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            "THE DIRECTOR'S VIEW" 
                      APRIL 2008

Welcome! Time passes too fast for all of us at "Medical Assisted Treatment of America. "  There just isn't enough hours in a day to get everything we need done.   We work on limited funds but we try to reach out to all of you. Most of you know we take calls twenty-four hours every day of the year.  If you can't afford to give us a call then we will call you at our expense. 

If you haven't visited us before, then let me introduce myself to you. My name is Deborah Shrira. --- I want each and everyone of you to know I am accessible to you.  I want you to know when you call- you can talk to me if you like. I am your friend and I am familiar with the trials you deal with on a daily basis.  --- I am a methadone patient the same as many of you and everyone working with me is acquainted with the stigma attached to methadone.

I am the Founder and Creator of "Medical Assisted Treatment of America."  I worked most of my life as a Pharmacist and then later as a "Certified Medical Assistant."  Methadone saved my life.  It totally changed my life and turned me in a different direction. I couldn't keep quiet about a medication so miraculous.

We believe in and support methadone at "Medical Assisted Treatment. "  We
treat you with the respect you deserve. If you have any questions, we are here to answer them for you.  We provide an Online Support Community just for you. We actually have a Certified Substance Abuse Counselor there to help and she is accessible as I am. She knows what it is all about and takes methadone.    

Drugs and alcohol are not only addictions, but diseases. (If they weren't would insurance companies be paying for treatment?) As such, people with the affliction should be treated accordingly.  Although people initially make the choice to use drugs, they are soon factually "sick" and "debilitated" and need care.

Addiction is a disease that requires the sufferer to be fully committed and involved in their own treatment and recovery (as opposed to administering antibiotics to cure an infection).  But if we (society) have not educated the afflicted how to proceed, if we do not provide adequate tools for their self help, and if we instead treat them as lepers then we all have failed.

And, as with any illness, calamity, setback, disaster (whatever-you-want-to-call-it) no one is immune and would also want help, understanding, appropriate attitudes and treatment ? 


Celebrity magazines all too often feature stories about overdose deaths and rehab admissions, and the Office of National Drug Control Policy is running an advertising campaign about the dangers of prescription drug abuse.

But when taken as prescribed, just how risky are drugs like Oxycontin or Vicodin?                                                    

The truth might surprise you. Myths and misinformation about opioid painkillers are widespread. Here are the facts.

Myth No. 1: Toughing it out is always better than relying on painkillers.

Although Americans pride themselves on their toughness, those who refuse medications despite severe pain may be putting their health— and their jobs and relationships— at risk.

“Uncontrolled pain is associated with adverse consequences in terms of daily functioning, mood, sleep, overall quality of life, energy level, the ability to work and marital relationships,” says Russell Portenoy, chair of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City.

Adds Dr. Richard Payne, professor of medicine and divinity at Duke University: “Newer studies actually show that persistent pain causes changes in the brain and spinal cord that begets more pain.” Some animal studies suggest that controlling pain could help prevent these problems.

“It’s clearly obvious that people whose pain is controlled effectively following surgery go home earlier, have fewer complications, get out of the hospital faster and recover better,” says Dr. Gavril Pasternak, a neurologist at Memorial Sloan-Kettering Cancer Center in New York City. “On the other hand, do I think every time a child scrapes his knee he needs an opioid? No.”

Myth No. 2: People on opioids are always impaired—and cannot drive safely or work in demanding jobs.

Studies of drivers on steady doses of opioids do not find impairment. In fact, says Portenoy, “At least one study by Finnish researchers showed that impairment on standard driving measures was more correlated with poorly controlled pain than with taking medication for it.”

“What people are concerned most about is judgment and somnolence,” says Pasternak.

“Would I recommend that someone just starting opioids drive? Of course not. But I would give the same advice to someone starting a sleeping pill. Once someone has been on the same dose for a while, they can.”

Adds Payne: “For people on a stable dose, they acclimate or develop tolerance to sedative and mental clouding effects.”

Myth No. 3: When taken as directed, opioids are more likely to kill you than aspirin, ibuprofen or naproxen.

“False. When taken as directed, opioids are safe drugs,” says Pasternak.

