Methadone - Addiction

I would like to welcome all of you to News and Views. Most of you have met me by now but for many of you it may be your first visit with us. My name is Rozi and I am responsible for keeping you updated on news which affect most all of us with issues of addiction. I believe you need to know what is happening all around you and to many of your friends. It could happen to you. It is one of the main reasons we take the time to increase your knowledge because we believe, "Knowledge is Power."

I intend to keep you updated with all that is happening. If you want to know what is happening with Methadone, you will find it waiting on you. I will not only be sharing what is happening to those of us taking Methadone, but I will be sharing
instances where many of us have been discriminated against simply because we legally took methadone. All of you do need to know what is happening to your brothers and sisters on methadone, be it for pain or addiction. We need to start caring and being concerned because if it can happen to them - it can happen to us.

It's not just methadone but I will sharing the latest news on Addiction. I will try to get it to you as soon as it hits the presses. If you are not a constant on Medical
Assisted Treatment of America, then let me share with you how reliable we are. We print the truth and we may not agree with all we print but we back all of our articles up with references. You can depend on us giving you the sources if you need them and if you need more, then we will assist you in locating them.

We are here to educate you and keep you in tune to "What's Happening?" all around you. We report "News" but we want you to participate. We may share people's views with you but we have given you an outlet to share yours. Speak
out and be heard. If you have any feedback then please send it to me at the address I have given you. We can learn much from each other.

Please be patient with me as I get this "News and Views" brought up to speed. And please, if there is anything at all that you would like to see here, feel free to email me at Rozi.Director@MedicalAssistedTreatment.org .

Associated Press - January 10, 2008 7:35 AM ET

PORTAGE, Wis. (AP) - The warden at Columbia Correctional Institution is looking for ways to stop the theft of prisoners' medication.
Information from
The third prison guard in two years has been charged with stealing methadone and other drugs from inmates.

Fifty-3-year-old David Yatalese (yah-tah-LEES') of Baraboo was arrested this week at the Portage prison after another employee noticed prisoners' prescriptions needed renewal too quickly.

The officers have the responsibility of giving the prisoners their prescribed drugs. Yatalese is a 12-year corrections veteran. He's accused of stealing medications for his own use between 30 and 40 times since April.

Two other guards also faced charges for stealing medication in separate cases.

Warden Greg Grams says he'd much rather have medical personnel in each housing block administer medications. But, tight budgets force most prisons to rely on their correctional officers to get medications to prisoners.

FROM DIRECTOR: This article actually comes from where I live.

Source: Portage Daily Register, http://www.wiscnews.com/pdr

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Anna Nicole Smith's son Daniel intentionally took the methadone believed to be the primary factor in his death, an inquest has heard.

"But for the methadone he would not have died," said Dr Lee Hern, who said he did not believe the 20-year-old was a habitual user of the drug.

Under questioning, Dr Hern, the lab director for the Miami-Dade County medical examiner's office, said he felt Mr Smith's death was the result of an "intentional" overdose.

This was because the methadone ingested was such a large amount taken in such a short period of time.

Although he was found to have taken as many as eight tablets, these could have been dissolved in a liquid that could "camouflage" their taste, the court heard.

The inquest was also told that Howard K Stern appeared to have flushed away two white tablets that fell out of Daniel's clothing after his death.

Daniel died mysteriously on September 10, 2006, in the Bahamas, three days after his sister Danielynn was born there.

He had been sleeping in a hospital room along with his late mother and Stern, her companion, when he was found unconscious.

"It's not common for people in recreational use to take large quantities all at once," Hern explained.

"In my study of drug abuse patients people don't take such a quantity of pills to get high.

"They take one or two and if the effects are not there they may take more."

He also indicated there were no "signs of tolerance" in Daniel's system to indicate he was a habitual user.

Based on his 21 years of experience in the field, Dr Hern said it was his opinion it was an "intentional ingestion."

But he said in order to suggest it amounted to suicide, Daniel's case would require "self destructive statements or suicidal thoughts heard by people that were close to him."

He added there is "certainly" the possibility that "one might not know what they were taking".

Dr Hern said the methadone tablet is "water soluble" and although such a high quantity would taste bitter in a liquid "this could have been camouflaged".

