Editorial Comment: AATODs Letter to Treatment Magazine

January 9, 2009


Ted Jackson Editor and Publisher
Treatment Magazine
Post Office Box 3 196
Lantana, Florida 33465

Dear Mr. Jackson:

I am writing with regard to the "Publisher's Note," "Another Use for Methadone?!!," which was published in the November 2, 2008 edition of Treatment Magazine.

You note that methadone is "...one of the most studied drugs on earth. "It would be helpful for you to read some of the literature because you would find that there is absolutely no scientific evidence that supports the statement that methadone " ...rots your teeth." It is useful to cite a statement from the National Institutes of Health Consensus Statement of November 1997.

"Many of the barriers to effective use of methadone maintenance Treatment in the treatment of opioid dependence stem from misperceptions and stigmas attached to opioid dependence the people who are addicted those who treat them and the settings in which services are provided."

An impartial observer might conclude that your "Publisher's Note" further stigmatized this long-proven and effective treatment for opioid addiction. The Association welcomes the expansion of buprenorphine medication and an increasing number of opioid treatment programs are using buprenorphine products in addition to methadone to treat chronic opioid addiction. With regard to methadone being antiquated, you should know that there is a major expansion in the use of this medication to treat chronic opioid addiction in Europe, China and Vietnam with an interest to use this medication in other developing nations.

You also indicate that "...the principal use for methadone is as a maintenance replacement for other opiates." This has been the case for the past four decades to present, there are approximately 260,000 patients being treated with methadone in 1,203 registered and certified OTPs. There are more than 700,000 patients who receive prescriptions for methadone from private physicians in treating chronic pain.

After years of struggling to support rigorous scientific evaluations of medications and to promote evidence-based treatment for opioid addiction, it is extremely disheartening to have the publisher of a treatment magazine for the addiction industry make such unfounded comments.

Sincerely yours,


Mark W. Parrino, MPA
President

IDUD 2008 Gathers Top International Advocates

National Alliance of Methadone Advocates
Press Release

Contact Persons:
Joycelyn Woods, Executive Director, edirector@methadone.org
Roxanne Baker, President, president@methadone.org
Phone/Fax: 212-595-NAMA

For Release:
November 17, 2008

BrugerForeningen (BF), NAMA’s Danish Affiliate hosted the International Drug Users’ Day (IDUD) in Copenhagen Denmark October 30 to November 3, 2008 to bring together the top user activists from around the world.

IDUD event was founded in 1995 by the national Dutch umbrella user organisation Landelijk Steunpunt Druggebruikers (LSD) and their director Theo van Dam. IDUD was an international conference and celebration for drug user activists to network, share ideas and unite user organizations. The last IDUD was hosted by BF in 2003 and gathered 96 activists from 16 different nations. The event was documented by Howard Lotsof (NAMA and Dora Weiner Foundation) and can be read on the BF website at http://www.brugerforeningen.dk/bfny.nsf/engelsk/nl003?OpenDocument&S=UK

Ths year’s event brought together 120 activists from around the world. Presentations included:

• Méta d’âme’s new facility and the peer delivered services.


• Syringe and needle distribution in jails and how to go about it.


• Lifesaving prevention of peer distributed Naloxone to reduce overdose deaths.


• Making user unions accepted in wider society by providing services (i.e. syringe patrols & prevention lectures at schools) and using the parents and relatives of drug users to promote the union.


• Improving the lives of drug users through the union’s advisory services to the community and advocacy.


• Publications: user magazines and special concepts such as the J-Key Cards to educate drug users and promote user organizations.


• Heroin trials and treatment.


• Memorial Day events for deceased drug users – 21 July.


• Human rights for drug users and what user organizations should know.


• Attracting funding for user groups and interest organizations.


• Working with journalists and using the media to promote user organizations.

This was the fifteenth year anniversay of BrugerForeningen and on November 1, 2008 120 activists were served a three course meal. After dinner the gala party continued with a live band consisting of activists musicians from Italy, Australia, Denmark, Norway and Belgium with Pat O’Hare in lead.

NAMA presented Joergen Kjaer and BF the International Advocate of the Year Award for 2009 for “...the exceptional work they have done in Denmark and throughout the world advocating for drug users and those who are voiceless. Their efforts have resulted in a more united network of user organizations throughout the world, helped to create a unified voice and brought the issues that confront drug users to the public.”

Congratulations to BF and Happy Anniversary with many more successful years to come.

Photos of the events can be seen at these links.

IDUD Conference:

http://cid-19d32a68e122a231.spaces.live.com/photos/cns!19D32A68E122A231!110/

Gala Dinner:

http://cid-19d32a68e122a231.spaces.live.com/photos/cns!19D32A68E122A231!425/

Variations In Key Genes Increase Caucasians’ Risk Of Heroin Addiction

ScienceDaily (Oct. 5, 2008)

Sometimes, small changes do add up. In the case of addictive diseases, tiny variations in a few genes can increase or decrease the likelihood of some people developing a dependency on heroin. Now, by examining a select group of genetic variants in more than 400 former severe heroin addicts, Rockefeller University researchers have identified several genetic variations in American and Israeli Caucasians that influence the risk for becoming addicted to one of the world’s most powerful substances.

--------------------------------------------------------------------------------
In a collaborative effort with statistical geneticists and several methadone clinics, scientists led by Mary Jeanne Kreek, head of the Laboratory of the Biology of Addictive Diseases, analyzed 1,350 variations in 130 genes and found nine, from six genes, that were either more or less common in recovering heroin addicts when compared to Caucasians with no history of drug abuse. These small changes in the gene sequences can cause significant changes in protein function that can influence addictive behavior — changes that may affect people of different ethnic background differently.

“The idea of ‘personalized medicine’ makes this field really exciting but also very complicated,” says Orna Levran, a senior research associate in the Kreek laboratory and first author of the study. “Although seven of these variants increase the risk for developing heroin addiction in Caucasians, the same seven may not have the same effect in other populations. So ethnicity and, more precisely, genetic information in each individual may become important factors for treating and diagnosing addictions to different drugs.”

In their analysis, Kreek, Levran and their colleagues looked at a string of letters called nucleotides, the building blocks that make up genes. In each of the six genes, at least one letter is replaced by another, a genetic variation known as a single nucleotide polymorphism, or SNP. The researchers found that all of the single-letter variations exist in parts of the genes that do not translate into proteins but instead may have a regulatory or a structural effect.

Out of the nine SNPs, the group found six in the μ, δ and κ opioid receptors, a finding that reinforces the idea, and many other findings of the Kreek laboratory, that opiate receptors play a major role in severe heroin addiction. The remaining three SNPs were found in genes coding for the serotonin receptor 3B, casein kinase 1 epsilon, which acts as a regulator of the circadian clock genes, and galanin, which modulates appetite and alcohol consumption. This is the first study to show that specific variants in these genes are associated with heroin addiction, explains Levran.

The SNPs in the κ opioid receptor and casein kinase 1 genes were found more in the control group than the heroin addicts’ group, suggesting that they conferred protection from heroin addiction — not vulnerability to develop addiction.

“Individually, these SNPs probably have a small effect,” explains Levran, “but collectively, we are seeing that they could have a larger effect. One of the goals now is to find all of these gene variants and assess how they influence people of different ethnic backgound.”

--------------------------------------------------------------------------------

Journal reference:

Levran, Londono, O'Hara, Nielsen, Peles, Rotrosen, Casadonte, Linzy, Randesi, Ott, Adelson, Kreek. Genetic susceptibility to heroin addiction: a candidate gene association study. Genes Brain

and Behavior, 2008; 7 (7): 720

Adapted from materials provided by Rockefeller University.

ABSTRACT

Genetic susceptibility to heroin addiction: a candidate gene association study

O. Levran*,†, D. Londono ‡ , K. O'Hara † , D. A. Nielsen † , E. Peles § , J. Rotrosen ¶ , P. Casadonte ¶ , S. Linzy**, M. Randesi † , J. Ott ‡,†† , M. Adelson †,§,** M. J. Kreek †
  † The Laboratory of the Biology of Addictive Diseases, and  ‡The Laboratory of Statistical Genetics, The Rockefeller University, New York, NY, USA,  §Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Elias Sourasky Medical Center, Tel Aviv, Israel,  ¶VA New York Harbor Healthcare System and NYU School of Medicine New York, NY and  **Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Las Vegas, NV, USA, and  ††Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China

Correspondence to   *O. Levran, The Laboratory of the Biology of Addictive Diseases, 1230 York Avenue, Box 171, The Rockefeller University, New York, NY 10065, USA. E-mail: levrano@rockefeller.edu

Copyright Journal compilation © 2008 Blackwell Publishing Ltd/International Behavioural and Neural Genetic Society

KEYWORDS: Association study, candidate gene, heroin addiction

Heroin addiction is a chronic complex disease with a substantial genetic contribution. This study was designed to identify genetic variants that are associated with susceptibility to develop heroin addiction by analyzing 1350 variants in 130 candidate genes. All subjects had Caucasian ancestry. The sample consisted of 412 former severe heroin addicts in methadone treatment, and 184 healthy controls with no history of drug abuse. Nine variants, in six genes, showed the lowest nominal P values in the association tests (P < 0.01). These variants were in noncoding regions of the genes encoding the mu (OPRM1; rs510769 and rs3778151), kappa (OPRK1; rs6473797) and delta (OPRD1; rs2236861, rs2236857 and rs3766951) opioid receptors; the neuropeptide galanin (GAL; rs694066); the serotonin receptor subtype 3B (HTR3B; rs3758987) and the casein kinase 1 isoform epsilon (CSNK1E; rs1534891). Several haplotypes and multilocus genotype patterns showed nominally significant associations (e.g. OPRM1; P = 0.0006 and CSNK1E; P = 0.0007). Analysis of a combined effect of OPRM1 and OPRD1 showed that rs510769 and rs2236861 increase the risk of heroin addiction (P = 0.0005). None of these associations remained significant after adjustment for multiple testing. This study suggests the involvement of several genes and variants in heroin addiction, which is worthy of future study.

--------------------------------------------------------------------------------

Notice: Medicaid Medicare New Rule Put on Hold

October 3, 2008

NAMA has been working behind the scenes with provider organizations regarding a New Rule proposed by the Center for Medicaid and Medicare that would set low limits for both Medicaid and Medicare. But the greatest impact it would have had would be to stop all Medicaid funding for methadone treatment.

It was worded in a way that if Medicare did not cover a service then Medicaid would also have to eliminate that service. It not only impacted methadone treatment but many other services that are not provided within a hosptial, such as: dialysis, women's services, HIV services, disabled children and mental health. Since the majority of programs are not hospital based and Medicaid funding would be ended.

The Center for Medicaid and Medicare also proposed 6 other rules that have also been put on hold until April 2009.

Here are some documents you can read about the rule.

Upper Payment Limit Federal Register
CMS PROPOSED RULE Revised
CMS Upper Payment Limit Rule-Coalition Response
Comment on Outpatient Hospital

Victory for Addiction Equity: Wellstone-Domenici Bill Passed by Congress and Signed by President Today

After twelve years frustrating hard work determined advocacy has finally produced the victory. Today Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 - comprehensive mental health and addiction parity legislation in honor of the late Senator Paul Wellstone. The bill was included in financial bailout package passed by the Senate on Monday and the House today. It now moves to the President's desk.

The parity bill does not require health-insurance plans to cover addiction or mental health, but insurers will now be barred from imposing any caps or limits on behavioral healthcare service that are not applied to other health conditions. Most insurance plans do include behavioral-healthcare coverage, and advocates say that past experience shows that passage of state-level parity laws has not led to insurers dropping such coverage.

We are still only half way there but that is better than not being there at all.  The bill will start to pave the way so that all Americans can receive help for their addiction.

NAMA salutes Faces & Voices for their strong support of this bill and medication assisted treatment.

Gulf Coast Area: Did Emergency Preparations Work?

National Alliance of Methadone Advocates
Press Release

Contact Person:
Joycelyn Woods, Executive Director
edirector@methadone.org
1.212.595.6262

For Release 
September 6, 2008

 

Did Gulf Coast Programs Give Patients Enough Preparations for Gustav?

Policy Makers and Regulators are all congratulating one another for the great work done during Gustav. Patients got out of town and were given enough medication until they could get back. Thus far no complaints.  However all seemed to go well because Gustav ended up a Category 2 hurricane but what if it had been a Category 4 or greater.

NAMA needs to know if patients in the Gulf Coast Area had the correct emergency information to get through a larger hurricane. Can you answer some questions?

* * *

When did your program notify you to come in and get emergency evacuation medication?

If your area was not evacuated then did your program give you information what to do in case evacuation occurred?

Whether you evacuated or not how many days medication were you given and on what day?

Were you told what to do in case you could not return within the amount of days medication you were given?

Were you given information of what to do in case you could not reach your program after the hurricane?

Program Name:

City:

State:

 

Send your answers to edirector@methadone.org

We will take your answers and notify the proper authorities about what happened right and what did not happen that should have.

 

 

Hurricane Gustav Threatens Texas to Mobile, Including New Orleans

 

National Alliance of Methadone Advocates
Press Release

Contact Person:
Joycelyn Woods, Executive Director
edirector@methadone.org
1.212.595.6262

For Release
August 31, 2008

 

While most Americans are enjoying the Labor Day Weekend residents from Galveston. TX to Mobile, Alabama are being warned about Hurricane Gustav. In the middle of the estimated path is New Orleans.

 

NAMA has already begun to get phone calls from patients in the area who are being told to evacuate.  One patient was just given 4 days medication and no other instructions in the case they could not return.  Neither were they provided with a letter stating their dose and other information.

Advise to Patients

If you need to evacuate get a letter from your clinic.  The standard Travel Letter that is given to patients should be enough that states you are patient, that you need to take ____ mgs of methadone a day and information about contacting the clinic.

Get a list of programs in the area in case you can not get back to your program and the State Methadone Authority.

 

New Orleans Programs

DRD New Orleans Medical Clinic
417 South Johnson Street
New Orleans, LA 70112 (504) 524-4701

Desire Narcotic Rehabilitation Ctr Inc
4116 Old Gentilly Road
New Orleans, LA 70126 (504) 301-8871

New Orleans Narcotic Treatment Center
7606 Westbank Expressway
Marrero, LA 70072 (504) 347-1120

Choices of Louisiana Inc
128 Woodland Drive
La Place, LA 70068 (985) 651-3777

Baton Rouge Treatment Center Inc
11445 Reiger Road
Baton Rouge, LA 70809 (225) 932-9867

If you need a program farther than New Orleans or you are in another state you can use the Treatment Facility Locator at:

 http://findtreatment.samhsa.gov/

State Methadone Authorities

Brenda  Lands
Louisiana Office for Addictive Disorders 
1201 Capital Access Road, 4th Floor 
Baton Rouge, LA 70802
Telephone: (225) 342-8735 
Fax: (225) 342-3931 

Christine  Ramirez
1100 West 49th Street 
Austin, TX 78756-3199
Telephone: (512) 834-6700 x2146 
Fax: (512) 834-6638 

Robert  Wynn
Department of Mental Health
P.O. Box 301410, 100 North Union Street
Montgomery, AL 36130-1410
Telephone: (334) 242-3956
Fax: (334) 242-0759

 

NAMA will continue to post information as it becomes available.