The vast majority of opioid-related deaths occur amongst recreational users or deliberate suicides. Deaths amongst pain patients are rare— in fact, recent research finds that even for people with advanced illnesses, use of high-dose opioids does not significantly increase risk of death.

Nearly three times as many people die from complications of correctly taking painkillers like aspirin and ibuprofen— known as non-steroidal anti-inflammatory drugs—than die from opioid overdose.

“More people die from gastro-intestinal bleeding from NSAIDs taken in correct doses than from inadvertent opioid overdose,” says Payne.

“It is true that the death rate has increased from accidental overdose related to opioids, but still the number of deaths related to accidental OD is dwarfed by the gastro-intestinal and [stroke and heart-related] complications of other analgesics,” Payne adds.

Myth No. 4: Accidental overdose is common amongst pain patients.

Most opioid overdoses do not result from medical use.

“As patients take opioids over weeks and months, they develop a tolerance to the respiratory depressive effect, which is the thing that can cause death,” says Payne.

This means that even if people forget they’ve taken their medication already and accidentally double their dose— unless they have dementia and do this rapidly and repeatedly— the risk of death is low.

Instead, the vast majority of opioid overdoses involve combinations of drugs that cause sedation— typically alcohol and sleeping pills or anti-anxiety medications like Valium or Xanax (benzodiazepines).

At least 80 percent of opioid overdoses are actually caused by such drug mixing—and while some severe pain patients need both benzodiazepines and opioids, they are prescribed together with great caution.

In many overdose deaths, use is obviously non-medical because the victims injected or snorted drugs meant to be taken orally.

Myth No. 5: Most people who get addicted to painkillers are “accidental” addicts who sought pain treatment and had no prior history of drug problems.

When a Florida newspaper covered the “OxyContin epidemic” in 2003, it later had to retract its series, in part because a man portrayed as an innocent victim of a pill-pushing doctor actually had a prior federal cocaine conviction.

Inadvertently, the paper had illustrated the real story of painkiller addiction: The vast majority of people who become addicted to prescription opioids have significant prior histories of drug problems.

Nearly 80 percent of OxyContin addicts have taken cocaine, for example, according to large national survey research. This means either that pain patients prescribed OxyContin suddenly start using cocaine—or, more plausibly, that most people who misuse opioids have a past or current drug problem.

“We published data on this; we looked at people who had Oxycontin addiction who presented for treatment—essentially, nobody had gotten addicted to Oxycontin who hadn’t previously been using opioids recreationally,” says Thomas McLellan, professor of psychiatry at the University of Pennsylvania.

More than three-fourths of the patients who had misused OxyContin in this national sample of addicts in treatment had never received a prescription for it.

Even having chronic medical problems—which includes chronic pain—did not increase risk for OxyContin addiction.

If you do not have a personal or family history of addiction—especially if you have never suffered psychiatric problems like depression, schizophrenia or bipolar disorder, and especially if you are middle-aged or older—your risk for developing addiction during pain treatment is “vanishingly low,” says Portenoy.

Myth No. 6: Addiction is inevitable if opioids are taken long-term or in high doses—and the risk of addiction is very high for short term use.

This myth stems from confusion about the nature of addiction. Many people believe that addiction is simply needing a substance to function—but if this were the case, everyone would have to be considered addicted to food, air and water. “To the average person, addiction is going cold turkey— they view addiction as physical dependence,” says Pasternak.

In fact, psychiatry defines addiction as compulsive use of a substance despite negative consequences—and it is this craving, impairment and loss of control that people fear. However, while most people who take opioids for long enough will develop physical dependence and suffer withdrawal if the drugs are stopped abruptly, addiction in pain patients is rare.

“The reality is that addiction appears to be distinctly uncommon in patients without a prior history of addiction or a family history of addiction,” Portenoy says. In his own research on more than 200 patients treated with OxyContin for chronic pain over three years, no new cases of addiction were reported.

“Over 30 years, I’ve seen a few thousand patients with cancer and sickle cell [disease] and other [conditions], and less than five that I’m aware of became addicted,” Payne says.

Myth No. 7: Opioid withdrawal is extremely debilitating and potentially deadly.