Speaking outside court, the attorney representing Anna Nicole's mother Virgie Arthur, said Daniel did not express any thoughts of self-harm.

"So what we are left with is homicide," he said.

Ford Shelley, a friend of the late Anna Nicole Smith, also gave evidence at the inquest.

He described Daniel as "brilliant" but frustrated about living in his mother's shadow.

Shelley told the court how in the days after Daniel's death he helped Stern move some of his clothes.

As they did so, he said, two white tablets drop out of a pair of trousers.

"Howard picked the pills up, went into the bathroom," he said.

"He closes the door. He walks out and I can hear the toilet flushes. I said 'what happened?' he said 'I took care of the problem'."

He also told the court that Anna Nicole kept her drugs in a duffel bag, which he had seen in the Bahamas.

He said he saw prescription bottles including methadone in pill and liquid forms.

The inquest continues.

Find this story at http://www.dailymail.co.uk/pages/live/articles/showbiz/showbiznews.html?in_article_id=511291&in_page_id=1773
©2008 Associated New Media

Women on methadone maintenance who have recently given birth, concentrations of the drug in breast milk are low and have no apparent behavioral or any neuro-logical effects on their breast-fed infants, according to the results of a small study.

Dr. Lauren Jansson, of Johns Hopkins University School of Medicine, Baltimore, and colleagues evaluated the concentrations of methadone in the breast milk and blood of eight women at 1, 2, 3, 4, 14 and 30 days after delivery.

Blood samples were also obtained on the same days from eight women on methadone maintenance who fed their newborns with formula.

Blood samples from infants in both groups were obtained on day 14, Jansson's group reports in the medical journal Pediatrics.

Low concentrations of methadone were observed in breast milk, ranging from 21 to 462 nanograms per milliliter. Methadone levels in breast milk were not related to maternal dose.

Even though methadone concentrations in breast milk increased significantly over the sampling period, the average amount was less than 0.2 milligrams per day.

The blood concentrations of methadone in the infants were low in all samples, ranging from 2.2 to 8.1 nanograms per milliliter.

When all of the infants underwent neurobehavioral assessments on days 3, 14 and 30, the investigators found no significant effects that could be attributed to breast-feeding.

More infants in the formula-fed group required drug treatment for opioid withdrawal syndrome; however, this association was not statistically significant.

"In general, these results support the recommendation for breast-feeding among methadone-maintained women if it is appropriate and desired," Jansson and colleagues conclude, although they acknowledge that further studies are needed to assess the safety of long-term breast-feeding.

I would like to interject a word or two here for a moment. It is crucial that we all understand the meaning since the Final Rule has been issued. The Drug Enforce-ment Agency announced physicians' are now allowed to write a prescription for a ninety-day supply of Schedule Two medications.

Helping America Reduce Methadone Deaths, an anti-methadone organization, did not totally understand the meaning and therefore confused many others with their interpretation.

They published their misunderstanding in prbuzz, 28 December 2007, regarding
Drug Enforcement's Deadly Decision. They believed the physician would write for a ninety-day supply of methadone and the patient would be able to obtain all of it at once. Common sense dictates the absurdity of such a belief. How could anyone, if they just stop one moment to think, would realize it was not true? How many of you agree with me? I want to set you straight - it is totally incorrect.

We take pride at Medical Assisted Treatment in printing the truth. The truth is, yes the patients will receive a ninety-day supply of methadone. You will receive a total of three prescriptions dated separately for the next three months. You will proceed to take all three to your Pharmacist and He will file them. He will not be able to fill them until the date written on the two prescriptions and not a day before. They will only be able to fill one prescription at a time just as they presently are doing.

Schedule Two medications can't be called in verbally over the phone. The only benefit the patient derives from the new law is h/she won't have to see her Pain Management Specialist except once every three months. I can assure many Pain Specialists will still insist on having their patients come in once monthly because they would be losing money, if you comprehend what I am saying. I am truly hoping many will take advantage and dispense a three-month supply because it will certainly save the patient money which I think most all of us can use now.

If you haven't heard about their Final Rule allowing"three-month's supply" of any Schedule Two Narcotic, such as Cocaine, Methadone, Oxycontin, Morphine and
Ritalin, then you must read the article below.