Finally NAMA Website Goes Back Up

 

National Alliance of Methadone Advocates
Press Release

Contact Person:
Joycelyn Woods, Executive Director
edirector@methadone.org
1.212.595.6262

For Release
August 31, 2008

 

It has been nearly 6 months since Calyx the service that has hosted the NAMA website went down. Several attempts to get the server up and running again have been attempted and failed. This left NAMA with the problem of having to find a service that could host a site the size and activity of the website but that would not be expensive.  We think we have found it and so the website is slowing going back up.

It will take us several weeks to get the website up and equal to what it was when it went down.  Many pages need updating while others may have broken links, missing pages, lost images and vanished pictures but we will track them down and upload them if you tell us what is missing.

Tell Us When You Find An Error

If you find something missing on a page send us a message with:

the name of the page,

the link and

what is missing,

to: whoops@methadone.org

Kerry Wolf New We Speak Methadone Administrator

National Alliance of Methadone Advocates
Press Release

Contact Person:
Joycelyn Woods, Executive Director
edirector@methadone.org
1.212.595.6262

For Release
August 6, 2008

NAMA is pleased to announce that Kerry Wolf will be the new We Speak Methadone (WSM) Administrator. Ms. Wolf has been the second in command at WSM for several years and is already known at the forum for her commitment to spreading the truth and telling the untold success stories about methadone. Her energies sometimes seem to be endless and we at NAMA are very fortunate to have her.

Charles "Hoss" Kitts has been the administrator of WSM for many years.  He will most undoubtedly be missed for his caring and concern for patients that need help.  However Hoss is not actually leaving the family of NAMA as he will still be Director of the West Virginia chapter and we hope to see him posting at WSM on occasion.

Methadone Promising in Hard-To-Treat Leukemia

By Karla Gale
Reuters, August 1, 2008


NEW YORK (Reuters Health) - Methadone, a drug used to treat people addicted to heroin and other opioid drugs, holds promise as a new treatment for leukemia, especially treatment-resistant leukemia, according to results of a study.

Laboratory tests show that methadone kills leukemia cells without harming healthy blood cells, researchers at the University of Ulm in Germany report in a paper published today in the journal Cancer Research. Methadone was even effective in killing leukemia cells resistant to killing by chemotherapy and radiation.

"Leukemia cells express opioid receptors, to which methadone binds," study chief Dr. Claudia Friesen told Reuters Health. "Surprisingly, we found that methadone kills leukemia cells efficiently. We never expected that."

These results "provide the foundation for new strategies using methadone as an additional anticancer drug in leukemia therapy, especially when conventional therapies are less effective," the investigators conclude.

"We find this very exciting, because once conventional treatments fail, which occurs in old and also in young patients, they have no other options," Friesen said.

She predicts that methadone will have similar effects in other cancers that express opioid receptors. "In our lab we found that we also can kill solid tumors," she added.

Friesen and her team are studying methadone alone and in combination with other chemotherapy drugs in animal models of cancer.

SOURCE: Cancer Research, August 1, 2008.

Other Links

Methadone Breaks Resistance In Untreatable Forms Of Leukemia
Science Daily, August 4, 2008

Methadone Kills Resistant Leukemia Cells
HealthDay News, August 1, 2008

Lab Study Shows Methadone Breaks Resistance in Untreatable Forms of Leukemia
American Association for Cancer Research, August 1, 2008

Posted: August 4, 2008

Indiana Poses New Regulations That Would Force Hundreds Out of Treatment

National Alliance of Methadone Advocates
Press Release

Contact Persons: Roxanne Baker, President
president@methadone.org
Joycelyn Woods, Executive Director
edirector@methadone.org
1.212.595.nama

For Release
February 15, 2008

Indiana Poses New Regulations
That Would Force Hundreds Out of Treatment

The Indiana Legislature is proposing some excessive regulations that will force hundreds of patients out of treatment. And those seeking treatment will find barriers that make it nearly impossible to access treatment.

The Indiana House Bill 1258 calls for:

1. Excessive and unnecessary urine testing,
   


2. Discharge any patient testing positive for any drug not in their treatment plan,
   


3. Not allow anyone under 18 years in a program unless they are being treated there or transporting a patient,
   


4. Requires a designated driver for any patient leaving the program.
   

These regulations will force programs to discharge patients that test positive for any drug that is not part of their treatment plan. This means that any patient that develops a secondary addiction while in treatment will be denied treatment for their opiate dependence no matter how well they may be doing with it.

Every woman with children will now have the additional burden of a babysitter so that they can attend the program.

Making patients have a designated driver is really against all the scientific evidence that is known about a stable patient taking methadone.

This is an issue of legislators delving into something and making assumptions about things that they know nothing about. They do not understand that opiate addiction is a brain disorder and that methadone is a medication and they do not view patients as seeking recovery.

It is interesting to note that these regulations do not include other powerful medications that can cause impairment. They are focused on methadone and patients in medicated assisted treatment because they harbor prejudices and stigma towards them.

Methadone has been evaluated for over forty years throughout the world. Studies evaluating the functional potential of methadone patients have found no differences between the patients and control groups. In fact in some studies the patients had a faster reaction time and another study that followed driving records found patients were safer drivers (Gordon, 1994).

What is the most disturbing is that Indiana legislators are making regulations without consulting any professionals, researchers or patients to first assess the needs and impact of the new regulations. One would hope that there intention would be to make Indiana a better place for all of it’s citizens.

The MAG is Working in Indiana

The MAG of Indiana NAMA’s Indiana Chapter is working to mobilize patients and advocates to speak out against this legislation. Even if you live in another state it is important that you write to these legislators and tell them how devastating this will be to patients.

What Can You Do?

You can download the following to help with contacting legislators:

Indiana Legislators Target Methadone Patients Flyer

Who to Write To

District Reps for methadone clinics

House Bill 1258

Courier-Journal Article

Patient Info Sheet for SB 0157 (Designated Driver)

Petition for Designated Driver

Phone Script for Designated Driver

Porter Starke Ready to Open New Indiana Clinic

National Alliance of Methadone Advocates
Press Release

Contact Person:
Joycelyn Woods, Executive Director
nama.president@Verizon.net
1.212.595.6262

For Release
November 12, 2007

Located in Valparaiso the clinic is attached to the main Porter-Starke Services building has everything in place except the actual methadone according to advocate and director Carmen Arlt. The clinic has been inspected by state and federal officials and is now waiting for the federal certificate. Once the certificate is received the clinic could be open within days. According to Arlt they are expecting a large number of transfer patients from the Gary area since many of the patients that attend those clinics are from the area

Carmen Arlt is also director of NAMA’s Indiana Chapter The MAG and is one of the few patient advocates to be recognized with the prestigious Marie (Dole-Nyswander) Award.

About
Since its beginning over 40 years ago methadone maintenance has been the most effective treatment for narcotic addiction. In spite of its success, methadone maintenance is often disparaged as a "substitute drug" by those who ignore the positive benefits that it has clearly brought to society. Such attitudes negatively impact on methadone treatment in a variety of ways, but it is the methadone patients themselves who are particularly stigmatized and harmed. Patients are mistreated and misinformed and considered as social outcasts. They are victims of discrimination in health care, the job market, education, insurance and housing. The National Alliance of Methadone Advocates (NAMA) was organized as a formal mechanism for methadone patients to voice their own needs and to form a strong, unified public presence on their behalf. The primary objective of NAMA is to advocate for the patient in treatment by destigmatizing and empowering methadone patients. First and foremost, it can confront the negative stereotypes that impact on the self esteem and worth of many methadone patients with a powerful affirmation of pride and unity.
Website: http://www.methadone.org


Contact Persons:
Joycelyn Woods, Executive Director, ediretor@methadone.org
Roxanne Baker, President, president@methadone.org
Phone/FAX: 212.595.nama

See attached article from Post Tribune.
###

Attachment
Final touches on clinic
November 10, 2007
By Teresa Auch Post-Tribune staff writer
VALPARAISO -- The new methadone clinic at Porter-Starke Services is ready to open, just as soon as the federal government gives approval.
The clinic, one of 13 in the state, was supposed to open July 1, Carmen Arlt, director of addiction services said. But the group wanted to put in more safety features, such as cameras and locks, to make the community and staff feel safe.
"We were slowed down by the process of renovation," Arlt said.
The clinic, which is attached to the main Porter-Starke Services building at 701 Wall St. in Valparaiso, has everything in place except the actual methadone.
A camera hovers over the entrance, as do several others in the lobby. Patients coming to get a prescription of methadone must first sign in at a front window.
They then move to another window, walled off from the lobby, to take their dosage.
The clients must sign electronically and then swallow the liquid in front of the registered nurse giving the dose, nurse staff member Don Sison said.
"Sometimes we engage in conversation after they have taken it to make sure they have swallowed it," Sison said.
The conversation also allows the nurses to get a feel for how patients are doing.
The clinic includes several side rooms for physicals, mandatory drug tests and interviews. Anyone who wants to become, and remain, a patient must prove they have tried other measures and that they are making improvements in their lives, Arlt said.
As for the dispensary, the room is made of steel walls, the door has a double lock, along with motion detectors.
Anyone entering the room has to have a nursing certificate posted on a board inside. The methadone supplies are kept in a special safe.
Arlt said the clinic has passed all levels of state and federal regulations.
"We're actually more safe over here than a bank," she said.
As soon as the federal government gives official certification, the clinic can be open within a few days.
That could happen anywhere from days to a few weeks from now, she said.
Arlt said she expects to see a heavy volume of patients soon.
The state government has warned her that about 60 percent of the patients who go to the clinics in Gary are from Porter County and will likely go to Porter-Starke once its clinic opens.

Leaders of NAMA’s Swedish Affiliate Svenska Brukarforeningen (SBF) Report to Police for Handing Out Clean Needles

National Alliance of Methadone Advocates
Press Release


Contact Person: Joycelyn Woods, President
nama.president@Verizon.net
1.212.595.nama

For Release
May 17, 2007

On May 4 SBF’s President, Berne Stålenkrantz and the Stockhom Director, Johan Stenbäck presented themselves to the Norrmalm Police Station in Stockholm for handing out clean needles to drug users.

The purpose of the action was to get an official assessment of the their crime and to bring to the public the fact that Sweden does not allow syringes to be sold in pharmacies as is done is all other countries in the European Union (EU). SBF is also considering reporting Sweden to the European Union for its failure to comply with EU rules surrounding the common market.

In southern Sweden needle exchange programs have been keeping the spread of HCV nd HIV under control for the past 20 years. County and Town Councils have been allowed to establish needle exchange programmes if they so wish. However in Stockholm no such programs have been established.

According to Stålenkrantz if the penalty is mild they will continue with what they are doing. However after SBF publicized that they were providing drug users with clean needles the organization suddenly found its financing from Stockholm City Council under threat.

Stålenkrantz also reported that a colleague suffering from a Hepatitis C was planning to report the city's social services department to the police because he has contracted a deadly illness after being refused clean syringes. He will also state that he was a victim of SBF’s having received clean syringes from the organization.

Needle exchange programs have been used worldwide for the past twenty years and provides a way for drug users to avoid the risks of drug use as well as a way to access support services including treatment.

"We are handing out syringes for purely humanitarian reasons. And we are forced to do so since society is not providing this type of healthcare," said Stålenkrantz.

NAMA Calls for An End To Using The Term Substitution Treatment Asking That Governments and Their Agencies and Organizations End Its’ Use

National Alliance of Methadone Advocates
Press Release

Contact:
Joycelyn Woods MA-CMA (212) 595-NAMA/6262


For Release:
May 4, 2007


The National Alliance of Methadone Advocates, our international affiliates and chapters in the United States call on all governments, governmental agencies and international organizations to end the use of “Substitution Treatment” when referring to medication assisted treatment (MAT) for opiate addiction.

The term “Substitution Treatment” infers that any medication used in the treatment of opiate dependence is a substitute. No other medication is referred to in this manner creating significant misunderstandings towards the medication and especially the patients. The use of “Substitution Treatment” stigmatizes patients receiving treatment for the opiate dependence, promotes ignorance and pollutes the development and growth of this life saving medication for those needing help for their opiate dependence.

Governments have rejected buprenorphine and particularly methadone because they it is viewed as merely a substitute for heroin or other illicit drugs. Officials in rejecting these medications have expressed the belief that their citizens should have the right to an effective treatment. Thus hundreds of thousands of opiate dependent individuals “are being denied” the most effective treatment because “Substitution Treatment” is misleading and confusing.

In the United States the term Substitute and Substitution Treatment is only used to denigrate both methadone and buprenorphine treatments. Calling these medications a substitute has been used to hurt Patients by denying them opportunities and other benefits that they deserve and have worked for. Thus, in the United States only those against methadone and buprenorphine call them a Substitute.

At Bratislava in 2006 Dr. Icro Maremmani, the President of Europad called for his European colleagues to end the use of “Substitution Treatment. He asked his colleagues to follow the philosophy and principles of Drs. Dole and Nyswander who believed that opioid dependence and addiction was a medical condition and conceptualized the drug dependent person as a person with a brain metabolic disorder.

The last years of Dr. Dole’s life were spent working to resolve the stigma and prejudice that affects patients in medication assisted treatment. Dr. Dole was acutely aware of the stigma that terms like “Substitution Treatment” create towards patients. He always spoke out against any inference that medication assisted treatment was a substitute. In his experience, methadone and more recently buprenorphine were medications that stabilize the endogenous opioid system damaged by narcotics.

We, at the National Alliance of Methadone Advocates believe that the use of Substitute or Substitution Treatment denigrates this treatment. And that by denigrating this treatment patients receiving medication assisted treatment are injured.

As patients we reserve the right to define ourselves and our treatment. It is therefore the spirit of our own self identity we ask governments and their agencies, organizations and professionals to cease using “Substitution Treatment. Methadone and buprenorphine are medical treatments and should be defined as “Medication Assisted Treatment” or “Opiate Agonist Therapy”.



It is therefore in the spirit of our own self identity we ask governments and their agencies, organizations and professionals to cease using “Substitution Treatment. Methadone and buprenorphine are "medical treatments" and should be defined as such. However if you must put a name to addiction treatment then we suggest “Medication Assisted Treatment” or “Opiate Agonist Therapy”.

Méta d'âme Announces New Housing Initiative for Methadone Patients in Montreal

National Alliance of Methadone Advocates
Press Release

Contact Persons:

Joycelyn Woods, President
nama.president@Verizon.net
1.212.595.nama

Guy Pierre Levesque, Méta d'âme
guypierrelevesque@yahoo.com

For Release:
April 12, 2007


Méta d'âme NAMA’s affiliate in Montreal has announced a new housing project that will provide housing and peer services to methadone patients. Construction of a new building will begin in August with the building of 22 units that consisting of studio and 1-bedroom apartments. The building will have a green roof and community hall for meetings. Meta d'âme will own and manage the project with peer workers in collaboration with clinic referrals. Guy Pierre Lévesque spokesperson for Méta d'âme reports that the organization will also occupy half of the ground floor starting June 2008.

The housing project is named Promethéus (Promethe) from the Greek god. A favorite of Zeus Promethe was punisheed for disobedience because he stole fire from the gods and gave it to mortals for their use. This was the beginning of enlightenment for man. An appropriate name for the project Promethean refers to events or people of great creativity, intellect and boldness.

Also in the planning is a French International Methadone Conference and other medicated assisted treatment (MAT) for opiate dependency. Translations will be made available in English. Méta d'âme will be involved in the planning and also include peer-working at the conference. In addition to the conference Méta d'âme is involved in the development of a Canadian Methadone Association.

