Reader Survey Results
Hepatitis Haunts MMTP's
From the Editor
Association, Texas Style
Nimby Alive in Chicago
Where to Get Info
Patients' Perspectives
Research Notes
NIMBY Alive & Well in Chicago
After a six month search for a location, the new
methadone clinic was finally ready to open. Furniture was installed;
staff hired. Then last June, Bob Buonauro, Executive Director of the
Chicago Treatment and Counseling Center, Inc., 601 W. Polk Street, Chicago,
IL 60610, learned firsthand about NIMBY (Not In My Back Yard) Chicago
style.
When he took his application to the Illinois Department of Alcohol and
Substance Abuse (DASA) they said he'd need zoning approval from the
City of Chicago. This was news to Buonauro even though he had worked
in area methadone programs for many years. But, no problem, he went
across the street to the zoning office.
The zoning administrator agreed that the inner city location was suitably
zoned for a medical clinic, but after delaying a decision for several
weeks Buonauro's request was denied. Why? The zoning administrator was
uncertain that the program qualified as a medical clinic and advised
Buonauro to talk to the ward alderman.
the alderman claimed a program like Buonauro's wasn't needed in his
ward; that they already had plenty of social service programs. he told
Buonauro to go to someone else's ward. This even though according to
Buonauro, most programs have a waiting list of 200 to 300 people, and
a recent newspaper article reported that 95% of people applying are
turned away from drug rehabilitation programs in Chicago. In fact, Buonauro
already had a list of 350 people waiting to come into his clinic.
Buonauro's only recourse was to hire a lawyer and file an appeal with
the city. They were finally given a hearing date in October. Between
June and October, while Buonauro was paying rent and salaries on a never-opened
facility, the alderman solicited letters objecting to a new methadone
clinic in the ward and tried to introduce a new city ordinance further
restricting methadone programs.
Buonauro's lawyer did some research and found that, in a prior case
which went all the way to the Illinois Appellate Court, a program like
theirs was indeed classified as a medical clinic. The Chicago Zoning
Board was thus obligated to approve zoning for Buonauro's program and
they opened last November.
Buonauro says, "The most important thing I've learned from all
this is not to take anything for granted. Private programs like ours
provide a valuable service that doesn't cost the state or local government
any money at all. Yet, despite the need, in many communities programs
like ours just aren't wanted. It's the NIMBY attitude."
Where to Get Info
Newsletters Worth Reading
Here are two newsletters produced by methadone patient advocacy groups
that should be of interest to patients and health care professionals.
One comes from America's West Coast, the other from the East.
METHADONE AWARENESS-is the newsletter of the Philadelphia and Atlantic
City Chapter of NAMA (National Alliance of Methadone Advocates). it
is a "forum for methadone patients, professionals, family and friends
to express themselves. Our goals are to educate about methadone maintenance
and advocate patients' rights."
CONTACT: Katherine Bolton, Publisher, 5311 Atlantic Avenue, #B-2 Ventnor,
NJ 08406. Phone: 609-822-9421 Fax: 609-823-0406
M.A.L.T.A. MESSENGER-is published by the Methadone As a Legitimate Treatment
Alternative Organization based in California. This patients' right advocacy
group focuses on promoting the positive benefits of methadone treatment
to the public and appointed or elected officials.
CONTACT: Diane Fleury-Seaman, Editor, M.A.L.T.A., P.O. Box 1716, Marysville,
CA 95901
Patients' Perspectives
Ignorance is Greatest Foe of Methadone Success
What are the concerns of patients today regarding methadone treatment
programs?
For some answers, A.T. Forum spoke with Stan Novick, President of the
National Alliance of Methadone Advocates (NAMA) in New York City. Founded
in 1988, NAMA has grown to 8,700 members in 18 chapters covering 15
states, plus affiliate chapters in Canada, Australia, Sweden and India.
They have also networked extensively throughout the U.S. and abroad.
According to Novick, there are 120,000 methadone patients in the U.S.
being treated in about 700 clinics. And, it is shocking, he notes, that
half of those clinics still provide inadequate methadone doses to patients.
That is, daily doses which are below the protocols recommended by the
CAST State Guidelines or in the vast technical literature on methadone.
(His assertion also is consistent with our "A.T.F. Dosage Survey"
reported in Vol. II, #3 and Vol. III, #1-ed.)
Why? "Ignorance," claims Novick. "People in this field
aren't properly trained." Consequently, there is little understanding
of the neuropharmacology of methadone and the brain chemistry that's
involved. Myths and prejudices abound. Many addiction treatment professionals
still view methadone as merely substituting one addictive drug for another.
Novick stresses that the question of treatment success should not focus
on what sort of prescribed medication a patient is taking, but on how
well the person functions in society and what contributions the person
is making to his family and the community.
Most methadone patients are powerless, Novick asserts. They are completely
outside the treatment decisionmaking process and are often treated with
a lack of dignity or sensitivity. For example, he points to blind-dosing
programs where patients are treated like children and not even informed
of the dosage they're receiving.
Other abuses also exist, according to Novick. In some programs there
is what he calls "fee-toxing"; if a patient owes the clinic
money, their methadone dose is reduced accordingly (a form of involuntary
detox). Another disturbing and humiliating trend is "eye to urethra"
urinalysis wherein the patient is monitored while discharging a specimen.
In another example, patients have been discharged for having smoked
marijuana. "It doesn't make sense," Novick says. "Here's
an opiate addict who gets on methadone and no longer uses opiates or
shares needles. He smokes a stock of pot and is thrown back into the
streets to use heroin again."
