatment (OBOT) providers, as a treatment tool for caring for opioid dependence. He notes that more than 40 years ago he proposed that private physicians be permitted to offer methadone maintenance, in addition to OTPs. And now that buprenorphine can be utilized in OBOT, why not methadone, he asks rhetorically. Dr. Newman also notes the extremely limited willingness of office-based physicians to become “waivered” to prescribe buprenorphine. “I think some of the practices of programs are so foreign to what is done in every other field of medicine that medical colleagues view this as something that is from Mars and refuse to get involved in any form of opioid-dependence treatment.”

In fact, the requirement that patients go to a clinic every day is a barrier to care. Dr. Newman is skeptical about the effect of the Affordable Care Act (ACA) on OTPs in particular. “I have seen repeated references to the notion that under the ACA, there’s going to be a sudden upsurge of demand for addiction treatment,” he said. “Increased demand, maybe,” he said. “But how is that demand going to be met? You can have all the insurance you want, but an awful lot of people who need treatment will avoid OTPs because of the requirements and the stigma, and there are not that many OBOT providers.”

Nevertheless, he noted that hundreds of thousands of patients do go to OTPs for MAT, which shows how motivated these patients are. “How many people would have the motivation to deal with obesity, smoking, hypertension, or a great many other medical problems if the treatment regimen required many months of daily attendance and a host of other demands? The fact that there are 300,000 people enrolled in MAT is amazing.”

 Methadone Safety and Dosing

With an appropriate dosage schedule, methadone is an extremely safe medication, said Dr. Newman. But he warned that some OTPs give induction increments that are too great. The federal regulations state that the dose on the starting day must not be more than 40 milligrams—the first dose has to be no more than 30, and an additional dose that day can be 10, said Dr. Newman. But after that, there are some programs that raise the dose too quickly. “Some programs have induction protocols of 30, 40, 50, 60, 70,” with the dose going up daily, he said. The rule of thumb—“start low, go slow, aim high”—needs more of an emphasis on “go slow.”

 Federal Exclusions

Finally, Dr. Newman would like to see more support for methadone treatment at the federal level. The insurance plans of the federal Department of Veterans Affairs and the Department of Defense have an exclusion against methadone and buprenorphine maintenance treatment, something Dr. Newman has long railed against. “Tom McLellan (then deputy director of the federal Office of National Drug Control Policy) and other very high-level officials have said the exclusion is bad, and that they were trying to change it,” said Dr. Newman. “But it persists, and that’s inexcusable and shameful. “

What Dr. Newman wants advocates to do is to speak up. “Silence equals death,” he said, citing an oft-used slogan of AIDS activists years ago. And he is not going to be silent. “There are a lot of windmills still out there.”

Addiction Expert: Treatment Providers Can Perpetuate Media Stereotypes of Patients

“Stereotypes about addiction, perpetuated by the media, can be unintentionally reinforced by addiction professionals, according to a New York addiction expert.

“When you go to a diabetes clinic, you don’t expect your doctor to have diabetes. But many people treating those who are addicted have themselves been treated for addiction, and tend to use the same lingo as their patients to make them feel more comfortable,” Dr. Edwin A. Salsitz, MD, Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center, said at a recent meeting, “Solutions to the Addiction Crisis.” “They use terms like ‘dirty’ or ‘clean’ to refer to a urine drug test, instead of the more medical ‘positive’ or ‘negative.’ Using slang in addiction medicine can be confusing and demeaning, and reinforce the stigma attached to addiction.”


Source: JoinTogether.org – February 5, 2013

Prepaid Card Designed to Help Those in Recovery From Addiction Manage Money

Three men who met while in recovery have developed a prepaid card designed to help others who are recovering from addiction manage their money, the New York Daily News reports.

