A Collaborative Initiative for Patients and Clinical Professionals

A.T.F. Volume V, #3. Fall, 1996

A.T. Forum on the Internet
Medical Methadone Survey
From the Editor
Meetings to Note
Staff Attitudes & MMT Success
Methadone Under Managed Care
Where to Get Info

A.T. Forum on the Internet

Just Enter http://www.atforum.com
When we first began publishing Addiction Treatment Forum four years ago, the World Wide Web, also called "The Electronic Information Superhighway," was little more than a bumpy dirt road. Today, of course, that has changed dramatically and we are proud to present this off-ramp in your travels through Cyberspace.
Here are some of the features awaiting you:
· The current and past issues of A.T. Forum, plus some longer, unpublished articles of interest.
· News reports and updates from media sources around the country.
· A listing of meetings and events, and where to get further information on various topics.
· A "Question of the Month" which solicits the opinions of visitors to the site regarding selected topics of importance. Summaries will be provided the following month so you can see the trends of how others feel about the issue.
· A "Forum Feedback" area where you can express your personal viewpoints on any topic, just say hello, and/or post news of upcoming meetings or events.
· Links to other, related WWW sites dealing with addiction treatment and methadone maintenance.
· The printed version of the A.T. Forum newsletter will still be
published quarterly and you can register for a free subscription at our Web site.
We will be updating this Web site on a regular basis to provide more extensive and timely information than is possible in our quarterly printed version of A.T. Forum. So be certain to "bookmark" it in your browser and visit often.
If you are not currently on the World Wide Web, gaining access is relatively easy. First, you will need a personal computer with a modem - these are becoming rather standard fixtures in most clinics and many homes. Then you will need to sign-up with an Internet service provider. Here are phone numbers for some of the more popular nationwide services:
· America Online - 800/827-6364
· CompuServe - 800/524-3388
· Prodigy - 800/776-3449
· Microsoft Network (MSN) - 800/386-5550
· Netcom - 800/501-8649
Other services are available also, and there is a monthly service charge from each that varies, so you may want to shop around a bit. Each will provide the necessary software, instructions and technical assistance to get you started. Make certain the provider you choose has a local phone number for your modem to dial into; this saves on phone charges. If you have questions, a local computer store can most likely be of assistance.
Happy Web "surfing," and we hope to see you soon at
http://www.atforum.com

Medical Methadone Survey

Medical Methadone Maintenance: Yes/No?
In our last edition, we asked readers to respond to the question: "Should Medical Methadone Maintenance Programs be widely available? Here are some results from that survey.
To recap, medical methadone maintenance (MMM) in the U.S. was originated as a research project for "rehabilitated patients." Patients report only monthly to a physician's office where they provide urine samples and receive take home methadone on-the-spot, or a prescription for redemption at a pharmacy.
MMM patients must have been in a conventional MMT program for a specified period with a good record of compliance and no illicit drug use or criminal activity. Patients must also be employed and have financial resources to pay the monthly fee.
In the U.S., and other countries, the MMM approach has been quite successful and many authorities believe such programs should be expanded beyond research settings. In our reader survey, 83 percent of those responding agreed that MMM programs should be widely available.
A response from a woman in Michigan seems to sum-up the patients' perspectives. She has been in MMT for 7 1/2 years, paying about $70 per week for treatment:
"There are many who should be allowed to go to a physician and be prescribed methadone, just as a diabetic would be prescribed insulin, or a patient with hypertension be given blood pressure medication," she writes. "For many of us [on methadone], the only ties we have with the `drug world' are the clinics we attend where everyone is lumped together as addicts no matter what their degree of recovery."
Since being on methadone, this patient has returned to college and has authored papers in her area of expertise dealing with the criminal justice system. Yet, as she says, "I'm not trusted with more than a week's worth of methadone. There's no good reason I shouldn't be able to obtain a prescription for methadone and pick it up at the local pharmacy. I don't need to see a counselor all the time; I don't take other drugs, I don't associate with people who do, and I certainly don't divert my methadone. Why should I pay a full-service clinic $280 per month which I can't afford - and there's no good reason for Medicaid to pay those clinic fees for me to basically just be policed."
While it came as no surprise that patients would be enthusiastic about MMM, we also received very positive responses from MMT staff and medical professionals around the country:
Clinic nurse, Florida - "MMTs limit a client's ability to travel and accept jobs. Dispensing by pharmacies would help immensely and possibly help remove the stigma."
Case worker, Texas - "Availability would certainly make it easier for clients to adjust and get on with the business of living their lives."
Administrative assistant, Maryland - "I feel medical maintenance should be used for treatment on demand. We need treatment for thousands and this may be the way."
Health services director, New York - "Clients reaching preset determinants, such as stable home and employment, should be transferred from public clinics to such programs. This will open slots for other clients in the clinics."
Methadone researcher, Wisconsin - "It's time methadone treatment
is put into the hands of the medical profession. Patients who have worked long and hard toward becoming socio-economically accepted back into society, along with becoming free of illicit drugs, deserve nothing less."
We also heard from a mother whose son has been in an MMT for over eighteen years:
"As a family, we have learned that methadone may always be a part of our son's life. We have long felt that after a person has been in the program for an extended period of time and can be trusted to follow the rules, he should be able to obtain methadone via prescription at the clinic or a primary physician. Going to the clinic weekly can cause unnecessary hardships which can affect the person's job and family obligations, as well as extra expenses of traveling sometimes long distances."
Most of those who voted "No" (17 percent of total responses) were concerned about two issues: diversion of methadone, and the inability of primary care physicians to effectively deal with recovering addicts on methadone:
Medical services director, Ohio - "No! What the average physician knows about addiction (specifically opiate addiction) would fill your average thimble."
Clinic nurse, New Mexico - "Primary care MDs need more education about methadone, without therapy it [methadone] is not a good idea."
Clinic director, New York - "Too many doctors are naive about drug addiction and addicts' powers of manipulation."
Counselor, Arkansas - "Methadone patients often need psychosocial rehabilitation to re-enter society and thus should continue in that [full-service MMT] modality. Some are capable of medical maintenance, but can be prescribed through medical directors of clinics."
Clinic director, Maryland - "Com- pliance and diversion risks are issues that would require more monitoring than such a system [MMM] would provide. It would also contribute to further fragmenting the treatment services available."
Clinic chief executive, New Jersey - "Diversion issues continue to be real!"
Certainly, the further expansion of MMM is a complex issue with many viewpoints, and a more complete listing of reader responses can be found at the A.T. Forum Web site. As promised in our last edition, we will be forwarding a package of reader responses and survey results to David Mactas, director of CSAT, for his response. We will include this in our next issue of A.T. Forum.