He believes treatment providers in many cases have a monopoly on methadone
treatment. In the past 20 years not one new methadone clinic has been
opened in New York state, Novick observes, even though nearly a third
of patients reside in the state. "As long as there is no open competition
and great pent-up demand fore treatment, there will be an abuse of power,"
he says. "A patient can be discharged from treatment and there
are many others waiting to take his place."
Whatever happened to interim methadone treatment? According to Novick
not one state has adopted it and not one state organization of providers
has pushed for it. "Here we have the federal government saying
that it's okay to bring more people into treatment, much more rapidly,
without all the ancillary services. After a time, they could be moved
into more comprehensive programs." However, Novick suspects that
many providers don't want competing, low cost programs taking away their
monopoly. They've argued that there would be a rash of no frills clinics
sprouting up that would not offer adequate care.
"NAMA supports interim programs because people are dying on the
streets," he says. "The faster you get them into treatment,
the faster you curtail the spread of disease and get these people healthy
again." What is needed are more ways of delivering methadone to
patients, followed eventually with ancillary services if those would
be of benefit; not fewer clinics or controls on the numbers or types
of clinic settings available.
Methadone treatment is a health care delivery system, Novick contends.
"And patients as consumers have a right to demand quality health
care. If you go to a physician and he treats you badly, you go someplace
else. Methadone patients can't do that," Novick says.
Aren't there many good programs around the country? "Yes,"
Novick concedes, "but we find it disturbing that instead of the
good programs acting as models to bring up the bad ones, the good ones
appear to be sinking to lower levels." And, in this age of managed
health care, some of the clinics are becoming ever more draconian or
controlling in their treatment approaches.
He says it's almost as if there is a "conspiracy of silence"
surrounding methadone treatment. All of this sends a message to patients
that they are second class citizens. They are made to feel horrible
about their treatment and hide it from employers and even their families.
The patients have no voice, and those willing to speak out don't have
a forum to do so. The successful patients become invisible; no one hears
about them.
One of NAMA's major goals is to end the silence and empower patients
through education of the public and treatment providers. They are trying
to develop a training institute specifically geared to methadone medical
maintenance, and there is some indication that the American Medical
Association is leaning toward supporting the concept. Novick points
out that medical and addiction training programs devote amazingly little
time to discussing methadone. And the public at large is totally unaware
of methadone maintenance or aware only of negative publicity in the
past. This has to change.
Research Notes
Two-Year Study to Focus on Substance Abuse Treatment
The White House Office of National Drug Control Policy (ONDCP) is funding
an extensive nationwide assessment of substance abuse treatment programs
that will involve 200 treatment programs and about 2,000 patients over
a two-year period. The study will be conducted by the Center on Addiction
and Substance Abuse (CASA) at Columbia University, New York.
The CASA study will track individuals when they start treatment and
again at intervals of three and twelve months after entering a substance
abuse program. More than $3 million has been budgeted for the study.
According to CASA president Joseph A. Califano, Jr. (former Secretary
of Health, Education & Welfare from 1977 to 1979, "It is essential
to understand which treatment programs work for whom and under what
circumstances, to look at the age, gender, employment and ethnic and
racial background of the patients."
This effort will assess the effectiveness of substance abuse treatment
and aftercare in deterring relapse, the cost effectiveness of different
treatment programs and how well treatment programs enable their patients
to secure employment and maintain their physical and mental health.
"There are some 6 million drug addicts and some 18 million alcoholics
and alcohol abusers in America. We need to find more effective ways
to treat these individuals," said Califano.
Drug Treatment Pays Off in California
Some answers for the CASA study, mentioned above, may already be available
from an extensive evaluation of addiction treatment programs in California.
The $2 million study covering 1,850 participants in 83 programs was
conducted by the University of Chicago's National Opinion Research Center.
A major finding was that every dollar spent on drug and alcohol treatment
saves $7, mainly via reduced crime. There were cost savings for medical
care also; for example, emergency room admissions among study participants
fell by a third.
In 1992, California treated about 150,000 people for drug and alcohol
addictions at a cost of $200 million. According to the study, savings
accrued during treatment and in the following year reached $1.5 billion.
For methadone treatment programs, benefits of treatment outweighed costs
by a 12 to 1 ratio. According to the study, while some social services
may not show benefits for years, "(addiction) treatment managed
to pay for itself the day in which it was delivered."
One finding, however, was discomforting; the economic condition of participants
didn't improve after treatment and in some cases earnings declined.
But, the researchers noted that many patients who worked in the year
before treatment lost or quit their jobs and then started working again
at lower pay afterward.
The University of Chicago study is but one of many over past years to
support the benefits of drug abuse treatment. Yet funding for programs
is often difficult to come by, partly because drug addicts engender
little sympathy.
One critic of such programs observes that many people quite drugs or
alcohol on their own, especially as they mature. "If we want to
shrink the pool of heavy drug users, getting more people to quite without
professional help may be a more important option," claims Mark
Kleiman, associate professor of public policy at Harvard University's
John F. Kennedy School of Public Affairs.
"I don't think a cost-benefit analysis is going to change many
minds," Kleiman says. "If you hate people who take drugs and
want them to die, you will not be in favor of drug treatment."
Under the Nixon administration, drug treatment programs enjoyed broad
federal support and funding. But such funds were sharply scaled back
under President Reagan. Since then, federal money has been returned
to treatment, but always below the level devoted to law enforcement
measures.
(Reported in Brandon, K. "Drug Treatment Dollars Paying Off in
California." The Chicago Tribune, October 5, 1994, p. 1)