The Drug Enforcement Administration has issued a final rule allowing prescribers to give patients multiple prescriptions for up to a 90-day supply of Schedule II narcotics. Current laws is unclear on dispensing more than a 30-day supply on a single Rx for Schedule II narcotics or refills, forcing many patients with chronic conditions to visit the doctor monthly to receive a new prescription. While some doctors had given multiple prescriptions to patients in the past, prior to the rule it was unclear whether the practice was legal.

Drug Enforcement Agency received nearly 300 comments after the rule was first proposed, with the majority approving of the change. Under the new rule, which is set to go into effect December 19, prescribers can give patients multiple dated prescriptions for the same Schedule II drug that when combined do not add up to more than a 90-day supply. Pharmacists will not be able to fill prescriptions except once monthly according to the date transcribed by physician.

An article in The Olympian (Washington State) on 01 Jan stated that a woman with a 3-year old child in the car was cited for drunk driving while on her way to her methadone clinic. The clinic "told her she had to find someplace else for treatment soon." A social worker has been trying in vain to find an alternative provider and indicates that if she's not successful soon the woman will have to "go cold turkey."

Can one imagine any other medical care provider abruptly discontinuing treat-ment -- especially treatment for a condition known to have a significant risk of death - because she/he was cited for drunk driving? Would a diabetes clinic tell a patient on insulin she/he had to find another provider or else simply do without insulin? Or a provider of care for cardiac disease or hypertension or prenatal care or . . .?

Unthinkable, and if a provider for whatever reasons were to threaten to do then it would be deemed therapeutic abandonment and subject the physician in charge to possible revocation of medical licenses as well as God knows what civil actions. How incredibly ironic that this particular medical care provider, whose raison d'etre is caring for chemical dependence, should have such policies and practices!

An additional issue raised by the article:
narcotic dependence is a medical condition with the most severe consequences for the individual and the community. For the former there is the risk of getting and spreading HIV, hepatitis and other illnesses, arrest and incarceration and loss of child custody, and death from overdose.

For the community, there are enormous social and also financial costs. While to date no one can make a credible claim for a cure for narcotic addiction, effective treatment exists - and no form of treatment is recognized as being as effective as methadone maintenance.

So . . . shouldn't some voices be raised demanding the State explain what is being done to eliminate the irrationality and inhumanity of requiring those seeking help to languish on waiting lists? The social worker quoted in this article reports that waiting times routinely are 1-1.5 months. Indeed, someone should be demanding to know what consideration is being given to increasing capacity sufficiently to allow the state to take the initiative with public service announcements urging more narcotic dependent people to seek help.

RGNewman, MD http://opiateaddictionrx.blogspot.com/2008/01/dwi-leads-to-abrupt-discontinuation-of.html

Woman was turned away by social services before child's death, report finds.

A month before Vernice Harris allegedly killed her daughter by giving her methadone and beating her, the mother asked a Baltimore Department of Social Services caseworker for help but was turned away.

That's one of the findings of an investigative report released Tuesday by the State Department of Human Resources, which oversees all child protective services statewide. DHR Secretary Brenda Donald ordered the report in the wake of Vernice Harris' recent arrest on charges of first-degree murder in connection with the two-year-old's death in June.

Bryanna is one of six children who have died since 2003 despite the fact that their families, which had histories of abuse, had prior contact with the social services agency. In the case of the Harris family, two older children had already been removed from the home after the agency found Vernice Harris had neglected them. Bryanna, however, was allowed to stay with her mother in a house police later found to be filthy and infested with cockroaches.

The report by the state Office of the Inspector General depicts the city social services agency -- which cares for roughly 6,000 children in foster care as well as some adults -- as chaotic and dysfunctional. At least 18 supervisors and case-workers had contact with the Harris family over a seven-year span before and during Bryanna's short life, the report states. However, those workers didn't communicate well enough with each other and missed important clues about the family's well-being, the report says.

"To have a child die is obviously the worst thing [that can happen] in the work we do," Donald said Tuesday at a news conference. "We do this work because we care about children and families, and to have a situation like this is heartbreaking."

Donald said she will review employees' conduct with the family and decide by mid-February if any workers should be reprimanded, demoted or fired. The report shows that supervisors and caseworkers did not adhere to existing policies to protect vulnerable children and that, at times, they were not even following basic rules of good casework.