“It is possible to make things happened if we believe in what we do,” says Lévesque. Therefore it appears that the impetus of Méta d'âme is creating some important advances in Canada.

MOUNT SINAI TO ABANDON AFRICAN-AMERICAN AND HISPANIC PATIENTS OF EAST HARLEM

National Alliance of Methadone Advocates
Press Release

Contact:
Joycelyn Woods MA-CMA (212) 595-NAMA/6262

For Release:
April 9, 2007

The Mount Sinai Hospital is planning to close the Narcotic Rehabilitation Center (NRC) a program with an international reputation for excellence in treating opiate addiction. After 37 years of providing rehabilitation services to Upper East Side residents afflicted with opiate addiction, Mount Sinai has determined that there is no longer any room for the program.

Even after accepting funds for the renovation of the facility from the New York State Office of Substance Abuse Services (OASAS) the hospital appears to be moving to quickly close NRC. In NRC’s place Mount Sinai is planning a multi-million dollar project that will include luxury high-rise apartments. It is difficult to comprehend Mount Sinai’s decision to eliminate a program that has been important to the local neighborhood. The situation could be easily averted since NRC can be easily relocated to the selected site that is renovated, licensed and ready to open. Therefore it is difficult to understand why Mt. Sinai can not find a way to keep these valuable services.

Has Mount Sinai Forgotten it’s Mission?

The National Alliance of Methadone Advocates (NAMA) has already begun to hear from fearful patients and their concerns about having to go to another program that they do not know. Certainly, patients will have to travel into other neighborhoods for treatment, change their schedules and develop new relationships with program staff. This creates stress for patients and their families. And now with fewer options to treatment in East Harlem any increases in drug use could easily develop into a public health crisis.

NRC that serves 700 patients has a international reputation for providing quality medicated assisted treatment and is known for having exceptional services. The programs that will have to take on the responsibility of accepting these patients do not have the services that NRC has developed over the years. Programs in Northern Manhattan are already operating close to capacity and certainly do not have room for large numbers of patients creating a carry over effect. If the 7 closest programs accepted 100 patients each the burden on them would be tremendous. Program staff already over worked and stressed will not be able to provide the level of care that they were providing. Therefore a large number of patients from an area with pockets of destitution will not be able to obtain the services that they need to change their lives. In addition to the 700 patients from NRC at least another 3500 patients will be affected by the closing of NRC.

The Harlem area and nearby neighborhoods will be impacted from the effects of the closing of NRC. The improvements that the Harlem area has experienced in the last decade will begin to deteriorate. Individuals seeking help for their opiate dependence will be turned away from local programs, a rarity in New York City. Crime in East Harlem will undoubtedly increase and spill into neighboring communities. The standard of living will be reduced for all as hospitals admissions increase and other public health indicators increase (i.e. HIV, overdose deaths, TB). Therefore the impact of NRC closing on the community and on the city is not insignificant.

NAMA urges Mount Sinai to re-think their decision and to continue with the decision to utilize the site that has been selected and is ready for the program to move into. Proceeding with the current decision to close NRC is an indication that the needs of community are not important in comparison to the new luxury high rise residents. NAMA believes that the patients of NRC and the East Harlem community deserve more from Mount Sinai and will make every effort to insure that the patients of NRC and the community are not forgotten. East Harlem is a vibrant community and the people deserve the right to have access to medicated assisted treatment within their community.

STOP METHADONE IGNORANCE

National Alliance of Methadone Advocates
Press Release
Contact Person: Joycelyn Woods, President


For Release:
March 10, 2007



It is not uncommon for individuals with a long history of illicit opiate use to remain in methadone treatment as a long term patient. Many often say that without methadone treatment they would probably be dead. Other forms of treatment were not effective and they had come to believe that they would die an "addict". Numerous studies have demonstrated that the majority of persons who leave methadone treatment revert to illicit heroin or other opioid use in relatively short time though of course there are exceptions.



NIDA and NIH considers "addiction" as a chronic relapsing brain disorder. A full text article, The Neurobiology of Addictive Behaviors and its Relationship to Methadone Maintenance by Stimmel and Kreek is available from, http://www.mssm.edu/msjournal/67/page375_380.pdf



You get an excellent idea of the benefits of methadone maintenance by visiting a petition web site that was recently established by NAMA to counter anti-methadone groups trying to restrict this valuable therapy. Read the patient reports on the petition and you will get a significant understanding of the benefits to the patients of this form of therapy.



However recently there have been an increase in methadone overdose deaths attributed to an increase in prescribing methadone for pain medication. Also methadone has been in the media recently adding to the fervor and sensationalism.



The change in regulations created a more realistic situation for both programs and patients seeking recovery. However recently several sensational websites are promoting stricter regulations on methadone treatment in an effort to end the increase overdose deaths. These measures will be ineffective as most of the deaths are due to a number of factors including mishandling of medication. In an effort to protect our life saving treatment and to make methadone safer for pain management NAMA recommends education rather than restrictions.



We are also asking patients and their families to sign a petition "Methadone Patients Against Hysteria and Further Restrictions". The petition in brief, reads as follows:



We are Methadone Patients, Providers, Families and Friends AGAINST the Hysteria which is calling for Further Restrictions on the Prescribing of Methadone."
http://www.thepetitionsite.com/takeaction/360731625

NAMA Announces NAMA NorCal's House Party Rokki's Education Party for HBO's Addition Special

National Alliance of Methadone Advocates
Press Release



Contact(s):
Rokki Baker, CMA, NAMA Vice President and NAMA NorCal Director
bluelady16.1@netzero.net
Joycelyn Woods, President
nama.president@Verizon.net



For Release:
March 5, 2007


All across the country people are coming together to watch and discuss the new HBO series, ADDICTION. Americans will be coming together to discuss what needs o happen in their communities to make alcohol, drug treatment and recovery support available and show the power of long-term recovery. For to long patients in medicated assisted treatment (MAT) have not thought of themselves as being in recovery and it is time to change. Join NAMA NorCal for Rokki's Education to discuss MAT and recovery and ways to introduce it to the MAT community. This is our opportunity to be counted.

What is HBO's ADDICTION Project

The documentary, ADDICTION, examines recent advancements in research and effective new treatments. It demonstrates that treatment and recovery is possible. And it is positive to MAT by emphasizing that addiction is a brain disease.

ADDICTION is a series of four programs that premieres from Thursday, March 15, to Sunday, March 18. In participating cable systems it will be free for the weekend.

NAMA NorCal will host an ADDICTION ACTION House Party.

When: 03/16/07 04:00 PM

Where: NAMA-NorCal
3400 Portola Drive #A2
Santa Cruz, California

RSVP: Guestlist

Contact Organizer: Roxanne Baker

Click here for a complete series broadcast schedule.
http://www.addictionaction.org/watch/broadcast.html

Visit Addiction Action.
http://www.addictionaction.org/

Visit NAMA website.
http://www.methadone.org/


Together, we can make a difference.

New Jersey Advocates Announces New State Access Initiative

National Alliance of Methadone Advocates
Press Release

Contact(s):
Claude Hopkins, CMA-RMA (732) 678-5172
NJadvocate@Comcast.net
Joycelyn Woods MA-CMA (212) 595-NAMA/6262

For Release:
February 3, 2007

NAMA's New Jersey Chapter Announces
New State Access Initiative

New Jersey Advocates NAMA's official chapter for the state of New Jersey announces a new state access initiative. The New Jersey Access Initiative (NJAI) is a program of the Division of Addiction Services and administered by the Center for Family Services, Inc..

The program was created to "enhance" traditional substance abuse treatment to New Jersey residents addicted to opiates. NJAI provides funding for assessments, inpatient detoxification, opiate drug treatment utilizing a modality of medicated assisted treatment (i.e. methadone and buprenorphine), drug-free treatment and Recovery Mentoring services.

Eligible MAT patients actively engaged in treatment will be given a choice of a Certified Recovery Mentor who will enhance their care during treatment and facilitate their transition from treatment to long-term recovery and a successful life in the community. The Recovery Mentor Associates will assist with brokering necessary services and removing the common barriers to recovery.

This program is presently accepting all eligible applicants who is suffering from an addiction to opiates. At the present anyone who is attempting to get onto a methadone program but is having difficulty due to a lack of funding or anyone who is presently on a methadone program but is in the process of loosing their status as a patient due to not having the funds to continue would most likely be eligible for a voucher to pay for treatment. This voucher would give them access to treatment in a methadone treatment facility for 6 mos and any needed covered services along with a Recovery Mentor.

Anyone interested in this program can contact the New Jersey Addiction Hotline at 1-800-238-2333, 24 hours a day, seven days a week and ask to be placed on the access initiative program.

Not all New Jersey MTPs have asked to be part of the program however, as NJAI expands more will become providers for this initiative. There are several drug-free providers throughout the state. You will receive a list of all eligible providers once you receive your voucher number over the phone. You can then take your number to one of the approved providers to receive your assessment which starts the treatment process.

Anyone needing assistance can contact Claude Hopkins at the phone number or email below.

Phone: (732) 678-5172
Email: NJadvocate@Comcast.net

Call for Nominations of the Richard Lane Patient Advocacy Award

National Alliance of Methadone Advocates
Press Release

Contact(s):
Joycelyn Woods MA-CMA (212) 595-NAMA/6262
Fred Christie AFIRM (516) 897-1330
Chris Kelly ARM (202) 246-6850



For Release:
December 29, 2006

Call for Nominations of the

Richard Lane Patient Advocacy Award

The National Alliance of Methadone Advocates (NAMA) in collaboration with Advocates for the Integration of Methadone and Recovery (AFIRM) and Advocates for Recovery with Medication (ARM) is seeking Nominations for the Richard Lane Patient Advocacy Award to be presented by the American Association for the Treatment of Opioid Dependence (AATOD) at the 2007 National Conference.

The award will be presented during the Conference Banquet to be held in San Diego (October 20-24, 2007). The recipient will receive roundtrip Coach Class airfare to the conference, two (2) nights in the hotel and full conference registration.

Richard Land was a long-term heroin user who, upon release from prison in 1967, was instrumental in establishing one of the Nation’s first methadone treatment programs. In 1974, he became the Executive Director of Man Alive (Baltimore) and later served as Vice President of the American Methadone Treatment Association and as Vice Chairman of the Governor’s Council on Alcohol and Drug Abuse in Maryland. Mr. Lane was a passionate advocate for methadone treatment and, by disclosing his own treatment experiences, provided inspiration to patients and colleagues alike. This award was established in 1995 and recognizes extraordinary achievements in patient advocacy.

The following criteria should be applied in making the selection:

Only one (1) nominee can be submitted to the AATOD Conference Awards Committee. There may be a number of nominees, who will be fielded by The Committee in the methadone patient advocacy movement, however, The Committee will be responsible for submitting only one (1) “consensus” nominee to receive this honor.

The nominee must have been involved in the field of methadone advocacy for a period of five (5) years.

The nominee must have been actively engaged in methadone advocacy for a period of five (5) years.

The nominee must have made meaningful and consistent contributions, which have had a significant impact on opioid treatment within a state or region of the United States.

The Committee will be responsible for completing the nomination form and retaining letters of support describing the nominee’s achievements, which are required before any final nomination can be submitted to the AATOD Awards Committee.

All submissions should include the completed Richard Land Patient Advocacy Award Nomination Form that is included.

Deadline for submissions is February 14, 2007.
Please email to nama.president@verizon.net

Please distribute to all interested persons.

Download Nomination Form:
http://www.methadone.org/downloads/nomination_form.pdf

Download Press Release

http://www.methadone.org/downloads/press_release_richard_lane.pdf

NAMA is Proud to Announce the World Famous CODAC All-Stars Holiday Music Jam at the Catfish Cafe

National Alliance of Methadone Advocates
Press Release


National Alliance of Methadone Advocates

Contact Person: Joycelyn Woods, President
nama.president@Verizon.net
212.595.nama

For Release:
December 6, 2006

NAMA IS PROUD TO ANNOUNCE
THE WORLD FAMOUS CODAC ALL-STARS

HOLIDAY MUSIC JAM AT THE CATFISH CAFE

Saturday, December 9, 2006

Providence, RI

The CODAC All-Stars and Friends bring you a night of music, stories and holiday favorites.

When
Saturday December 9th at 7 PM
Come early for the Jam Session 2-6 PM

Where
The Catfish Cafe at The Mediator
50 Rounds Avenue, Providence RI

Admission
Donation
Or A New Unwrapped Present for Kids 1-16 Years

Refreshments Available

The Mediator is easy to find - just off Narragansett Avenue (near Reservoir)
or from Elmwood and Roger Williams Avenue
Call 401-263-7232 for Directions

For More Information
WWW.CATFISHCAFE.INFO
OPEN JAM SESSION FROM 2-6PM

James Gillen "Catfish Jim" is the manager of the CODAC All-Stars and founder of Tales from a Small Planet a project in which Gillen uses his passion for storytelling, music and audience participation. Gillen also uses his storytelling abilities to give presentations on substance abuse and tobacco prevention in schools and other facilities. Additionally, an experiment using musical therapy to help people recovering from addictions tap into the creative energy within has blossomed into an ever-expanding group of musicians, singers and drummers. They are now known as the World-Famous CODAC All-Stars. This group has appeared as part of the Catfish Café, which included a performance that brought down the house last year at the City of Providence’s New Year’s Eve Bright Night event.

Jim Gillen is a director of NAMA's Rhode Island chapter MARC, a Licensed Chemical Dependency Professional (LCDP) and Certified Criminal Justice Professional (CCJP) in the state of Rhode Island.

The state of Rhode Island's Division of Substance Abuse presented Jim with the 2003 Counselor of the Year Award. In March of 2006 Jim was named recipient of the prestigious Jefferson Award for RI for outstanding service to the community.

For booking information for “Tales From a Small Planet” or the “CODAC All Stars”, e-mail: planetcatfish@cox.net

Rhode Island MAT Patients Celebrate Recovery

National Alliance of Methadone Advocates
Press Release


Contact Person: Joycelyn Woods, President
nama.president@Verizon.net
212.595.nama

For Release:
September 17, 2006

Rhode Island MAT Patients Celebrate Recovery

Reported by Jim Gillen
MARCAP/NAMA
planetcatfish@cox.net

Yesterdays RI's celebration was beyond belief in a good way, from perfect weather to a HUGE crowd. Did I say a HUGE peaceful, joy filled crowd!!!!!

The role that medication assisted patients, staff from clinics, methadone advocates were a big,big part of this celebration. From the band (MAT patients) to the set up and break down crew - first ones in and last ones out.

We painted faces, distributed food, blew up over a hundred balloons, set up tents. I wanted to put the NAMA/MARCAP table next to NA but they came later - wouldn't that just be a hoot!!! Oh well, there is always next year!!!

This event to me is a great blueprint for success - mix it with a big general public event !!! Go figure!

We got our MARCAP first aid kits with phone number and methadone.org on it. If any one wants a few we could send some off.

Sharon Dembowski of NENAMA-MOM was great yesterday as usual and has photos of the event.

Keep the faith!!!

SAMHSA Awards $9.8 million for Peer to Peer Recovery Support Services

Date: Sept 6 , 2006
Media Contact: SAMHSA Press
Telephone: 240-276-2130

SAMHSA Awards $9.8 million for Peer to Peer
Recovery Support Services

The Substance Abuse and Mental Health Services Administration (SAMHSA) today announced the award of seven Recovery Support Services grants totaling $9.8 million over four years. These grants to community-based organizations are designed to deliver and evaluate peer-to-peer recovery support services that help prevent relapse and promote sustained recovery from alcohol and drug use disorders.