They have launched the Next Step Prepaid MasterCard, a reloadable card designed for people in recovery, and for those who are financially supporting them. The card gives family members and guardians control over funds, while teaching people in recovery how to manage their money, the article notes.

http://www.drugfree.org/join-together/addiction/prepaid-card-designed-to-help-those-in-recovery-from-addiction-manage-money?utm_source=Join+Together+Daily&utm_campaign=07bd0ab527-JT_Daily_News_Prepaid_Card_Designed&utm_medium=emailSource: JoinTogether.org – January 31, 2013

Access to Health Care Services for Addiction Will Improve Dramatically: Faces & Voices of Recovery

Once the Affordable Care Act (ACA) is fully implemented in 2014, access to effective health care services for addiction will improve dramatically, according to Faces & Voices of Recovery. In an issue brief, the advocacy group describes how the new legislation will make it possible for many in or seeking recovery to be included in the health care system for the first time.

Those who will benefit from the new law include people who were previously enrolled in Medicaid, and then were disenrolled; those who are coming out of the criminal justice system; and people who have not been able to afford insurance.


Source: JoinTogether.org – January 18, 2013

The NAOMI Study: After a Year on Heroin Maintenance, Is it Ethical to Terminate?

A Canadian study that started in 2005 comparing heroin maintenance with methadone maintenance has given rise to a protest from the patients used as guinea pigs.   The patients protesting were actual subjects, clinical trials participants who were injected on a daily basis with heroin for a year. They had already failed methadone maintenance treatment twice. At the end of the year, however, the study was over and after a three-month detox, they were given a choice of methadone or buprenorphine.

Last year, 44 of these subjects formed a group called the North American Opiate Medication Initiative (NAOMI) Patients Association (NPA), and started comparing  notes on how they did after being taken off heroin. In a report released in March full of bittersweet reminiscences of a year on heroin and some scathing comments on how they were treated in the trial (10 minutes to inject, and if they were late, they missed the appointment), and how they survived the years following, NPA members detail their experience, some managing to get clean, some cycling in and out of drug use.

The NAOMI study, published in 2009 in The New England Journal of Medicine, concluded that heroin maintenance was effective. The findings had little effect in the United States since heroin is Schedule I and not used as a treatment medication here.

But the study publication contributed to the formation of the NPA, with patients questioning why the trial would be shut down. In other countries where such trials were done, patients continued to receive heroin. Although NAOMI researchers asked the Canadian government to allow the people who were given heroin to stay on it for compassionate reasons, the government, which runs health care, refused in 2007.

There are some serious questions posed by the NPA about ethics: for example, because people wanted heroin, they signed up for the trial. Under these circumstances, can informed consent really be given? In addition, if something works, can you take it away? One of the participants quoted in the NPA report put it succinctly: “They’re experimenting with a drug for cancer and it starts working. I mean, what are they, what are you going to do? Oh no. You can’t have it anymore.”

Proponents of medicinal injectable heroin in Canada think that it’s better at keeping patients in treatment than methadone maintenance, for people who have relapsed from methadone maintenance at least twice before.

There are some flaws to this argument, however. First of all, methadone maintenance in Canada isn’t as regulated as it is in the United States, with counseling requirements. Another flaw is that 75 percent of the NAOMI patients on heroin were unemployed; that is not the case with OTP patients in the United States. In addition, the cost of treatment with heroin in the NAOMI study was $14,891 per patient a year, because of the cost of daily injection, compared to $3,192 for methadone maintenance. And finally, while the heroin maintenance group did have better retention in NAOMI than the methadone group, the dose of the methadone may have been too low; the average dose was 96 milligrams.

Can it happen here? Well, not exactly. But in a large-scale, short-term trial, tapering the buprenorphine dosage of opioid-dependent patients was a self-fulfilling disaster. More than nine out of ten patients relapsed in this trial—more than even the principal investigator had expected. Yes, everyone had expected dismal results. Yet the trial, funded by the National Institute on Drug Abuse, went ahead with that design because that is the way most physicians were using the medication for patients dependent on prescription opioids—as a detox drug. Let’s see if NIDA’s Prescription Opioid Addiction Treatment Study (POATS), as the buprenorphine study was called, leads to its own patient association.