We’ve all seen the movies: the desperate addict shivering, shaking and vomiting from heroin withdrawal, pleading for relief. But while opioid withdrawal can be unpleasant, it doesn’t have to be.

“You can probably take 80 percent of people off opioids by decreasing the dose 50 percent every other day and they will be asymptomatic,” Pasternak says.

In fact, many patients go through withdrawal without even realizing that their “flu symptoms” are linked to the fact that they decided to stop their pain medication suddenly.

The severity of withdrawal also appears to have a genetic component—some people are susceptible to miserable symptoms, while others suffer few or even no effects. Portenoy describes a female patient on a very high dose of morphine whose prescription ran out before her appointment. Rather than asking for a renewal, “She waited to come and see me,” he says, “and she had no withdrawal.”

While withdrawal from alcohol or barbiturates is potentially fatal if not properly managed, even the worst opioid withdrawal is unlikely to be deadly. However, withdrawal can be risky if the patient is still in pain or on other drugs. “Managed incorrectly and in concert with other drugs, it can be very dangerous,” says McLellan.

Pasternak says the main reason people suffer withdrawal has “nothing to do with medicine, but rather to societal pressures that have led to laws that the Drug Enforcement Agency is required to enforce.”

For example, it is illegal for a doctor to prescribe opioids for addiction outside of certain settings, so some physicians are afraid to taper patients’ doses for fear of being arrested for having “maintained” an addict. Similarly, doctors may drop patients suddenly if they suspect addiction, without tapering their medications.

Worst of all, many physicians won’t prescribe opioids at all—even when they are clearly warranted—because they fear dealing with addiction and law enforcement issues. The unfortunate result: Patients in pain are left to suffer.

Source:  Maia Szalavitz is a freelance journalist and senior fellow at media watchdog, stats.org 


The means by which persistent or chronic pain affects an individual’s ability to live a ‘normal’ life ..............has been clarified by investigators at Northwestern University’s Feinberg School of Medicine.

People with persistent pain live a life that often includes coping with a host of symptoms beyond the non-stop sensation of throbbing pain. They have trouble sleeping, are often depressed, anxious and even have difficulty making simple decisions.

In the new study, researchers identified a clue that may explain how suffering long-term pain could trigger these other pain-related symptoms.

Scientists found that in a healthy brain all the regions exist ...........in a state of equilibrium.   When one region is active, the others quiet down.  But in people with chronic pain, a front region of the cortex...  mostly associated with emotion “never shuts up,” said Dante Chialvo,  lead author and the  associate research professor of physiology at the Feinberg School.

“The areas that are affected fail to deactivate when they should.” They are stuck on full throttle, wearing out neurons and altering their connections to each other.

This is the first demonstration of brain disturbances in chronic pain patients not directly related to the sensation of pain. The study will be published in The Journal of Neuroscience.

Chialvo and colleagues used functional magnetic resonance imaging (fMRI) to scan the brains of people with chronic low back pain and a group of pain-free volunteers while both groups were tracking a moving bar on a computer screen.

The study showed the pain sufferers performed the task well but “at the expense of using their brain differently than the pain-free group,” Chialvo said.

When certain parts of the cortex were activated in the pain-free group, some others were deactivated, maintaining a cooperative equilibrium between the regions. This equilibrium also is known as the resting state network of the brain.  In the chronic pain group, however, one of the nodes of this network did not quiet down as it did in the pain-free subjects.

This constant firing of neurons in these regions of the brain could cause some permanent damage, Chialvo said. “We know when neurons fire too much they may change their connections with other neurons and or even die because they can’t sustain high activity for so long,” he explained.

If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life,” Chialvo in your brain makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain.”

Chialvo hypothesized the subsequent changes in wiring “may make it harder for you to make a decision or be in a good mood to get up in the morning. It could be that pain produces depression and the other reported abnormalities because it disturbs the balance of the brain as a whole.”

He said his findings show it is essential to study new approaches to treat patients not just to control their pain but also to evaluate and prevent the dysfunction that may be generated in the brain by the chronic pain.