"Peer recovery support services are expected to extend and enhance the treatment continuum," said Assistant Surgeon General Eric Broderick, D.D.S., M.P.H., SAMHSA's Acting Deputy Administrator. "These grants will help prevent relapse and maximize the opportunities to create a lifetime of recovery and wellness for self, family, and community. And, when individuals do experience relapse, recovery support services can help minimize the negative effects and if needed make sure there is an appropriate referral to treatment."

The seven awards in five states are funded up to $350,000 per year in total costs. Continuation of these awards is subject to the availability of funds as well as the progress achieved by the grantees. Total funding for year one is $2.4 million.

The Recovery Community Services Program grantees are as follows:

Arizona

Pima Prevention Partnership, Tucson -- $350,000 to recruit and train a 10-member core group of peer leaders in recovery, who will develop and implement the service infrastructure in four months. Recovery Services will be offered at the partnership's Learning Center and offer peer-led emotional, informational, instrumental and affiliation support services five afternoons/evenings per week, including Saturdays.

Tohono O'odham Nation, Sells -- $350,000 to implement a comprehensive peer-to-peer system to support individuals in recovery with a full range of recovery support services provided locally in the 11 districts that make up the federally recognized tribe, which has one of the highest rates of substance abuse among all populations in the United States .

Georgia

Recovery Consultants of Atlanta, Inc. -- $350,000 per year to provide peer-led support services that help sustain Atlanta's inner city addiction recovery community. The program will provide a recovery center offering more than 40 weekly 12-step, faith-based, health-specific (HIV and Hepatitis C, a liver disease), gender-specific and family-specific support groups.

New York

National Alliance of Methadone Advocates, Inc., New York City -- $349,998 per year to provide peer-to-peer recovery support services to patients of the Albert Einstein College of Medicine's Methadone Maintenance Treatment Programs. The overall goal is to create a climate for recovery among a population usually neglected by the larger recovery community.

Center for Community Alternatives, Inc., Syracuse -- $350,000 per year to develop a network of peer-lead community services for individuals in recovery and who also have past criminal justice involvement. The project will extend services into two additional cities, Rochester and Albany.

Oklahoma

Oklahoma CART System, Oklahoma City-- $350,000 per year to implement Sister to Sister, the states first model of peer-driven substance abuse recovery support services for women in Oklahoma County. This project expects to serve over 580 women in all stages of recovery and their children.

Texas

El Paso Alliance, Inc., El Paso-- $350,000 per year to enable the Recovery Alliance to improve existing services and support the development of new ones through a peer recruiting and retention system.

SAMHSA, is a public health agency within the Department of Health and Human Services. The agency is responsible for improving the accountability, capacity and effectiveness of the nation's substance abuse prevention, addictions, treatment, and mental health services delivery system.

SAMHSA is An Agency of the U.S. Department of Health & Human Service

Letters Needed for Our Friend Dr. Shinderman

National Alliance of Methadone Advocates
Press Release

Contact Person: Joycelyn Woods, President

nama.president@Verizon.net
212.595.nama

For Release:
September 7, 2006

Letters Needed for Our Friend Dr. Shinderman

NAMA, patients and concerned professionals have been watching the situation in Maine concerned that a fellow advocate, Dr. Shinderman would be facing serious criminal charges. On July 20, 2006 a federal jury convicted him of crimes relating to prescribing ancillary medication when the jury was instructed not to consider his good faith in relying on another physician’s permission to prescribe. Specifically when Dr. Shinderman began working in Maine he applied for a state license to prescribe. While waiting for the license approval he was informed that it would be all right for him to use the medical director of the clinic’s license. This was all done in the course of treating patients for ancillary medications. The point is that these were extra doctor’s appointments and the patients were not charged. Only a very few methadone clinics treat patients for other conditions and even fewer do not charge for these services as is typical at CAP Quality Care. This demonstrates Dr. Shinderman’s care of his patients; he really treated his patients and considered their total medical care as part of their addiction treatment.

A civil lawsuit filed by the government against the Westbrook Clinic. The clinic CAP Quality Care is owned by his wife where Dr. Shinderman was a consultant.

The media has sensationalized this case because the clinic was a methadone clinic. Several writers have been using the case to write distorted news and promote their careers. This has been at the expense of all methadone patients without concern for the impact it will have on their lives. This would have never occurred if the same thing had happened in diabetes or pulmonary clinic but because the clinic treats addiction it is easy picking for the media and the DEA.

In spite of the support Dr. Shinderman has received from local officials and policy makers he is facing difficult opposition and needs our support.


Now You Can Help Dr. Shinderman!

He needs letters seeking leniency and extolling his good work. This certainly will not be difficult for advocates because there is a lot that can be said about the good that Dr. Shinderman has done. He has helped individual patients and consulted with other physicians about the problem, research that has impacted medication assisted treatment in the U.S. and abroad, his advocacy and support of patient issues and to how he delivered treatment with dignity and respect.

There are four groups of individuals whose letter of support may be particularly helpful: (1) physicians and other professionals who respect his work and can report to the court both about my contributions to the field of addiction medicine, but also how incarceration will negatively impact the influence of this good work; (2) patients and their families who can report to the court about his impact on their success and survival; (3) family and friends who can talk about his good works, good intentions, and good character; and, (4) government officials who can do the same.

No letter should contain criticism of the Judge or the process. They will not be able to use any letter that contains those. The appeal process will address such issues if they exist.

With regard to other letters to the U.S. Attorney General, Drug Enforcement Administration, Members of Congress and other governmental officials, and the news media, each individual or organization should decide for themselves whether they should make those contacts.

It would be inappropriate for Dr. Shinderman to have any involvement because the prosecutor could then persuade the judge that Dr. Shinderman is attempting to influence sentencing with public opinion appeals.

Support Letters should be sent only to Dr, Spiderman’s legal team and if possible a copy to him because he will need them for any licensing problems which are inevitable in Illinois and Maine.


The letters should go to:
Michael A. Cunniff
McCloskey, Mina & Cunniff, LLC
12 City Center
Portland, ME 04101
Phone (207) 772 6805
Fax (207) 879 9374

The letters should be addressed to:
Honorable D. Brock Hornby
United States District Judge
District of Maine
United States District Court
156 Federal Street
Portland, ME 04101



References

Some of these articles are available at:
President’s Blog:
http://nama-president.blogspot.com/

Debate over methadone has value for Maine, Portland Press Herald (ME) August 2, 2006
Page A6.

Clinic's troubles a setback for addicts By GREGORY D. KESICH Staff Writer
Maine Sunday Telegram (Portland, ME) July 30, 2006 Page B1.

Clinic doctor guilty of forgery By GREGORY D. KESICH Staff Writer Portland Press Herald (ME) July 21, 2006
Page A1.

No verdict in doctor's fraud trial By GREGORY D. KESICH Staff Writer Portland Press Herald (ME) July 20, 2006
Page B1.

Doctor defends method of writing prescriptions By GREGORY D. KESICH Staff Writer Portland Press Herald (ME) July 18, 2006 Page A1.

Federal drug agent testifies against operator of clinic By GREGORY D. KESICH Staff Writer Portland Press Herald (ME) July 15, 2006 Page B1.

Witnesses: Doctor gave prescriptions By GREGORY D. KESICH Staff Writer Portland Press Herald (ME) July 12, 2006 Page B1.

Methadone doctor facing prescription-forgery trial By GREGORY D. KESICH Staff Writer Portland Press Herald (ME) July 11, 2006 Page A1.

Methadone doctor argues for dismissal of charges By GREGORY D. KESICH Staff Writer Portland Press Herald (ME) April 29, 2006 Page B1.

METHADONE TREATMENT ENTERS A NEW ERA: NAMA AWARDED RCSP GRANT

National Alliance of Methadone Advocates
Press Release

Contact Person: Joycelyn Woods, President

nama.president@Verizon.net
1.212.595.nama

For Release:
September 7, 2006

METHADONE TREATMENT ENTERS A NEW ERA:
NAMA AWARDED RCSP GRANT

This week the Substance Abuse and Mental Health Services Administration (SAMHSA) announced the 7 recipients of the Peer To Peer Recovery Grants. NAMA one of the recipients is the first methadone group to receive a Recovery Community Services Program (RCSP). The grant will provide peer-to-peer recovery support services to patients of the Albert Einstein College of Medicine’s Methadone Maintenance Treatment Programs in the Bronx, NY. The announcement continued, “The overall goal is to create a climate for recovery among a population usually neglected by the larger recovery community.”

This is a project that NAMA has envisioned for a number of years to educate medication assisted treatment patients (MAT) so they understand why they are taking a medication. While MAT patients are educated at the start of treatment when the message comes from another patient the message takes on a new meaning. This importance of peer services was realized during the early years of methadone treatment when Drs. Dole and Nyswander oversaw the program. However as methadone treatment expanded the contributions that MAT patients had made to the program was minimized and almost forgotten. NAMA believes that “peer-to-peer services” was the piece of the program that made methadone treatment so effective during the first 10 years when methadone treatment was initiated. Patients felt they had contributed to the program and therefore felt an ownership towards it.

Patients Were Proud To Be On The Program!

Compare that to today when most patients feel ashamed of the very treatment that has helped them. They feel alone, no longer "dope fiends" but still not a part of society, and with nowhere to turn for support. This situation is hardly conducive to rehabilitation. Yet the majority of methadone patients have proven themselves capable and successful in the practical world, as lawyers and waitresses, construction workers and housewives, teachers and cab drivers.

Medication assisted patients don’t consider themselves as recovering persons primarily because they have never been allowed too. Recovery is defined as a larger construct then sobriety or abstinence. However, Recovery is not possible without sobriety. Until MAT patients understand that sobriety has nothing to do with taking a medication they will not be candidates to move on to the larger construct of recovery that embraces a reengagement with the community based on resilience, health, and hope. The Medication Assisted Recovery Service (MARS) project will work to change the negative atmosphere that patients experience and replace it with a sense of accomplishment, well being and recovery.

The goal of NAMA’s MARS project will be to demonstrate the value of peer-to-peer services and that when these services are paired with the most effective treatment for opiate dependence, namely methadone the results can only be outstanding. NAMA knows that this project would put a “smile” on Dr. Dole’s face who died on August 1st. The later years of his life were spent working to end the stigma and prejudice directed at MAT.

INTERNATIONAL JOURNAL OF DRUG POLICY Call for Papers

INTERNATIONAL JOURNAL OF DRUG POLICY

Special Issue
Women and Harm Reduction: Spanning the Globe

Guest editors:
Susan Sherman, Adeeba bte Kamarulzaman and Patti Spittal

Outline abstracts or other short descriptions (not exceeding 400
words) are invited for contributions to a forthcoming special issue of The
International Journal of Drug Policy on “Women and Harm Reduction:
Spanning the Globe.”

The issue aims to examine:
Ø the unique factors (e.g. cultural, relational, legal or economic) that contribute to women's use of psychoactive drugs (licit and illicit);
Ø the stigma associated with women's drug use;
Ø proximal and distal effects of drug use on the lives of women
drug users as well as drug users’ female sexual partners;
Ø examine patterns of use and consequences of different types of
drugs (e.g. ATS, alcohol, opiates);
Ø to explore the effects of different types of drugs;
Ø to examine gender-related policies regarding harm reduction
services and treatment; and
Ø to examine innovative programs targeting women drug users.

The issue aims to include work representing a range of geographic
regions (e.g. former Soviet Union, Middle East, South Asia, Southeast
Asia, Africa, Europe/North America).

Papers must be relevant to harm reduction and policy.

We invite several types of contribution:

Scientific review papers (max 8,000 words)
Original research papers (3,000 – 7,000 words)
Short research reports (up to 1500 words)
Descriptions of interesting (positive or negative) programmes or
policies (2,000 – 5,000 words)
Descriptions of problems (e.g. structural barriers) in gaining
access to needed services or programmes (2,000 – 5,000 words)
Policies and/or historical analyses (3,000 – 7,000 words)
Commentaries (max 4,000 words)
Editorials (1,500 - 2,500 words)

The deadline for outline abstracts is September 23, 2006.

Outline abstracts should be sent to ssherman@jhsph.edu. If selected
for submission, the deadline for completion of draft contributions will
be in December, 2006. Submissions will be made on the Elsevier on-line
electronic submission system and will be subject to peer-review.

Susan G. Sherman, ssherman@jhsph.edu
Pattricia Spittal, pspittal@cfenet.ubc.ca
Adeeba bte Kamarulzaman, ADEEBA@ummc.edu.my

Methadone Survives 4 Decades of Tough Politics (API August 12, 2006)

Methadone Survives Four Decades of Tough Politics
By DAVID B. CARUSO
Associated Press Writer
Newsday, August 12, 2006

NEW YORK -- In the late 1960s, a band of black militants paid a visit to a Brooklyn medical clinic to discuss the new treatment it was offering heroin addicts, a drug called methadone.

They came armed with bayonets.

"They were going to kill me," recalled Dr. Beny Primm, director of the Addiction Research Treatment Corp. "They thought I was part of the white man's way of enslaving black folk, and one of the ways they enslaved black folk was to put them on methadone."

Methadone's long struggle for acceptance has been a topic of discussion again lately with the death last week of Dr. Vincent Dole, a founding father of its use as a treatment for addiction.

His passing came eight weeks after another force in the treatment of heroin addiction, Beth Israel Medical Center, marked the 40th anniversary of its methadone program, the first to apply the treatment he and Dr. Marie Nyswander developed at Rockefeller University.

The mood of both events was largely celebratory. Study after study has validated Dole's methods, and Beth Israel's methadone program now serves 6,000 patients at 17 clinics, or about 1 in 6 of all methadone patients in the city.

And yet, supporters of the medication also voiced a regret: Even after four decades, methadone is as mistrusted by the public as the days when militants were banging on Beny Primm's door.

"That's been the frustration of my life for the past 35 years," said Dr. Robert Newman, president emeritus of Continuum Health Partners and a longtime overseer of the methadone program at Beth Israel.

"There are no votes to be garnered by supporting methadone. The knee-jerk reaction of most voters when they hear someone wants to shut clinics down is applause."

Today, the medication is still assailed by critics who say it keeps patients in a drug-dependent limbo. Clinics face resistance wherever they open. Public figures from Howard Dean to Tom Cruise have assailed methadone programs as morally flawed.

As recently as 1998, Rudolph Giuliani, then mayor of New York, announced a plan to do away with methadone treatment in all city-run clinics. The goal of every addict, he said, should be total abstinence.

The plan never got off the ground, but it illustrated how little the debate about methadone has changed since Dole and Nyswander first began promoting the medication in 1964.

Drugs like heroin were then viewed predominantly as a criminal problem rather than a medical one. Addicts were shunned, even at hospitals, which rarely had beds for detoxification.

The suggestion that heroin users be switched to methadone, an equally addictive narcotic, struck some as illogical.

One of the early skeptics was Primm, who had taken to commandeering unused office space in Harlem to offer treatment to addicts.

"I didn't understand it," he said. "We're going to legally give narcotics to people? That was kind of antithetical to what we'd been taught."

Over time, though, methadone won him over because of its ability to alleviate the symptoms that usually make addiction so crippling.

Once their dose is calibrated, people taking methadone don't experience withdrawal symptoms or physical cravings for more narcotics. The drug blocks them from experiencing the euphoric rush from injecting heroin.

