Wednesday, July 26, 2006

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.

Saturday, July 22, 2006

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

Copenhagen, Denmark
22nd July 2006

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
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:

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

Dr. Mark Shinderman

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:

Staff photo by John Ewing

Wednesday, July 12, 2006

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

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:

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