For the NPA report, go to http://drugpolicy.ca/wp-content/uploads/2012/03/NPAreportMarch5-12.pdf

Stop Stigma Now: Small Organization Rises to Raise Funds for Methadone Treatment PR Campaign

 Stop Stigma Now, a small group of retired opioid treatment program (OTP) providers has a big—and honorable—goal: eradicating stigma against the methadone treatment field. It began about five years ago with the closure of the Mount Sinai Narcotics Rehabilitation Center in New York City, recalls Joycelyn Woods, project coordinator with the National Alliance for Medication Assisted Recovery (NAMA Recovery).

The physician and administrator who led that program got together and started talking about the fact that the stigma situation isn’t any better than it was in 2007. “It’s worse,” said Ms. Woods. “Nobody is going to do anything about it unless we do something about it ourselves. I had hoped for a long time that the federal government would do it—they have the money and the resources.”

Sy Demsky, the former administrator at Mount Sinai (he retired shortly before the closure), and Philip Paris, MD, the physician, helped organize the Stop Stigma Now group. “Their idea is to raise money from new sources and create a huge PR campaign,” said Ms. Woods. One suggested way of raising money was to ask OTP patients—each of whom would contribute one dollar. “The programs have to decide whether to cooperate. This could be impossible to manage,” she said.

This leaves Stop Stigma Now in a difficult position—doing something very important, without adequate funding to make it happen.  With prescription opioid abuse rampant, OTPs and state substance abuse agencies seeking to address this are faced with new zoning restrictions or outright prohibition based on prejudice or unfounded fears.

“We wish to let the public see our patients as the successes so many of them are,” Dr. Paris told AT Forum in an e-mail. “Our patients are dependent on their medication, not addicted,” he said. “They are not substituting methadone for their street drug. Instead, methadone helps to correct the illness induced by years of using heroin or abusing pain medications.”

Stop Stigma Now attended the AATOD conference in Las Vegas, prominently passing out buttons and letting the addiction treatment field know about their work. “We were received warmly with a show of support by many of the leaders in the field,” said Dr. Paris. “We received many pledges for future financial support. That is very important if we are to be able to widen our anti-stigma message.”

To find out more about Stop Stigma Now, and to make a donation, go to http://www.methadone.org/stopstigmanow/.

Link accessed May 27, 2012

EEOC Sues Employer for Discriminating Against Methadone Patient

The federal agency charged with keeping discrimination out of the workplace has good news for methadone patients in medication-assisted treatment. In a lawsuit filed last summer by the U.S. Equal Employment Opportunity Commission (EEOC) against United Insurance, a Chicago-based company, the federal government is fighting for the rights of people in methadone treatment for opioid dependence. According to the complaint, United Insurance offered a position as an agent to Craig Burns, who has been in methadone treatment since 2004. The job offer was contingent upon his passing a drug test; Mr. Burns’ test indicated that he had methadone in his system.

Mr. Burns’ treatment provider gave him a letter for the company saying that he was in treatment and taking a legally prescribed medication. When the company got that information, it withdrew the job offer, according to the EEOC, which charges that United Insurance violated the Americans with Disabilities Act (ADA).

Past Drug Addiction is a Protected Disability Under the ADA

The EEOC sued United Insurance in the U.S. District Court for the Eastern District of North Carolina. “It is unfortunate that many employers still deny the opportunity for work to people who are ready and able simply because of inaccurate perceptions of disabilities,” said Lynette A. Barnes, regional attorney for the EEOC’s Charlotte District, in a press statement in August. “Employers’ decisions are often based on irrational fears or stereotypes about individuals with a record of past substance abuse. The EEOC will continue to fight for the rights of people victimized by such prejudices.”

EEOC Sues Capital Healthcare Solutions for Disability Discrimination – Health Care Staffing Firm Refused to Hire HIV-Positive Nursing Aide, Federal Agency Says

A leading national health care staffing firm violated federal law by withdrawing an offer of employment to a certified nursing assistant because she was HIV-positive, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a lawsuit it announced Oct. 5.