It is also cheap and long-lasting. Patients down a dose in the morning and feel normal for the rest of the day _ no different than someone taking pills for high cholesterol.

"It's very boring. There is no high to it," said Lisa Torres, an attorney who has taken methadone for 16 years, including her time at law school.

A downside of methadone is that it only works for as long as someone takes it, meaning that most clinics recommend that patients use it daily and indefinitely.

That might not be a burden, patients say, if getting methadone was as easy as filling a prescription.

It is not.

"This is a magnificent medicine," Torres said. "The problem is what you have to do to get it."

At the Vincent P. Dole clinic in Brooklyn, patients begin lining up at 7 a.m., some having traveled for an hour to reach the office. The clinic, tucked behind an unmarked entrance in a busy shopping plaza, is pleasant enough. What makes it grueling, patients say, is the routine.

A majority of people in the program must come every weekday for their dose _ even if they have jobs, or come down with the flu, or get hit by a blizzard. Medical vans carry in elderly or disabled patients too frail to commute.

Aside from doses given out for the weekends, take-home supplies of methadone are a tightly regulated privilege.

Many patients only qualify for two or three weeks of take-home doses following years of clean urine samples, which in some cases are collected in the presence of a staff member to eliminate tampering.

"It's so burdensome. It's so onerous. It's so unbelievably awful," Torres said of the clinic system. "There has to be a better way."

Just what the future holds for the treatment is unclear.

In the past few years, a promising alternative called buprenorphine became available on a limited basis, and researchers have said it could hold some advantages over methadone.

Among other things, buprenorphine lasts longer, is more difficult to overdose on, and can be given in a doctor's office _ a potentially huge advantage over the clinic system.

Newman said it is too soon to tell, but he hopes both drugs will eventually overcome the stigma that still surrounds drug treatment.

"I pin my hopes on the fact that people will realize that it has to be better if there are 50,000 or 200,000 fewer people using heroin on the street, shooting up, getting AIDS," he said.

NAMA Announces the Resignation of Tony Scro and a New Grievance Coordinator Ericka Lear

National Alliance of Methadone Advocates
Press Release

Contact: Joycelyn Woods
nama.president@verizon.net

For Release:
August 5, 2006

NAMA Announces the Resignation of Tony Scro
and a New Grievance Coordinator Ericka Lear

It is with sadness that I am announcing the resignation of Tony Scro from the Board of Directors of NAMA and also from his position as Grievance Coordinator. It has been his knowledge of policy and guidance that has created a respect for NAMA's grievance procedure. His leaving NAMA will most certainly be missed not only by advocates but by providers and policy makers. We wish him well in all future endeavours.

In his place a Grievance Coordinator we are pleased to announce that Erika Lear, CMA will be taking on the challenge. Ms. Lear began her advocacy as Director of Colorado NAMA where she developed a strong relationship with the state methadone authority during the critical years when the new regulations were being implemented. Upon her moving to Pennsylvania she remained to assist in Colorado advocacy issues while working as part of the Pennsylvania NAMA network. In the past year she was appointed as Director of Pennsylvania NAMA and asked to serve as a Regional Director.

An Open Forum to Discuss the Efficacy of Methadone Treatment (Indiana Forum)

National Alliance of Methadone Advocates

Press Release

Contact: Carmen Arlt*
Phone: 219.476.4643

For Release: July 26, 2006

Valparaiso, INDIANA

An Open Forum to Discuss the Efficacy of Methadone Treatment

Dr. Alfonso Holliday is inviting the community to an open forum to discuss the efficacy of methadone treatment at the Hampton Inn, 1451 Silhavy Rd. in Valparaiso on Wednesday,

August 2, 2006 from 6 to 8 PM. Dr. Holliday has over 40 years experience in the addictions field and has been Medical Director of a methadone treatment program for over 30 years. He is internationally recognized and acclaimed for his success in treating patients who are suffering from heroin and other opiate addictions and certified by the American Society of Addiction Medicine. Dr. Holliday plans to do the following: 1. Inform the public about the benefits of all Medication Assisted Therapies for those addicted to Opioids; and, 2. Inform them that Holliday Health Care will submit an application to the Department of Mental Health and Addictions to open another facility in Porter County to provide methadone treatment services. Dr. Holliday will also discuss a planned Addictions Research, Education and Medicine Campus. Dr. Holliday’s team is currently evaluating a number of sites to locate the projected future growth of this Research Site.

* Carmen Arlt is Director of NAMA's Indiana Chapter The MAG and Co-Regional Director for the Central States.

3rd International Memorial Day for Deceased Drug Users Friday the 21st of July (BrugerForeningen, Denmark)

Copenhagen, Denmark

22nd July 2006

Report

3rd International Memorial Day for Deceased Drug Users

Friday the 21st of July

Despite an extreme heat wave, an industrial holiday and the start of the weekend, approximately 120 participants gathered at 7 PM to listen to five relatively short, very varied but all very passionate speeches.

120 participants gathered for the Third International

Memorial Day for Deceased Drug Users.

Two poets read from some of their own highly emotionally charged poems and we witnessed the premiere of a song, composed for the occasion and performed by BF's resident singer songwriter; the song, "274 deaths" or "They'll never return" whose refrain, roughly translated as "And we just miss them so" was so warmly received that the audience demanded a repeat performance at the end of the evening program - all together the whole ceremony lasted for 55 minutes.

They'll never return, And we just miss them so.

During a minute of silence, one could literally hear a pin drop, another musical interlude was provided by the audience's loud, heartfelt rendition of the traditional Danish freedom fighters' song "Never walk in fear".

252 pairs of men's and women's shoes remind all that each

represents a real human being who died, mostly alone.

In the two days prior to the event BF activists succeeded in gathering 252 pairs of men's and women's shoes, dramatically lined up on the sunburned city garden lawn, to remind all present that 252 is not only a statistic, but that each represents a real human being who died, mostly alone. Every year we lose far too many relatively young friends to what are, for the most part, preventable, overdoses.

A remembrance wreath was placed next to the engraved memorial:
"Here we commemorate deceased drug users".

A large coloured mixed flower wreath with a wide orange silk ribbon marked with BrugerForeningen and LFHN (the parent's organisation in BF) - and several fresh flower bunches placed right next to the granite engraved memorial text: "Here we commemorate deceased drug users" was flanked by two flaming torches.

BF's speaker's rostrum - a glass container topped with a

wooden table - containing bloody syringes and needles,

empty methadone bottles and a mixture of colourful

sandbox toys- was a constant reminder of the reality.

BF's usual speaker's rostrum - a 1.3 metre high glass quadrant container topped with a round wooden table - containing 2.500 bloody syringes and needles, several empty methadone bottles and a mixture of colourful sandbox toys- was a constant reminder of the reality that the hard pressed citizens in the local district right next to the open drug scene, face daily in their own yards and other surroundings. The rostrum is an illuminating tool as we use it every time we have a chance in the ongoing debate about user rooms.

This year BF bought a little 50 cc 220 Volts 650 watt generator. Last year it annoyed us greatly that we were delayed and that eventually we had to move the rostrum out of focus, just because our 50 metres of electrical cable, fell just 1½ meter too short, to reach the friendly home on the second floor where we succeeded in borrowing the needed 220 volt electricity, needed to drive our microphones, the amplifier, loudspeakers and video gear. Now we can place the speakers stand exactly where it needs to be, and we don't need to beg anyone to lend us electricity, which really can be a hassle here in the middle of the summer holiday and a Friday evening when only very few people are home.

Since its planting back at IDUD in 2003 with assistance from user activists from 16 different nations, The Paradise Apple tree had been stripped of its beautiful flowers by vandals. So now it does not really look much like a real tree anymore. Therefore, we have decided to replace it with a red Beechwood tree, which, as well as being beautiful is a Fast Grower. Gardeners have advised us to wait until later in the autumn, a better season to plant trees. We now expect to do it on or around BF's 13th Anniversary on 3rd of November.

When this incident started and the cops came running

I thought that they were annoyed because we were

using our electrical amplifier.

While our resident singer was on the finale of the second rendition of his song, the Police drove by in a large van and abruptly stopped on the street beside the park, four large cops ran up and forced their way up to the front line, where they approached an apparently drunk guy who was drowsing next to the flowers. They swiftly grabbed him and dragged him back to the van - where they body searched him. It was later discovered that they had an alarm from a citizen who had, sometime earlier, seen him handling a pistol around the corner from the memorial ceremony in the Central Station. The allegation was true, the guy really was carrying a toy plastic pistol- so he was quickly arrested and driven away. When this incident started and the cops came running I thought that they were annoyed because we were using our electrical amplifier to boost the sound of the acoustic guitar. As such, I grabbed the written meeting permit issued by the local Police station, so I was ready to explain that what we were doing was legal, but I didn't manage to approach them before they went off with the guy. Incidentally while they were finishing searching the guy and beginning to drive off with the guy and the toy pistol, we had reached the point of the program, where we had to sing the freedom song "Never walk in fear". I couldn't resist commenting on the peculiarity of the whole funny and strange coincidence.

In a Reuter's article published in several of Friday's newspapers, complaining that the Police are not yet able to provide us with a realistic figure for overdose deaths in 2005. In this 'information age' it shouldn't be necessary to wait more than 8 months before we can get a realistic figure of the current situation. Actually it should be possible to follow the overdoses month by month, so we could act on the situation especially if it worsens. In "older days" just back in the mid-1990s we got the statistics from the previous year from the Police in late February or certainly by March. But that was also while we still had politicians, who cared and were interested in whether the numbers went up or down. Sadly, that does not seem to be the case anymore, and we must realize that - as long as no politicians really care to ask about the overdose statistics, we won't get the figures any earlier. Therefore, I promised that I will make it my business, and I'll work hard to make the politicians change their priorities so that this issue returns to the discussion table. Hopefully that will also mean that we know the 2006 figure when we meet at next year's Memorial Day.

As we left to go home - it was a day that we will all remember.

Joergen Kjaer - president

Clinic Doctor Guilty of Forgery (Portland Press Herald, July 21, 2006)

Clinic Doctor Guilty of Forgery
By GREGORY D. KESICH
Portland Press Herald, Friday, July 21, 2006


A federal jury on Thursday convicted addiction treatment specialist Dr. Mark Shinderman of forging prescriptions for patients at a Westbrook methadone clinic.

Shinderman, a well-known Illinois psychiatrist who is considered an expert in addiction medicine, faces prison time and fines for his convictions on 58 of the 68 charges against him.

He was found guilty in U.S. District Court of writing another doctor's name and federal registration number on 25 prescriptions for controlled substances. The prescriptions were written during 2001 and 2002, when Shinderman was seeing patients at CAP Quality Care, the for-profit methadone clinic owned by his wife, Noa.

Shinderman also was convicted of 24 counts of aiding and abetting the acquisition of controlled substances by deception, and two counts of falsifying records kept by a pharmacy. The jury split on 15 counts of making false statements on medical records, convicting him of seven and finding him not guilty on the rest.

Assistant U.S. Attorney Donald Clark said the convictions showed the jury rejected the defense claim that Shinderman committed only minor offenses while providing legitimate medical services to his patients and causing no harm to them.

"The harm is to the system of regulation," Clark said. "Every step in the closed system of distribution requires a Drug Enforcement Administration number, and the people expect accountability."

Clark said the verdict upheld the principle that Shinderman's disregard for the law is serious.

"The people of Maine expect their doctors to follow the rules," he said.

Although it was not part of the charges against him, Shinderman's 30-year history as a provider of methadone to treat people addicted to opiates such as heroin was a recurrent theme among the witnesses in the trial.

Shinderman owns and operates two methadone clinics in Chicago, Ill. But he testified that since coming to Maine in 2001, he had been the subject of a "witch hunt" by federal authorities, who denied him a DEA registration number to write prescriptions here.

Shinderman was supported by many who treat drug addicts in the state. They said his clinic offered the best treatment, in part because Shinderman, who is a psychiatrist, offered free services that included prescribing anti-anxiety and other medications to help patients deal with their addictions.

Supporters rejected the government's claim that Shinderman wrote the prescriptions to attract patients, saying the drug-addiction epidemic meant Shinderman had more patients than he could handle.

Michael Cunniff, one of Shinderman's lawyers, said that controversy over methadone treatment - giving an opioid addict daily doses of another addictive drug to prevent cravings and withdrawal symptoms - was the backdrop of the prosecution against his client.

"It was evident throughout the trial that methadone was an issue," Cunniff said. "We made every effort to keep it out."

Shinderman, 64, a tall and dignified-looking man with a neatly trimmed gray beard, bowed his head in the courtroom as the clerk read the jury's verdict shortly before 6 p.m. after nearly 13 hours of deliberation.

As soon as the jury left the courtroom, he comforted his wife and about 30 friends and family members before walking outside. He is on bail while awaiting sentencing, which could be in about three months. He faces up to five years in prison on each of the most serious charges and a fine of up to $250,000 on each count.

"I'm clearly disappointed about the verdict, but I'm happy I had my day in court," he said to reporters. "I just want to say thank you."

The government contended that Shinderman wrote prescriptions for controlled substances that included benzodiazepine drugs, which are known as "benzos" and are popular with some methadone patients because they enhance the euphoric effect of the drug.

Shinderman was also known for his published opinion that for years, doctors had under-prescribed methadone to some patients, causing them to relapse into using street drugs.

Although the normal therapeutic dose of methadone is 80 to 100 milligrams a day and never exceeds 150 milligrams at the only other Greater Portland clinic, according to trial testimony, some CAP patients received much more.

Sharon Pratt, who came to the clinic when it opened after becoming addicted to pain medication she received during cancer treatment, ended up receiving 1,050 milligrams a day. She said Shinderman also prescribed other medications for her.

As a result of her high dose, she said she fell asleep while driving her car and then had a heart attack she attributes to the methadone. She filed a complaint with the state medical licensing board and has a pending civil case against Shinderman.

Pratt testified against Shinderman at his criminal trial and waited at the court all day Thursday for the verdict.

She said patients at CAP liked to see Shinderman because he would write prescriptions without arguing.

"This sounds weird, but I think he did it because he wanted to be popular," Pratt said. "I think he liked the attention he got, with everybody thinking he was awesome."

She said she was grateful for the verdict "on behalf of everyone who was victimized by this man."

Shinderman's methadone practice will be the focus of a pending civil case against CAP by the U.S. government. It is expected to go to trial early next year.

Staff Writer Gregory D. Kesich can be contacted at 791-6336 or at: gkesich@pressherald.com

No Verdict in Doctor's Fraud Trial (Portland Press Herald, July 20, 2006)

No Verdict in Doctor's Fraud Trial
Portland Press Herald, Thursday, July 20, 2006
By GREGORY D. KESICH



Marc Shinderman admits he signed another doctor's name.

A federal jury deliberated for nearly four hours Wednesday without reaching a verdict in the case of an addiction treatment specialist charged with prescription fraud.

Dr. Marc Shinderman, 64, is charged with using another doctor's name and federal registration number to write prescriptions for controlled drugs used by patients of his Westbrook methadone clinic during 2001 and 2002. His trial in U.S. Distinct Court in Portland ended Wednesday morning as lawyers for both sides made closing arguments in the case, the result of a five-year federal investigation.

Whether he is convicted may have less to do with what Shinderman did than why he did it, lawyers said.