Source: Northwestern University

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Editor's Note:   I know many of you suffer from chronic pain. If you are one of those who suffers from chronic pain then you can definitely identify with the article above.  We are receiving numerous telephone calls from legitimate pain patients looking for help. Many patients are attending "Methadone Maintenance Treatment" programs moreso for pain. They, too need help in locating "Pain Management" services.   

I 'm asking all of you to let's get together and help one another. Many of you read "The  Director's View".  I'm asking you to help these patients out.  Remember, we are all in it together. If we join together we can succeed. If you know of anyone who will either write for opiates and/or methadone for chronic pain then please send their name,address and phone number to me.  I will take the time each month to post these names and all who are looking can check each month and surely one of us may find one,   

If you have ever lived with chronic pain then you understand having medication can make the difference in whether you can get out of bed in the morning.  It can decide whether you are able to make it to work and it certainly affects the quality of life you lead.  I'm asking you to try and help each other out. We  must start working together.

Congraulations!!!!
Primrose
Wahome, LPN
Newport
Integrated
Behavioral 
Center
Decatur, GA 30032

MOST AWESOME
APRIL NURSE


THANK YOU! 

"We want to take the time to "Thank You" Primrose for the dedication, kindess and compassion you express toward your patients and the field of work you have chosen. You are always there and waste no time in seeing your patients are dosed. Your patience and the thoughtful acts you perform help make our lives much easier.  We are are eternally grateful to you. "


Suboxone has made its way to the street and so has Methadone, OxyContin, Percocet, Neurontin, Clonidine, Klonipin, Phenergan, Elavil and ...the list goes on.

Some of these drugs stick out and we acknowledge that narcotics and benzo’s are on the street, but do we know that anti-nausea drugs, high-blood-pressure pills, etc., are on the street and have a street value? And no, the drug dealers are not selling Suboxone to be good Samaritans; they are dealing and serving the demand the same way they sell other drugs.

It is not okay that Suboxone is on the street; it is not okay that any of these drugs are on the street as they are clearly not being monitored and prescribed as they were intended. The reason these drugs are on the street is for purposes of abuse, they are used to potentiate other drugs and give some altered high or euphoric states.

At Boston Medical Center we have treated hundreds of patients with Suboxone since it became available more than five years ago, and we have sSuboxone has made its way to the street because folks are desperate for treatment, and cannot access it through appropriate channels. In Massachusetts, there are 37,369 licensed physicians and only 794 are licensed to prescribe Suboxone. This is a mere 2 percent of the physicians in the state that have taken the course and obtained a waiver to prescribe this treatment for addiction, and of those, many do not prescribe.

Historically, it had been against the law for physicians to treat opioid addiction in an office setting, but with the change in federal regulation, access to treatment has expanded, allowing patients to get Suboxone in the privacy of their physician’s office.een many people come forward seeking treatment who had never accessed treatment before. They report a desire for confidentiality, unwilling to go to traditional detox settings, chronic relapses, and not wanting their family or employers to know about their addiction.

Suboxone has opened the doors of treatment for many who never would have accessed care in traditional settings. We are told day in and day out how this drug has saved lives; we see first hand the kids who get back on track and graduate from college at the top of their class, the homeless person who secures housing and a job for the first time, the executive who gets rid of the separate bank account and supply of OxyContin in the basement and discloses it to his wife, the laborer who calls each year on the anniversary of his recovery for four years thanking us for saving his life!

Improving access and treating patients’ addiction as we treat other chronic diseases should be the gold standard, not the exception! Let’s stop making it so hard, stop stigmatizing the person with the disease of addiction and work on using whatever tools we have available to do so.

Suboxone is just that, a tool; it’s not perfect and it’s not for everyone, but it works for many just as other forms of treatment work. There are minimal tools in treating this disease that kills so many, and we need to take what we have and utilize it to the best of our abilities in fighting this disease!

Suboxone has been available for five-plus years now and we are learning more and more about it as we move forward. It is critical to take the lessons learned and implement changes to our practices to not only care for our patients but also provide responsible practices to minimize the diversion, improve quality addiction treatment, and allow our patients to access treatment.

Colleen LaBelle, RN, is the nurse program manager for the office-based opioid treatment program at Boston Medical Center. She lives in Hanover.