The EEOC charges that Pittsburgh-based Capital Healthcare Solutions, Inc. extended a job offer to an experienced certified nursing assistant but unlawfully rescinded the job offer less than one month later based on his disability. The job offer was conditioned on the nursing assistant passing a medical examination. In the medical form, his doctor noted that the certified nursing assistant was HIV-positive, but was not restricted from performing the required job tasks, so long as “universal precautions,” such as gloves and face masks, were used.

Even though the nursing assistant was well-qualified and able to perform the job, Capital Healthcare Solutions withdrew the job offer and refused to hire him because of his disability or because the company regarded him as disabled, the EEOC said in its lawsuit filed in U.S. District Court for the Western District of Pennsylvania, Civil Action No. 2:11-cv-01249.

Refusing to hire a qualified individual because of his disability, record of disability, or because the employer perceives a person as being disabled violates the Americans With Disabilities Act (ADA). The EEOC filed suit after first attempting to reach a pre-litigation settlement through its conciliation process. The EEOC is seeking injunctive relief barring the company from engaging in disability discrimination in hiring, and monetary relief, including back pay, compensatory and punitive damages on behalf of the nursing assistant. The nursing assistant is also represented by the AIDS Law Project of Pennsylvania, a nonprofit, public-interest law firm providing free legal assistance to people with HIV/AIDS and those affected by the epidemic.

“President Barack Obama has charged federal agencies to implement the National HIV/AIDS Strategy, which includes addressing and preventing employment-related discrimination against people living with HIV,” said Philadelphia regional attorney Debra Lawrence. “This case serves as an example of how the EEOC will strongly enforce federal laws to ensure that qualified people are not wrongfully deprived of an opportunity to earn a living simply because of their HIV status.”


Source: U.S. Equal Employment Opportunity Commission – October 5, 2011

MARS: Helping Those in Need Down the Path to Recovery – ONDCP Recovery Month Blog

Located in Bronx, New York, the Medication Assisted Recovery Support Project (MARS) is a collaborative endeavor of the National Alliance of Methadone Advocates (NAMA) and the Albert Einstein College of Medicine.  The program offers recovery support services to patients in the outpatient methadone treatment program.  These services are designed and delivered by recovering peers who have a unique understanding of the challenges and opportunities one encounters on the road to recovery.  The services provided by MARS complement those provided in the treatment program, focusing on giving participants the tools they need to be more effective facilitators of their own recovery and affirming that they are, indeed, bona fide members of the recovery community, and not individuals who are, as a common myth has it, substituting one addiction for another.

Our first priority at the MARS Project is to educate patients about opiate addiction, how medications work, and recovery.  Many do not realize or have been told not to believe that opiate addiction is a chronic brain disease and not a symptom of a lack of character or moral fiber.

As of December 31, 2010, the MARS project served 532 individuals for six months and, as a result of the program, many participants’ lives were improved.  The program was able to:

  • Nearly triple employment;
  • Decrease homelessness by more than 20 percent; and
  • Increase the rate of abstinence from drugs and alcohol by 26 percent.

MARS is proud to be the first program that serves persons in medication-assisted recovery to receive a Recovery Community Services Program grant from the Substance Abuse and Mental Health Services Administration’s (SAMHSA). These grants are made available to peer-led organizations that provide community-based recovery support services, such as recovery coaching, peer mentoring, housing and employment support.  Through the MARS program, we teach those we serve that there are many pathways to recovery, and that all are worthy of celebration.

Walter Ginter is Project Director at the Medication Assisted Recovery Support (MARS) Project

http://www.whitehouse.gov/blog/2011/09/27/mars-helping-those-need-down-path-recovery– 9/27/11

Note: For further information on the MARS project see the Fall 2010 issue of the AT Forum newsletter available at: http://atforum.com/newsletters/2010fall.php#peerrecovery

Office of National Drug Control Policy – September 27, 2011

Advocates Help New Moms in Methadone Treatment Fight Child Protective Services

advocatesAfter more than 50 years of evidence showing that methadone maintenance (MM) treatment works, the courts—both civil and criminal—are making decisions only a doctor should make, telling patients to stop taking their legally prescribed methadone. These decisions are coming down particularly hard on women, who in some cases are being told by Child Protective Services (CPS) that they have to get off methadone if they want custody of their newborn child.