In two days of testimony, Shinderman admitted that he signed the name and wrote the Drug Enforcement Administration number of Dr. Steven Keefe on prescription sheets, ordering anti-anxiety and other medications for patients of CAP Quality Care Inc., the for-profit methadone clinic owned by Shinderman's wife.

Prosecutors charge that Shinderman, a psychiatrist from Illinois, was able to lure patients to his clinic by prescribing drugs that would enhance the euphoric effect of the methadone they were receiving.

But Shinderman, who had the authority to write prescriptions in Illinois but not in Maine, claimed that he mistakenly thought he could use the prescription-writing authority of a colleague who saw the same patients. His lawyer said his actions were mistakes, not crimes.

The stakes for Shinderman are high. The government charged him with 67 separate crimes for forging prescriptions, aiding someone filling illegal prescriptions and falsifying medical records. If convicted, he faces up to five years in prison on each of the most serious counts and fines of up to $250,000.

The clinic is the defendant in a civil suit filed by the government, which is expected to go to trial next year.

The criminal trial began July 11 and featured testimony by current and former patients and staff of CAP Quality Care, as well as state and federal regulators. Shinderman took the witness stand for two days and freely admitted to doing everything the government alleged. Shinderman said he was more concerned with treating patients than making money.

On Wednesday, Assistant U.S. Attorney Donald Clark, who prosecuted the case, told the jury that the issue was simple: Shinderman intentionally wrote prescriptions in Maine even though he knew he was not authorized to do so.

Clark compared a doctor's DEA number to a driver's license and asked jurors to use their common sense.

"If you need a license, you get it," Clark said. "And if you don't have one and get caught, you don't say, 'My Mom has a licence and she let me use it,' or . . . 'I'm an excellent driver and I don't need a license.' "

For more than an hour Wednesday, Clark methodically showed the jury 26 prescription slips that were filled out by Shinderman using Keefe's name and number. Clark showed how 16 of the slips were connected by investigators to medical records kept at CAP in which Shinderman saw a patient and signed Keefe's name or initials. Clark said Shinderman was falsifying records to cover up what he knew was an illegal prescription writing practice.

"If he had written accurate records, the regulators would have seen what he was doing and would have stopped it." Clark said.

Shinderman's lawyer, Thimi Mina, told the jury that his client should not be convicted of a crime for making a mistake.

Shinderman believed that he could legally write prescriptions, and even if he was wrong, he was not doing anything but treating his patients' legitimate medical needs, Mina said.

"No criminal intent, no crime," Mina repeatedly told the jury.

Mina said Shinderman was not prosecuted for violating the law regarding prescription writing, but for his controversial views on methadone treatment for addicts.

"This case is all about methadone," Mina said. "If Dr. Shinderman were a pediatrician I submit we never would have been here."

In the first year of CAP's operation, greater Portland saw a rapid increase in the number of overdose deaths involving methadone. Shinderman came under special scrutiny because he published his opinion that some patients require much higher doses of methadone than normally prescribed at clinics. While the usual therapeutic dose of methadone is 80 to 100 milligrams a day, Shinderman had at least one CAP patient on 1,000 milligrams.

But Mina said Shinderman is committed to treating patients.

"The government has attacked a man who had devoted his life to treating people that that the rest of us step over," Mina said. "What the government asks for in this instance is not justice."

The closing arguments began at 10 a.m. before a packed courtroom, including friends and supporters of Shinderman, including state Sen. Ethan Strimling, D-Portland, and Gardiner Mayor and state Senate candidate Brian Rines. Other benches were filled with state and federal prosecutors and police officers curious about the outcome of the case.

Jurors are scheduled to return to the courthouse at 8 a.m. today to resume deliberations.

Staff Writer Gregory D. Kesich can be contacted at 791-6336 or at: gkesich@pressherald.com

Staff photo by John Ewing

Methadone Clinic's Medical Director Goes On Trial (AP, July 12, 2006)

Methadone Clinic's Medical Director Goes On Trial
Maine Today
Wednesday, July 12, 2006
From the AP WIRE

PORTLAND, Maine — A drug-treatment doctor is on trial in federal court for allegedly handing out illegal prescriptions to patients at his wife�s methadone clinic in Westbrook.

Dr. Marc Shinderman faces charges of falsifying records and ignoring regulations designed to prevent diversion of methadone.

Shinderman, an outspoken advocate for the use of methadone to treat addictions, has pleaded not guilty to all of the charges.

Shinderman has operated methadone clinics in Maine and Illinois for more than 30 years and is well-known among those who treat addictions. His CAP Quality Care, a for-profit methadone clinic in Westbrook, was raided two years ago.

Shinderman's jury trial before U.S. District Judge D. Brock Hornby was in its second day Wednesday.

Methadone Doctorl Facing Prescription-Forgery Trial (Portland Press Herald, July 11, 2006)

Methadone Doctorl Facing Prescription-Forgery Trial
Portland Press Herald
Tuesday, July 11, 2006
By GREGORY D. KESICH

Four years after a series of overdose deaths drew attention to his Westbrook methadone clinic, Dr. Marc Shinderman will go on trial today in U.S. District Court in Portland.

The nationally known and controversial addiction-treatment specialist is not charged with causing those deaths. Instead, prosecutors say information collected in a 2003 raid of CAP Quality Care offices by armed federal agents created the basis for charges that Shinderman forged prescription slips and made false statements to the government.

If convicted, Shinderman faces up to five years in prison for each of the 16 allegations that he created false medical records, and four years in prison for each of the 52 counts of violating federal regulations on controlled medications. He also would face a $250,000 fine on each count. The business, which is owned by his wife, is the defendant in a civil lawsuit filed by the government.

The trial will also revive the debate about the public risks and benefits of methadone maintenance treatment for opiate addicts, and will bring unwelcome attention to 1,500 licensed clinics that treat 240,000 patients each day, said Dr. Marc Parrino, president of the American Association for the Treatment of Opioid Dependency in New York City.

"It's still strange for some people to embrace the idea that you would use a medication that is itself dependence-producing to treat dependency," Parrino said. "There is a stigma surrounding the whole community, and any news that involves methadone will not be a favorable event."

The trial is expected to begin with opening statements at 8:30 a.m. Testimony in the complex case is expected to last for nine days. The government plans to call as many as 50 witnesses, including patients and former employees of the five-year-old methadone clinic.

According to court documents, Assistant U.S. Attorney Donald Clark will present evidence that Shinderman wrote 15 to 20 prescriptions a week using another doctor's DEA number, and forged the doctor's name and initials on forms.

Shinderman, a psychiatrist with a valid medical license in Illinois, was denied a DEA permit to write prescriptions for controlled substances in Maine because he had only a temporary license to practice here.

In his pleadings, Shinderman's attorneys say he did nothing wrong. While acknowledging the use of Dr. Steven Keefe's drug-prescribing authority, they say Shinderman was engaged in legitimate medical practice with no criminal intent.

Shinderman communicated with federal regulators about his ability to write prescriptions and was "confused" about his status, in part because of instructions he was given that later turned out to be false.

"The government instigated the conduct it now characterizes as a crime and . . . (Shinderman) was completely without predisposition to commit it," wrote attorney Thimi Mina. Later, he referred to entrapment as his "central defense."

Shinderman, 63, has worked in addiction treatment for 30 years, starting methadone clinics in Illinois and Maine.

Methadone is a synthetic drug that can ease the cravings and withdrawal symptoms in people addicted to opiates such as heroin or morphine. Taken in the right dosage, it allows patients to function normally, despite their addiction.

CAP Quality Care opened in October 2001. The following year there were 28 overdose deaths in Greater Portland, and law-enforcement officials questioned whether the area's two methadone clinics, CAP and Discovery House, could have been responsible.

CAP came under special scrutiny for its policies that permitted patients to take home doses for several days, and for Shinderman's published opinion that most clinics' doses were too small to cure an opiate craving and prevent an addict from supplementing his habit.

A state study later found that about half the deaths were related to clinic methadone, and involved clients from both CAP and Discovery House. The rest involved abuses of prescription medication. The clinics tightened their take-home policies in response.

Shinderman remains controversial in the methadone community for his higher-dose recommendations. Parrino said Shinderman's reputation is good, however.

"He's seen as a person who cares about his patients," Parrino said.

On Sept. 9, 2003, agents from the DEA and U.S. Department of Health and Human Services executed a search warrant at
CAP Quality Care offices, seizing records and copying computer files. Last August, a federal grand jury returned the indictment against Shinderman, charging him with falsifying prescription records.

In his brief, Clark said the government would have to rely on hostile witnesses, including Keefe, who still works for CAP.

"Some witnesses may not only be reluctant to testify, they may also be reluctant to tell the truth unless continually prodded with multiple questions," Clark said.

He asked U.S. District Court Judge D. Brock Hornby for latitude to question some of the government's own witnesses more aggressively than usual.

Staff Writer Gregory D. Kesich can be contacted at 791-6336 or at:

Copyright © 2006 Blethen Maine Newspapers Inc.

Curwensville DH Closing

Announcement

June 26, 2006

Program Closing Curwensville Pennsylvania

The Discovery House Program at Curwensville is closing at the end of the month of June.

Evidentally it is near an historical path and such a facility can not be located near it. A great decision for a great democracy.

The courts may allow the program more time to move but we all know how difficult it is to find a site for a program. This is the only program in the area.

Overdose Deaths In Michigan - Summary of Articles

Overdose Deaths In Michigan - Summary of Articles

Summary

Another drug overdose with fentanyl suspected
Detroit News, May 30, 2006

A new death takes toll to 48 in Wayne Co. Residents warned of lethal drug mix.
FREE PRESS, May 30, 2006

Drug mix cited in six more deaths. Medical examiner says fentanyl cocktail suspected; Wayne toll hits 47 since May 18.
Detroit News, May 29, 2006

Wayne County. More deaths bring county tally to 47.
FREE PRESS, May 29, 2006

Lethal heroin makes rounds. Task force chief says many overdose with Fentanyl-laced drug.
Chicago Tribune, May 29, 2006

Heroin Mix Likely Kills 3 More in Mich.
The Associated Press, May 28, 2006

Drug mix suspected in deaths. 3 more are reported in Wayne County.
Free Press, May 28, 2006

8 more overdose in 2 days
FREE PRESS, May 27, 2006

Death from possible overdose may be linked to fentanyl
The Oakland Press, May 27, 2006

Genesee County struck by heroin deaths. More than a dozen deaths are being blamed on a deadly drug combination.
GENESEE COUNTY WJRT, May 27, 2006

Overdose deaths blamed on painkiller
Washington Times, May. 27, 2006

Lethal drug combo has users uneasy. Heroin-fentanyl mix not new to Flint area.
THE FLINT JOURNAL, Saturday, May 27, 2006

Lethal drug mix claims more victims
FREE PRESS, May 26, 2006

-------------------------------------------------------------------------------------------------
Another drug overdose with fentanyl suspected
Lisa Martino
The Detroit News
Tuesday, May 30, 2006

DETROIT -- Wayne County health officials Monday reported another suspected drug overdose that they believe is related to a mixture of narcotics and the powerful prescription painkiller fentanyl.

Since May 18, at least 48 people have died in the county from overdoses that health officials believe are caused by a mixture of cocaine or heroin and fentanyl, said Teresa Blossom, a spokeswoman for the Detroit-Wayne County Community Mental Health Agency.

The exact cause of those people's deaths will not be confirmed until toxicology tests are completed, Blossom said. In the meantime, she said area health agencies have increased substance abuse prevention services and passed out 15,000 fliers detailing the dangers of fentanyl.

"Our outreach continues," she said. "(It has) been very, very strong."

Test results to determine if the drug was present at the time of death could take two to four weeks.

In Wayne County there have been 130 confirmed overdose cases in which fentanyl was mixed with either heroin or cocaine from January 2005 to April. On May 19, a dozen deaths suspected to have a fentanyl link occurred in 24 hours.

Fentanyl is more than 50 times stronger than morphine and is commonly given to cancer patients.

http://www.detnews.com/apps/pbcs.dll/article?AID=/20060530/LIFESTYLE03/605300390/1040

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A new death takes toll to 48 in Wayne Co. Residents warned of lethal drug mix.
BY KATHLEEN GRAY
FREE PRESS
May 30, 2006

Another person died from a probable drug overdose, Wayne County health officials reported Monday, bringing the toll to 48 people who have died since May 19.

Even though the number was dropping from the multiple deaths per day, health officials aren't ready to say the deadly overdose spurt is tapering off.

Toxicology results won't be available for several weeks, but health officials say they believe the deaths have been caused by a dangerous combination of heroin or cocaine and the painkiller fentanyl.

"The numbers have always fluctuated," said Teresa Blossom, Wayne County spokeswoman. "Some days, we've had three or four deaths, on others we've had one."

The latest surge in deaths first came to the public's attention when Wayne County issued a warning on May 19 because 12 people had died over a 24-hour span.

Since then, the county has distributed at least 20,000 flyers, warning people of the dangers of the illegal street drug and urging drug addicts to get treatment rather than risk using the substance.

"We want to continue to urge the public to be mindful that the deadly street drugs have increased," Blossom said Monday. "We hope that anyone can avoid engaging in the activity and for those who have addiction, we hope they can seek treatment."

From September through April, more than 100 drug overdose deaths were recorded in metro Detroit and most of those are believed to have been caused by the heroin/fentanyl mixture.

Neither Oakland nor Macomb counties reported any drug overdose deaths over the holiday weekend.

Contact KATHLEEN GRAY at 313-223-4407 or gray@freepress

http://www.freep.com/apps/pbcs.dll/article?AID=/20060530/NEWS06/605300322

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Drug mix cited in six more deaths. Medical examiner says fentanyl cocktail suspected; Wayne toll hits 47 since May 18.
Chrystal Johnson
The Detroit News
Monday, May 29, 2006

Six more deaths believed to be linked to a cocktail of street drugs and the prescription painkiller fentanyl were reported in Metro Detroit over the weekend, bringing the total of suspected deaths in the county to 47 since May 18.

Three deaths were reported by the Wayne County Medical Examiner's office on Saturday and three more on Sunday.

"At this point, we can say they probably are drug-related deaths," Cheryl Loewe, assistant chief medical examiner, said Sunday.

Loewe said the exact cause of death could not be confirmed until toxicology tests are performed. That can take two to four weeks.

Drug dealers mix heroin and cocaine with fentanyl to increase the kick.

"I would like to emphasize that fentanyl has been detected in cocaine. We found almost the same amount in cocaine as we did in heroin," Loewe said. Wayne County issued a warning May 19 about the spate of overdoses, after a dozen died in a 24-hour period.

County Executive Robert Ficano said officials have passed out more than 15,000 warning fliers. Counselors worked the crowds at Movement 06: Detroit's Electronic Music Festival, spreading word of the dangerous drug interaction.

"Hopefully, we are reaching out with bulletins, hot lines and general media," Loewe said.

From January 2005 to April, there were 130 confirmed overdose cases in which fentanyl was mixed with heroin or cocaine in Wayne County.

The large number of cases in a short period of time prompted the county to issue a public warning and for the Centers for Disease Control and Prevention last week to send investigators to Michigan.

Scores of deaths recently across the East Coast and Midwest have been blamed on the combination. In Chicago, officials said 50 deaths have been linked to the combination.

Fentanyl is given to cancer patients and others whose pain is too great for morphine to dull. The drug is more than 50 times as strong as morphine and can cause users to stop breathing.