Harris' attorney, Maureen Rowland, said that the mother was "doing the best she could" in raising Bryanna. But the attorney said the mother needed lots of guidance. "Any professional who had contact with her should have realized that," Rowland said. "She would run into [a] roadblock and not know what to do. ... It's a shame Department of Social Services couldn't pick up on that."

The state's investigation also found that: •Caseworkers failed to make sure that Vernice Harris, 30, got into a drug treatment program. Instead, Harris waited more than a month for drug treatment, all the while continuing to use drugs and putting Bryanna at risk. •The local department did not perform a comprehensive review of Bryanna's death.

To address lapses identified in the report, Donald said she is moving forward immediately to overhaul the city social services department. She said she had hoped to take more time to review policies and procedures, but circumstances, including Bryanna's death and the recent resignation of former DSS Director Samuel Chambers Jr., made that unthinkable.

"We can't pretend that it is life as usual," said Donald, who has been in her position for about a year. "We are going to move ahead as quickly as possible."

A big part of reform will mean retraining for close to 2,000 caseworkers and supervisors, Donald said. Their roles will also be clarified so there is no confusion about who should do what if a child is in immediate danger, she said. Improving communication between groups of employees also will be a priority, she said.

Donald also has requested legislation to authorize an alternative response to some reports of child abuse or neglect and has said that she will support a bill to expand the number of state employees required to report suspected instances of abuse. She also endorses the creation of a "birth match" program to alert social services when a child is born into a family with a history of abuse.

A spokesman for Gov. Martin O'Malley said he is committed to working with the city to reform a "historically" troubled institution.

"We're trying to find a balance between new legislation and administrative changes that might accomplish the same goal," Rick Abbruzzese said.

Del. Joseph F. Vallario Jr., chairman of the House Judiciary Committee, said there is momentum this General Assembly session behind possible legislative fixes.

"For 20 years we've heard about these horrible cases from time to time," he said. "And in light of the Harris case, there will be an abundance of legislation that will be introduced that we'll be considering."

Preventing child abuse and neglect has become a growing issue nationally as states struggle to find the most effective policies and programs to protect children from harm. At a news conference in Washington Tuesday, a nonprofit group called Prevent Child Abuse America released a study pegging the economic costs of child abuse and neglect nationally at $103.8 billion in 2007.

Local advocates said they have been begging for reform at the city agency for years -- especially in areas of caseworker training and recruitment.

"Historically, it has been a free- for-all," said Ameejill C. Whitlock, child welfare director for Advocates for Children and Youth in Baltimore. "They have said, 'Let's just get a warm body in here.'"

What do we really know about the cardiac “risks” of methadone maintenance? There have been many reports of prolonged QT intervals on electrocardiograms – but what does this mean?

Consider a very recent report in the French Revue de Medicine Interne (vol 28, 2007, pages 709-710), which describes a single case – a 51 year-old man who had been on methadone maintenance for nine years and on hospitalized for alcohol-induced cirrhosis and complications, but apparently without cardiac symptoms of any kind. He was found to have a prolonged QT interval on admission, which appears to have necessitated no treatment, and did not prompt change in the methadone regimen.

One of the references cited in the paper also deserves mention – a 2003 report in the form of a letter published by Annals of Internal Medicine (vol. 139, no. 2, pages 154-155).

That publication described a study of 132 patients for two months following induction on methadone maintenance. They demonstrated prolonged QT intervals, but there was no mention of any signs or symptoms of cardiac illness, and none of the patients apparently had the treatment plan modified as a result of the EKG changes.

The authors concluded by noting that “A critical question . . . is whether the QTc prolongation is clinically significant … [and] whether changes in QTc interval in patients receiving methadone are in fact associated with adverse cardiac out-comes.” Yes indeed – those are the questions!

And while they are being considered and answers sought, we must keep in mind the caution of the authors of the 2003 paper: “Any potential risk associated with [methadone’s] use must be weighed against its substantial demonstrated benefits.”

RGNewman, MD http://opiateaddictionrx.blogspot.com/2008/01/methadone-and-cardiac-arrhythmias.html

Please send any comments to Rozi.Director@MedicalAssistedTreatment.org

Assistant Editor: Rozi Fox Updated: 03 July 2008