This happened in a case of a model patient who entered MM treatment, and then found out that she was pregnant. The case, described to AT Forum by Emma Ketteringham, JD, director of legal advocacy for National Advocates for Pregnant Women (NAPW), involved a woman who was stable and doing well in MM treatment. “She did everything right, availing herself of all the services the opioid treatment program (OTP) had to offer, including parenting classes,” says Ms. Ketteringham. Yet when her baby was born, and she told the hospital she was receiving MM treatment, and even showed documentation from the program, someone from the hospital reported her to CPS. This report resulted in an immediate investigation, with the CPS caseworker telling her that she had to go off methadone if she wanted her baby back. She wanted to continue her successful MM treatment and regain custody of her child.

The law is on the side of women in MM treatment in OTPs. It is against the law for the court system—or any other government agency—to single out people in medication-assisted treatment (MAT) and require them to stop taking their medication, or to switch to another medication or another form of treatment, according to the Legal Action Center. If a child welfare caseworker tells a woman that she must stop taking methadone in order to gain custody of her child, this is a violation of the Americans with Disabilities Act (ADA), says Katie O’Neill, JD, senior vice president of the Legal Action Center. The ADA prohibits disability-based discrimination. “People who participate in MM treatment for opiate addiction are considered to be Individuals with a disability, so you cannot legally prohibit someone from receiving that treatment.”

But the job of CPS is to protect infants and children from abuse and neglect. When a newborn is going through the neonatal withdrawal syndrome, a caseworker who is not knowledgeable about methadone treatment may conclude that the mother has “exposed” her newborn to a drug—methadone. The caseworker interprets that as neglect, and threatens the mother with loss of her baby if she stays in MM treatment.

CPS investigations are secret—the person reporting the “neglect” does so anonymously. “We see cases from all over the country where women are threatened with loss of custody orhave had their children removed because they receive MM treatment during pregnancy,” says Ms. Ketteringham. Family court judges who make decisions about custody do sowithout a jury, and in some states, the mother has no attorney or is discouraged from fighting the charges by her own attorney, says Ms. Ketteringham. Family courts “notoriously make decisions relying on claims made by caseworkers rather than on evidence presented by experts,” she adds.

“Many lawyers appointed to represent women facing a loss of custody in family court are not knowledgeable about clinical or legal realities of MM treatment,” adds Ms. O’Neill.

The best way to prevent any problems after the baby is born is communication between the OTP, the hospital where the baby will be delivered, and the obstetrician. “Although the mother should not have to, she should organize advocacy on her behalf before the baby is born,” Ms. Ketteringham says. “She should make sure someone in her program will advocate on her behalf, have the printed or online literature about MM treatment during pregnancy handy, and contact a lawyer or organization that advocates for pregnant women and parents in the child welfare system.”

The model patient, Ms. Ketteringham’s client, eventually won her case, but it took nine months, during which time her baby was in foster care. When AT Forum went to press, the decision in the case had not yet been published, but the judge had returned the baby to the mother. She is still in MM treatment and doing well.

For Additional Reading

MMT and Pregnancy, an AT Forum patient education brochure, available in English and Spanish: http://atforum.com/patient/education_brochures.php#preg.

A newsletter from the National Advocates for Pregnant Women: http://advocatesforpregnantwomen.org/.

Know Your Rights, a brochure from the Legal Action Center on the rights of people in MMT, available in English and Spanish: http://www.lac.org/doc_library/lac/publications/Know_Your_Rts_-_MAT_final,_9.28.10.pdf,

SAMHSA Brochure Pregnant Women 2006.080904-39-5315-04-44[1].pdf: http://atforum.com/addiction-resources/documents/SAMHSAbrochurePregnantWomen2006.080904-39-5315-04-44.pdf

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