The Associated Press contributed to this report. You can reach Chrystal Johnson at (313) 222-2300 or cijohnson@detnews.com.

http://www.freep.com/apps/pbcs.dll/article?AID=2006605290330

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Wayne County. More deaths bring county tally to 47.
BY AMBER HUNT
FREE PRESS
May 29, 2006

Three more people have died of suspected drug overdoses, Wayne County officials reported Sunday, bringing the overdose death tally in the county to 47 in less than two weeks.

The latest deaths occurred Saturday night or Sunday morning.

Teresa Blossom, a county spokeswoman, said Sunday that officials won't know for certain whether they were caused by a mix of heroin or cocaine and the painkiller fentanyl until toxicology reports are completed. That process could take several weeks.

Fentanyl is typically prescribed for terminally ill patients with chronic pain.

Investigators say some drug users know fentanyl is mixed with heroin or cocaine and purchase the mix for a stronger high, while other buyers don't know they're getting the fentanyl mixture.

Wayne County officials have reported an average of more than four deaths a day from apparent overdoses since May 17. Last year, there were 1.25 per day, for a total of 457.

On May 18, after 12 people died in a 24-hour period, county health officials first alerted the public to the fentanyl concoction.

Wayne County Executive Robert Ficano said Saturday that a federal investigation points to Chicago or the East Coast as the source of the drugs.

The county has passed out more than 15,000 flyers warning about the lethal mixture, hoping to curb sales.

http://www.chicagotribune.com/news/local/southsouthwest/chi-0605290096may29,1,7672380.story?coll=chi-newslocalssouthwest-hed

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Lethal heroin makes rounds. Task force chief says many overdose with Fentanyl-laced drug.
David Heinzmann
Chicago Tribune
May 29, 2006

Heroin laced with the prescription painkiller Fentanyl has killed more than 40 people in the Chicago area in the last year, the head of a drug trafficking task force told Congress.

Tom Donahue, executive director of the High Intensity Drug Trafficking Areas, or HIDTA, program here told lawmakers that Fentanyl is a growing concern as "the drug problem in the Chicago area has dramatically increased over the past year."

Donahue was in Washington to brief a House subcommittee on budget problems facing drug investigators in Chicago.

The number of people treated for heroin problems in Cook County increased 54 percent in 2005 from the year before, Donahue said last week in his remarks to the House Subcommittee on Criminal Justice, Drug Policy and Human Resources.

As more people are using heroin, more heroin appears to be laced with Fentanyl, he said.

"The use of this drug has left unsuspecting heroin abusers the victims of overdose and death," Donahue told the subcommittee.

Fentanyl has hit several big cities hard in recent months. Detroit, where officials say more than 200 people have died from overdoses, appears to have the worst problem.

The figures Donahue quoted to Congress about Chicago are accurate and reflect that the use of "heroin, cocaine and marijuana are all increasing substantially," said Tom Green, spokesman for the Illinois Department of Human Services.

The surge in dangerous drugs comes as the federal government is considering curtailing the HIDTA task force with proposed budget cuts and a possible move under the control of the Justice Department after years of relative independence as a program overseen by the executive branch.

Donahue was asking lawmakers to protect HIDTA, which Chicago police have credited with helping reduce violence during the last three years.

"Any change in [HIDTA's] current structure or funding could result in a set back in the progress we have made in successful violence reduction strategies," Chicago police Supt. Philip Cline said.

The task force brings together federal and local drug investigators to trade intelligence and run investigations on drug trafficking throughout the Chicago region.

Donahue, a longtime Chicago narcotics investigator who later became a Cook County prosecutor, said Fentanyl is a front-burner issue for the task force.

"It's a big deal," Donahue said Friday. Investigators believe most of the Fentanyl in Chicago is coming from illicit labs making it in Mexico. One reason the drug may be emerging here now, he said, is that Mexican drug cartels are trying to squeeze their Colombian rivals out of the heroin market.

"It's a way for the Mexican cartels to bypass the Colombian cartels," he said. The drug "can be produced fairly easily."

But because Fentanyl is so much more potent than heroin, it can be deadly when not blended properly. Many users have died, he said, because dealers "haven't figured out the mix yet ... But once it's mixed, heroin users prefer it."

David Heinzmann
dheinzmann@tribune.com

http://www.wlns.com/global/story.asp?s=4960770&ClientType=Printable

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Heroin Mix Likely Kills 3 More in Mich.
The Associated Press
May 28, 2006

DETROIT -- Three more people in Wayne County have died from what authorities suspect is a combination of heroin or cocaine and fentanyl, a prescription painkiller.

The deaths, which occurred Friday night or Saturday morning, bring the county's total of overdose deaths believed to have been caused by the mixture to 44 since May 18.

Michele Reid, medical director of the Detroit-Wayne County Community Mental Health Agency and chairwoman of the newly created Wayne County fentanyl work group, is seen at her Detroit office Thursday, May 25, 2006. A deadly mixture of heroin and a powerful painkiller is circulating, killing unsuspecting users who believe they are taking pure heroin. In the Detroit area, the apparent hub of the problem, organizations like Reid's are scrambling to get the word out to users. (AP Photo/Gary Malerba) (Gary Malerba - AP)

http://www.washingtonpost.com/wp-dyn/content/article/2006/05/28/AR2006052800279.html

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Drug mix suspected in deaths. 3 more are reported in Wayne County.
Free Press
May 28, 2006

Wayne County reported three deaths Saturday that likely were drug-related, bringing the overdose death total in the county to 44 in the last 10 days.

The deaths, which occurred Friday night or Saturday morning, are believed to be caused by a deadly mix of heroin or cocaine, and the powerful painkiller fentanyl.

Wayne County Executive Robert Ficano said a federal investigation seems to put the source of the drugs at either Chicago or the East Coast. He said the county has passed out more than 15,000 warning flyers.

"It's sad," Ficano said Saturday. "Any family member that's had someone that's had a substance abuse problem realizes how tragic it is and how frustrating and difficult it is."

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8 more overdose in 2 days
BY KIM NORRIS AND MARISOL BELLO
FREE PRESS
May 27, 2006

With eight more deaths reported Thursday and Friday, metro Detroit continued to see an unprecedented increase in overdoses believed to be related to a powerful painkiller mixed with street drugs.

The new reports Friday from the Wayne County Medical Examiner's Office brought to 41 the number of overdoses in the county in nine days.

While it could be weeks before toxicology results definitively determine whether the painkiller fentanyl is the cause of the deaths, the sheer number of overdoses has medical officials worried that the drug is being mixed with heroin and cocaine with deadly results.

Fentanyl is used to treat chronic pain, particularly in cancer patients, and is 80 times more powerful than morphine.
As drug counselors hit the streets to inform people about the dangers, former drug users said Friday it's nearly impossible to get addicts to notice the risks -- if they come with the chance for a greater high.

"People are steady dropping out there and there's no doubt in my mind, I would have been just like that," said Joyce Jones, who has been in recovery for less than two months after being a heroin addict for 20 years.

If she weren't in treatment, Jones said, she'd be running straight for the fentanyl-laced concoctions being marketed on the street as "drop dead" and "suicide packets."

"It's our thinking. It's the addict's mind. It's so messed up, even if I was seeing a flyer say it would kill me," said Jones, 46. "They could have been putting rat poison in it and it would not matter. I would have snorted it," she said.

Investigators and public health officials are trying to determine why the sharp increase in deaths is occurring in metro Detroit. Carolyn Gibson, spokeswoman for the federal Drug Enforcement Administration's Detroit field office, reiterated Friday that DEA investigators are pursuing solid leads and hope to announce some developments within the next two weeks.

While fentanyl has cropped up with deadly results in other cities, including Chicago, Philadelphia and Camden, N.J., officials say no metropolitan area has seen such a sudden increase in the number of deaths believed related to the drug as Detroit has.

Since April 2005 there have been 42 fentanyl-related fatal overdoses in Cook County, which includes Chicago. In the Philadelphia area, authorities said at least nine heroin users had died in the last month.

Metro Detroit has had more than 100 people die in drug overdoses since September, with fentanyl suspected in most of those cases.

Contact KIM NORRIS at 248-351-5186 or norris@freepress.com.

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Death from possible overdose may be linked to fentanyl
The Oakland Press
May 27, 2006

Whether a powerful cocktail of heroin and painkillers is responsible for the death of a 17-year-old Bloomfi eld Hills girl is unknown, but officials say it could be involved in a number of recent drug deaths in Michigan.

Lauren Christine Jolly, a junior at Birmingham Groves High School, was found by a passerby slumped over the wheel of her car on Eight Mile Road near Riopelle in Detroit early Thursday morning. While toxicology reports are pending and could take several weeks, police in Detroit suspect Lauren, who lived in Bloomfield Hills, died of a drug overdose.
Lauren's parents could not be reached for comment.

According to Lauren's obituary on the A.J. Desmond and Sons Funeral Home Web site, the teenager was creative, imaginative and fun to be around. Her close friend Betsy Van Loo, 16, said Lauren was always telling jokes and laughing.

"She was a really good person," said Betsy, a junior at Groves. "I don't really want to talk about her too much. I knew her really, really well and this is hard."

Lauren is survived by her parents, Wayne and Beth Jolly; brother Brian; grandparents James and Sally Jolly and Christine (the late Gerald) Hatcher and several aunts, uncles and cousins. A memorial Mass will begin at 10:30 a.m. Monday at St. Regis Church, 3695 Lincoln in Bloomfi eld Hills. Visitation will be at 10 a.m.

Marcia Wilkinson, spokeswoman for Birmingham Public Schools, said Lauren's parents shared with the school community their desire to educate students about their daughter's death. There have been assemblies with ninth-, 10th- and 11th-grade students - seniors are not in school this week - about what happened to Lauren.

"We reassured the students that there is support out there," Wilkinson said. "We want to encourage them to be safe about the dangerous things going on. We also want to get the message out that students should talk to someone if there are issues or if they have a friend with issues. We'd like to prevent something like this from happening again."

A deadly mixture

Lauren's parents reportedly told school officials she died of a drug overdose.

What drugs she might have used remain a mystery, but some in the community have wondered whether the teenager was using heroin spiked with fentanyl, a narcotic painkiller commonly used to ease the pain of cancer patients. In recent weeks, Wayne County has had an increase in drugrelated deaths possibly involving fentanyl, said Vanessa Denha-Garmo, spokeswoman for Wayne County Executive Robert Ficano.

"Starting last Thursday we noticed the spike," she said. "Exactly why that is, we still don't know. That's what police are investigating."

According to Joyce Brown-Williams, public information manager for the Wayne County Health Department, there have been 106 deaths linked to fentanyl between September 2005 and March 2006. In the last week, there have been more than 20 such deaths.

Deaths in several cities

Deaths linked to fentanyl also have been reported in several other cities, including Philadelphia and Chicago.

Oakland County Sheriff Michael Bouchard said that in the past year, there have been nine deaths linked to fentanyl in the county.

"This is not confi ned to Wayne County," said Bouchard. "It's a very new trend and we're working aggressively to stop it. People need to be aware of the ramifications of this drug."

Officials in Wayne County say they are working to get the word out about the drug, including sending out thousands of fliers to reach users this weekend.

"This is a serious public health issue," said Brown-Williams. "We're doing everything we can to warn the public of the danger."

According to Janet Hoffman, a drug information pharmacist with William Beaumont Hospital, fentanyl is a very potent drug - especially when mixed with other drugs like heroin or cocaine. She said that, used properly, the drug is very effective in controlling chronic pain. But if used in higher doses or illegally, it can cause a person to stop breathing or to have an irregular heartbeat and could be fatal.

"It's much more potent even than morphine," she said. "We use it all the time as a prescription medicine and it works very well if used properly. But it can have very serious side effects."

'A very potent drug'

Hoffman said that, in recent years, fentanyl has become popular as an additive to heroin or cocaine, likely because it can cause a euphoric high. The drug has been around since the 1950s and Hoffman said there's evidence it was illegally mixed with heroin and cocaine for street use as early as the 1970s.

"It's a very potent drug," she said. "And mixing it with another drug would increase the euphoric feeling."

Experts say Wayne County has the highest nationwide death rate because of the mixture of fentanyl and heroin.
Bouchard said people continually experiment to get new and different highs and fentanyl represents a new - and dangerous - trend. Most fentanyl is stolen or obtained through illegal prescriptions, he said.

Most of the heroin seized in Oakland County recently has been laced with fentanyl, he noted.

Heroin usage still rare

Lisa Machesky, executive director of the Birmingham Bloomfield Community Coalition, said that while Lauren's death has stunned the community, heroin usage among teenagers remains rare. In a survey of high school students in the Birmingham and Bloomfield Township area in February 2005, Machesky said 3 percent admitted to trying heroin. She said 20 percent of students admitted it would be pretty easy to obtain heroin.

"This is such a tragedy," she said. "She was so young. We will continue to try and educate students and parents because that's the only way to stop this."

In Wayne County, Medical Examiner Carl J. Schmidt said he began noticing a rise in fentanyl-related deaths in September, but county officials did not begin treating fentanyl as a crisis until last week, when the number of overdoses began to soar.

"Sometimes divining what the role of fentanyl is in an individual's death is more an art than a science," Schmidt said, noting drug users often have multiple substances in their blood.

Before the recent surge, Wayne County had 20 to 30 fentanyl deaths a year, Schmidt said. Those cases tended to be severely ill people with legitimate prescriptions for fentanyl patches who committed suicide by putting on many patches at once or the occasional person who had stolen the drug, he said.

Point of origin

Detroit police spokesman James Tate said the department is following up on several leads about where the fentanyl is originating. So far, however, there is no indication that it is being manufactured locally, he said.

Officials emphasize there is help for people who have overdosed if they get to an emergency room immediately.

"Treatment is available, and treatment works," said Michele Reid, medical director of the Detroit-Wayne County Community Mental Health Agency and chairwoman of the newly created Wayne County fentanyl work group.
Lauren's death marks the second tragedy at Groves High School this month. On May 15, Jamarl Fordham, 16, collapsed during a pick-up basketball game with friends at the school. The exact cause of Jamarl's death is still pending the results of toxicology reports.

Jamarl, a sophomore who liked to play basketball and was a popular student, had no known health problems.
Officials say the deaths of Jamarl and Lauren are unrelated.

Click here to return to story:
http://www.theoaklandpress.com/stories/052706/loc_2006052703.shtml

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Genesee County struck by heroin deaths. More than a dozen deaths are being blamed on a deadly drug combination.
By Cathy Shafran
GENESEE COUNTY WJRT
May 27, 2006

GENESEE COUNTY (WJRT) - (05/27/06)--A deadly heroin combination that has killed nearly 100 people in the Detroit area has now been confirmed to have killed more than a dozen in Genesee County as well.

While fears grow in Metro Detroit about the mounting deaths from the heroin/fentanyl combination, a medical examiner is saying it is a growing problem in the Flint area as well.

The information we're getting tonight comes from the Oakland County Medical Examiners office.

The chief forensic toxicologist in Oakland County says that he's seen drug overdose deaths with an unusual mixture of heroin and the painkiller fentanyl since September 28th of last year.

In all, he's confirmed 20 deaths from the same mixture that has caused nearly 100 deaths in Metro Detroit.

What he has found interesting is that of the 20 deaths, only three have been victims who died in Oakland County; 17 have been victims transported from Genesee County.

And there are more cases he's still investigating.

Information can not be released about the geographical location of those Genesee County deaths, and, at this point he has no way of determining whether the deadly drug supply is coming from Detroit, or perhaps another direction.