Copyright 2008 The Patriot Ledger
Transmitted Saturday, January 26, 2008

If you are interested in learning more about Suboxone then we invite you to take the time and visit us at:

http://www.SuboxoneAssistedTreatment.org


A novel approach to methadone dispensing that could revolutionise the way some people receive treatment is about to be evaluated in United Kingdom.The "Advanced Dispensing System" " (ADS) -developed by UK company, GW Pharmaceuticals Ltd.may offer a new way of dispensing methadone that greatly reduces the risk of harms related to diversion and misuse, but at the same time offers greater individual freedom during treatment.

Advanced
Dispensing System
(ADS)

Because diverted methadone causes hundreds of deaths each year, there is growing pressure on treatment providers  to limit "take-aways" and use supervised dosing more often.However, the inconvenience of supervised dosing makes it harder for people to lead normal lives.

ADS provides people with take-away methadone in a way that helps to make diversion less likely, but without the inconvenience of supervised dosing.

The system has two main parts.   The first is a tamper proof titanium canister that holds a standard 500ml bottle of methadone and can be accessed only by a pharmacist.  The second is a handheld controller, somewhat resembling a mobile phone, that attaches to the top of the canister. The controller acts much like a bankcard, allowing the user to withdraw their methadone up to a programmed daily dose limit. Instead of entering a PIN number as for bankcards, the ADS user will swipe their finger over a reader in order to authenicate themselves and prevent others from getting easy access to the methadone.

The system does not store actual fingerprints as a way if identifying the intended user,
but rather uses the fingerprint to generate a unique indentifying code. Of course, ADS can not stop a person from voluntarily giving their methadone to someone else, but this is a problem which also applies to the way methadone take-aways are given out at the moment.

The idea is that instead of coming in and collecting take-away methadone in plastic containers, people will be given enough canisters to last a given period (eg. 1-2 weeks).
When the canister is empty, they will return to the clinic for replacements. For example, for a person receving 50 mg  methadone per day in a img/ml formulation, it would take 10 days before the canister would need to be refilled.     

It is hoped that ADS could be advantageous in reducing methadone diversion, preventing impulsive overdose and other type of misuse,promoting compliance and better outcomes from treatment,and allowing people to have greater flexibility and self-control during the
treatment.

The National Addiction Centre has been conducting a trial of ADS in London from late 2006 onwards.  As part of this evaluation feedback on the potential advantages and the disadvantages of this new approach is being sough using an online survey at:

http://www.iop.kcl.ac.uk/methadonedispenser

Source:  Dr. Tim Mitchell               Black Poppy  Issue 12


Research consistently shows that methadone itself is not a source of concern when it comes to driving motor vehicles. However, it should be noted, that the patients tested were well-established in MMT, receiving adequate methadone doses, and not abusing illicit drugs or alcohol. Patients going through opioid withdrawal due to insufficient methadone doses, or experiencing methadone overmedication effects, such as sleepiness or fatigue, might not perform as well.

The entire FAQ can be accessed at:

http://atforum.com/SiteRoot/pages/faqs/faqs2life.html

Thanks to all of you who have taken the time to "Rate Your Program."  I'm still asking all of you to please take the time. I will be covering some of the activities reported by many  in May's "The Director's View". We are defintely in need of
change. It just broke my heart to read how some of you have been treated. I can't do it alone but if you will join with me- we can bring about change.   

If you are attending one you feel has violated your rights then take the time to let all of us know about it.  We must all work together...   We must expose the truth.... We must start keeping them honest.  We have been abused much too long.  It's time we let everyone know we are not lepers and refuse to be looked upon as such.

We are always here for you.If you need help in finding treatment, give us a call.  If you just need encouragement and a sympathetic ear, we do want you to call.  You are never alone. If you have questions and need answers......  we are here.  Most of all, know if you relapse, we do understand and we are here to help you stay on the right road.  We are not here to condemn you...... We are not here to judge you but to empower you to stand up for yourself and take back your rights.

Phone:  770-428-0871           770-527-9119         770-428-8769

deborah_shrira@MedicalAssistedTreatment.org

Editor: Deborah Shrira©                     Date:  April 2008 Copyright

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