From the Editor

As We enter Our 5th Year of Publication, More Challenges than ever Confront MMT
Quite frankly, over the past four years we've observed little progress when it comes to the acceptance and any liberalization of methadone maintenance treatment, especially in the United States. Please, let us know if you disagree.
Our premier edition in the summer of 1992 featured an interview with Nina Peyser of Beth Israel Medical Center headlined "Myths and Misunderstandings Hinder Addiction Treatment." That statement still holds true. For example, our recent scan of media reports around the country shows there is still a NIMBY (Not In My Backyard) attitude toward methadone clinics that seems just as prevalent as back then. One more example: Congress recently mandated that drug and alcohol addictions no longer qualify as disabilities allowing patients to receive SSI or SSDI entitlements. [More details can be found at our new Web site - http://www.atforum.com.]
In 1992 we also featured "Current Comments" with Dr. Vincent Dole quoted in the headline saying, "Attitudes Regarding MMTP to Change." Now, as reported in this current issue of A.T. Forum, new research from Dr. John Caplehorn and his associates shows that many methadone clinic workers and medical practitioners themselves have ingrained attitudes which may hinder the acceptance and effectiveness of MMT programs. This strikes us as a rather discouraging answer to Dole's inquiry, "...one wonders about the motives of persons who prefer to have addicts continue to buy heroin on the streets rather than receive medicine prescribed by a physician." Indeed, such motives may be more pervasive and sinister than previously imagined.
Given the issues mentioned above, we wonder about the future of medical methadone maintenance whereby primary care physicians would be prescribing methadone for patients. Our reader survey, reported in this issue, shows overwhelming support for the practice. We're looking forward to receiving and reporting on the reactions of CSAT Director David Mactas as he promised.
Now, just to complicate matters even further, there is the specter of managed care entering the MMTP arena in a big way. This is one of the most misunderstood and complex issues we've ever attempted covering in A.T. Forum. Fortunately, we had the help of some experts, and hopefully we've made some sense of the issue. As usual, we'd like to hear from readers to learn of and report on your opinions. So, here's our survey question for this edition:
What is your opinion of MMT patients and/or programs coming under managed care plans? Is this a good idea, a bad idea, or are you uncertain?
Please provide your responses and comments on the postage-free feedback card in this issue, or write or fax us, or visit our new Web site to respond quickly and electronically.
A.T. Forum
1750 East Golf Rd., Suite 320
Schaumburg, IL 60173
FAX: 847-413-0526
Internet: http://www.atforum.com
Stewart B. Leavitt, Ph.D., Editor

Meetings to Note

NOVEMBER 1996
November 17-21 - APHA/NAPHP annual meeting; Sheraton New York Hotel, New York City. Special session Monday, November 18th, dealing with methadone maintenance: "The Most Over-Regulated, Under-Funded, and Effective Treatment for Drug Abuse." Call APHA at 202/789-5670
November 20-23 - The Southeastern Conference on Alcohol and Drug Abuse; Marriott Marquis, Atlanta, GA. Over two dozen educational sessions and an equal number of distinguished speakers will address all aspects of addiction. For information call: 800/845-1567 (In GA, call 912/750-2731).
November 21-23 - Pain Management & Chemical Dependency; Evolving Perspectives; Crowne Plaza Manhattan Hotel, New York City. This is the premiere conference addressing issues of pain management among drug addicted persons. Contact IMEDEX at: 770/751-7332; FAX: 770/751-7334.

APRIL 1997
April 13-16 - AMTA Conference; Sheraton Hotel and Towers, Chicago; Chaired by Eldoris Mason. For information contact the American Methadone Treatment Association (AMTA) at 212/566-5555; FAX: 212/349-1073.

[To post your meeting or conference announcement in A.T. Forum and/or our Web site, fax the information to: 847/413-0526 or submit it via e-mail from our Web site: http://www.atforum.com.]