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Overdose deaths blamed on painkiller
Washington Times
May. 27, 2006

At least 41 people have died in Detroit in little more than a week in what appear to be drug overdoses caused by a painkiller used to cut heroin and cocaine.

Eight deaths were reported Thursday and Friday, the Detroit Free Press said.

Investigators blame the deaths on a mixture of street drugs and fentanyl, a powerful painkiller normally prescribed to cancer patients.

A number of other cities, including Chicago and Philadelphia, have had spikes in overdose deaths because of fentanyl. But the number has been far greater in Detroit, with fentanyl blamed for more than 100 deaths since September in the metropolitan area, compared to 42 in the Chicago area in more than a year.

Counselors hit the streets of Detroit Friday, trying to warn addicts to avoid fentanyl-laced drugs, which sometimes come in packets labeled "drop dead." But one former addict told the Free Press that when she was still using drugs she would not have cared if they had been cut with rat poison.

http://www.washtimes.com/upi/20060527-083555-7149r.htm

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Lethal drug combo has users uneasy. Heroin-fentanyl mix not new to Flint area.
By Kim Crawford
THE FLINT JOURNAL FIRST EDITION
Saturday, May 27, 2006

They looked like they were dead, the second-shift officers say - two men from the Goodrich area, turned blue and barely breathing, slumped in the front seat of their car parked on a Flint side street, needles still stuck in their arms.
But then paramedics arrived and administered a medicine that counteracts the effects of opiate-type drugs. Slowly, the men stirred and regained consciousness, say the officers recounting the incident.

The outcome of that overdose situation, several weeks ago, puts those two men among the luckier Flint-area heroin addicts. While no one in law enforcement says for sure that the illegal drug those men had taken was cut with the cancer pain-fighting medicine fentanyl, the odds are in favor of that possibility, police say.

"We understand that we've had it here for some time," said Lt. Phil Smith of the Special Operations Bureau of the Flint police. "We've probably had a dozen cases of overdoses in the past several weeks.

"The heroin users around the area have been definitely concerned about it. But in terms of law enforcement, when we seize drugs and have them tested, we never hear about what those drugs are cut with."

Medical authorities says that scores of drug users in southeastern Michigan and hundreds across the country from New Jersey and Philadelphia to Ohio and Chicago have died as a result of using heroin mixed with fentanyl, a powerful prescription painkiller.

According to an Associated Press report, the alarm about the lethal mixture of opiates first was issued by officials back in April. In Detroit alone, nearly 20 people died late this week from the heroin-fentanyl combination.

Now, health officials and hospitals - as well as public health and substance abuse treatment officials - are warning heroin users of the potential danger.

As a matter of public health, the federal Drug Enforcement Agency and the U.S. Centers for Disease Control and Prevention want to know about the overdose cases and whether drugs seized by authorities contain fentanyl. But Flint-area law enforcement personnel say in cases against drug dealers, they almost learn what illegal drugs are mixed with, since that typically hasn't mattered previously.

These days, Smith says, he receives messages on a near-daily basis about the heroin-fentanyl mix. Since heroin comes into Flint from both the Chicago and Detroit areas, he and other officers say, it's little wonder that users in Genesee County also have suffered death and overdose because of the mix

Smith and Capt. Mike Becker of the Genesee County Sheriff's Department, a veteran paramedic, point out that fentanyl is 80 to 100 times stronger than morphine.

Smith said heroin addicts usually use tiny plastic spoons that were given out as coffee stir-sticks, formerly available from a fast-food restaurant chain, to measure the amount of dope they put into their fix. As a result, that measure is known to heroin users as a "mac," he said.

That may help to get across just how powerful fentanyl is, when one considers that a drug mixture measured in "macs" is enough to cause the deaths of scores of users across the country. Typically, such drug mixtures contain about 10 or 15 percent heroin, Smith said.

Becker notes that law enforcement officers typically don't know or may never find out what drug an overdosed person has used when they respond to a call. But if paramedics arrive on the scene of an overdose where they have reason to believe the person has used heroin, or morphine or fentanyl, which suppress breathing, they'll administer a drug call Narcan to counteract the effects of opiates.

"We've responded to quite a few of them recently," Becker said about the county paramedics.

But police note that it's difficult, if not impossible, for police to follow up on cases where a suspect has overdosed to find out where they're drugs come from.

"In the vast majority of cases, a person administers the drugs to themselves," he said. "If they did it to themselves, who are you going to prosecute?"
***
By Kim Crawford
kcrawford@flintjournal.com o 810.766.6242

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Lethal drug mix claims more victims
BY KIM NORRIS AND MARISOL BELLO
FREE PRESS
May 26, 2006

With the arrival of the long holiday weekend and the seventh annual Electronic Music festival expected to draw hundreds of thousands to downtown Detroit, law enforcement and health professionals are bracing for a possible rash of drug-overdoses resulting from heroin laced with a powerful pain medication.

Wayne County officials Friday reported five more deaths Thursday and three Friday likely related to fentanyl-laced heroin, bringing the total to 41 in nine days and cementing Detroit s position as the nation s leader in such deaths.

Drug abuse counselors and public health officials have been out in force distributing fact sheets warning drug users of the potentially lethal mixture on the streets. And they plan to be at the techno fest this weekend.

But their warnings may be falling on deaf ears. Authorities in substance abuse and users themselves report that the prospect of death is not enough to deter them.

Joyce Jones, a heroin addict for 20 years, has been in recovery for less than two months, but says she s glad she s off the junk now because would be running straight for the fentanyl-laced drugs if they promised a better high.

People are steady dropping out there and there s no doubt in my mind, I would have been just like that, said Jones, 46. It s our thinking, it s the addict s mind, it s so messed up, even if I was seeing a flyer say it would kill me. I still would have gone ahead and done it.

She said she never asked a dealer what was in the mix she scored.

They could have been putting rat poison in it and it would not matter. I would have snorted it, she said.

She said all public health officials can do to get hardcore users to consider the risks is to keep repeating it and hopefully eventually it might get through, Jones said. It might save them for one day.

This weekend s techno fest could be fertile soil for dealers peddling tainted stuff.

Dr. Michele Reid, who chairs the Detroit-Wayne County fentanyl working group and is the medical director for the Detroit-Wayne County Community Mental Health Agency, said hospitals report an increase in drug overdoses among young people during such events.

Fentanyl, which is used to treat chronic pain, particularly in cancer patients, is 80 times more powerful than morphine. Taken in excess or in combination with heroin or cocaine, the drug can cause respiratory failure.

Health care workers throughout the metropolitan area have been alerted to the public health threat via the Health Alert Network, which disseminates information electronically to first responders, including doctors, nurses, emergency technicians and ambulance personnel.

Dr. Tammy Lundstrom, chief quality and safety officer for the Detroit Medical Center, which operates the city s busiest emergency room at Detroit Receiving Hospital, said while everyone has been made aware of the possible increase in fentanyl-related overdose cases, treatment protocols are the same. Patients are administered reversal agents and monitored until the drug wears off. Those who exhibit breathing problems will be put on ventilators.

A spokesman for Henry Ford Health System, which operates Henry Ford Hospital in Detroit, said the hospital is not increasing staff this weekend and will continue to follow standard protocols for treating drug overdoses.

A week after Wayne County officials issued an alert to the presence of a killer drug on the streets, a host of state, local and federal investigators are still searching for answers to explain the scourge that is killing Detroit-area drug users in numbers not seen in other cities that have identified fentanyl-laced drugs.

The synthetic painkiller has tainted heroin supplies in Illinois, Michigan, Ohio, Maryland, Delaware, Pennsylvania and New Jersey, according to news reports. It also has shown up in combination with cocaine in some places.

In Chicago two weeks ago, 15 people were hospitalized after using heroin bought on the city s West Side. All of the overdoses happened within a one-mile radius, authorities said. In all, dozens of people have overdosed in Chicago this year including 10 who have died. Since April 2005 there have been 42 Fentanyl-related fatal overdoses in Chicago s Cook County.

In the Philadelphia area and nearby southern New Jersey, authorities said at least nine heroin users had died last month.

Carolyn Gibson, spokeswoman for the Detroit field office of the federal Drug Enforcement Agency said investigators still do not know why people are dying in greater numbers here than elsewhere or whether all the cities are connected by a common supply source.

She reiterated Friday that DEA investigators are pursing some solid leads and hope to announce some developments within the next two weeks.

In addition to the DEA, which first issued an alert about fentanyl-related drugs in November, local law enforcement authorities are investigating. And on Monday, two investigators from the federal Centers for Disease Control arrived in Detroit, at the request of state health officials, to look into the more than 100 suspected fentanyl-related deaths here since September. It s the first time the CDC has undertaken such an investigation.

Among the things investigators want to know:

Are the cases of fentanyl-laced drugs seen in other cities linked?

Where is the fentanyl coming from - legal sources, such as pharmacies and hospitals or clandestine labs, possibly as far away as Mexico?

What is the source of the fentanyl-laced heroin supply?

Why are more people dying in Detroit than elsewhere?

How can further deaths be prevented.

John Roach, a spokesman for the Wayne County Sheriff s Office, said as part of the investigation, the department is going through the records of the dead and interviewing their friends and family to try to find the drug houses where they bought their stash.

So far, though, he said, they ve haven t come up with anything solid.

Contact KIM NORRIS at 248-351-5186 or norris@freepress.com.

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The 2006 edition of our most popular book, Confidentiality & Communication: A Guide to the Federal Alcohol & Drug Confidentiality Law and HIPAA, explains everything you need to know about 42 C.F.R. Part 2 and HIPAA, with critical new information about recent rulings about HIPAA, updated model forms, and new sections on consent forms, use of modern technology, and many other topics.

Learn about confidentiality and get CEUs from the comfort of your homes or offices with the Legal Action Centers first-ever self-paced online training courses. The 2 hour Introduction course and 4 hour Advanced course explain what you need to know about both 42 C.F.R. Part 2 and HIPAA. They satisfy HIPAA training requirements and provide continuing education credits for users who pass the automatically-graded self-tests. You can start and stop the courses whenever you want, at your convenience.

The Legal Action Centers lawyers are the nations leading experts in confidentiality of alcohol and drug treatment and prevention records. Take advantage of that expertise and buy Confidentiality & Communication 2006 and our online courses today! Both are available at http://www.lac.org.

Buy the book online for just $89.99, $10 off the regular price, or take advantage of our bulk rates and receive even greater discounts. (You can also download and print an order form to order at regular prices.)

The Introduction to Confidentiality online course is just $40 per seat, and Advanced Confidentiality is $75. Get a 10% discount by buying 10 or more seats!

Dont delay! There are no better ways to ensure compliance with the HIPAA privacy requirements and also 42 C.F.R. Part 2 than by purchasing Confidentiality and Communication 2006 and the on line courses. We guarantee you will learn how "to comply" with both laws, and you can have a full refund if you dont agree.

Sincerely,

Paul N. Samuels
Director/President
Legal Action Center

Updated Directory of Drug, Alcohol Abuse Treatment Programs Available

Updated Directory of Drug, Alcohol Abuse Treatment Programs Available

FOR IMMEDIATE RELEASE
CONTACT: Teddi Fine 240-276-2130

May 30, 2006
www.samhsa.gov


The Substance Abuse and Mental Health Services Administration's (SAMHSA) updated guide to finding local substance abuse treatment programs is now available. The guide, National Directory of Drug and Alcohol Abuse Treatment Programs 2006, provides information on thousands of alcohol and drug treatment programs located in all 50 states, the District of Columbia, Puerto Rico and four U.S. territories.

The directory, a nationwide inventory of nearly 11,000 drug abuse and alcoholism treatment programs and facilities, is organized and presented in state-by-state format for quick-reference by health care providers, social workers, managed care organizations, and the general public. It lists both public and private facilities, all of which are licensed, certified, or otherwise approved by substance abuse agencies in each of the states.

The directory is designed to quickly provide the reader with key information not only about the location of specific facilities, but also about the nature of the programs and services provided, including level of care offered and areas of service specialization, such as programs for adolescents, persons with co-occurring substance abuse and mental disorders, individuals living with HIV/AIDS and pregnant women.

The 2006 directory identifies both long and short-term residential treatment facilities and facilities that provide residential beds for clients' children.

The updated directory is a paper-based complement to SAMHSA's internet-based Substance Abuse Treatment Facility Locator Service. The continuously-updated internet-based service provides driving directions to the nearest treatment facilities, as well as descriptions of services available, and contact information, including addresses and telephone numbers. By following simple instructions available on-line through this service, users can locate public and private substance abuse treatment facilities in any state, city or community anywhere in the nation. The direct website link is http://findtreatment.samhsa.gov.

To obtain a free copy of the National Directory of Drug and Alcohol Abuse Treatment Programs 2006, contact SAMHSA's Clearinghouse or call (800) 729-6686.

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SAMHSA is a public health agency within the U.S. Department of Health and Human Services. The agency is responsible for improving the accountability, capacity and effectiveness of the nation's substance abuse prevention, addictions treatment and mental health service delivery systems.

Buprenorphine Advocacy Newsletter

Announcement

May 26, 2006


The National Alliance of Advocates for Buprenorphine Treatment - NAABT publishes an advocacy newsletter.

To add yourself to the mailing list, please either write or send an email to: subscribe@naabt.org

Website: http://www.naabt.org/

A Critical Review of the Evidence for Policy Makers

Announcement

May 26, 2006

A Critical Review of the Evidence for Policy Makers
Join Together

A review of hundreds of studies examining substance abuse treatment found that treatment is not only effective in reducing alcohol and drug use, it also helps lower crime and healthcare costs. The report offers a helpful resource for coalitions looking to demonstrate the value of treatment to their community or for coalitions looking to enhance their treatment capacity.

Download Here

Download: 380K; Publication Year: 2005

Publisher

Alcohol & Drug Problem Association of North America
307 North Main
St. Charles, mo 63301
Phone: 314-589-6702
Website: http://www.adpana.com/

Specialized Care for Expectant Mothers on Methadone (NENAMA-MOM) (Join Together, March 13, 2006)

Specialized Care for Expectant Mothers on Methadone
Join Together
March 13, 2006

The Mothers on Methadone (MOM) Program at Kent Hospital in Warwick, Rhode Island dispels the stigma facing pregnant and postpartum women in methadone maintenance treatment (MMT) by providing them and their newborns with specialized education, support services and follow-up care, the Addiction Treatment Forum reported in its Winter 2006 issue.

Prior to delivery, pregnant women in the MOM Program receive specialized addiction counseling, prenatal education classes and assistance meeting healthcare needs. Specially trained staff provide support and explanations after the delivery to help new mothers deal with the infant's treatment for opioid withdrawal, or neonatal abstinence syndrome (NAS), which lasts 23 days on average. Phone consultations and referrals to community-based services continue after the mothers are discharged.

The MOM Program was begun in July 2005 by Sharon Dembinski, a pediatric nurse practitioner, certified methadone advocate and mother of five who first learned about addiction through her son's dependence on heroin. Dembinski is also the founder of the first chapter of the National Alliance of Methadone Advocates (NAMA) specifically for mothers on methadone, called the New England NAMA-MOM chapter.

"So far, the Moms who've delivered are doing quite well, with the majority remaining in MMT and relapse-free," said Dembinski. She hopes that her program can serve as a national model and as proof that adequate methadone doses during pregnancy are essential to the health of mothers and their infants.

Join Together, March 13, 2006