PRESCRIPTION DRUG ABUSE PREVENTION AND TREATMENT ACT OF 2011

(S. 507)

BILL SUMMARY

PROBLEM: LACK OF EDUCATION

Solution: Provider Education

• Background: Currently, there are no specific education or certification requirements for practitioners to fulfill before prescribing methadone or other opioid pain relievers. Linking education to the existing Drug Enforcement Administration registration system would help ensure that physicians get the education and support they need to safely prescribe these powerful drugs.

• Proposed Change: Require the Department of Health and Human Services (HHS) to establish a mandatory and comprehensive practitioner education program for methadone and other opioids, in collaboration with relevant professional societies. Completion of this education program will be required as part of the Drug Enforcement Administration’s (DEA) current registration process used to authorize practitioners to prescribe, dispense and administer controlled substances.

• Reason for Change: Under the Controlled Substances Act, the DEA must register practitioners who prescribe controlled substances like methadone or other opioid pain relievers. However, there is no federal education requirement for those who prescribe these drugs. For example, methadone stays in the body after its pain relieving effect has worn off – resulting in a greater risk of overdose. It is necessary for practitioners to be properly educated about the complicated nature of methadone and other opioid pain relievers so that they can properly and safely prescribe these powerful drugs.

Solution: Consumer Education

• Background: There is a knowledge gap about the dangers of prescription pain relievers and how to avoid diversion and misuse. Forty percent of teens believe that prescription drugs, even if they are not prescribed by a doctor, are “much safer” to use than illegal drugs. Sixty-four percent of teens (12-17) who have abused pain relievers say they got them from friends or relatives, often without their knowledge.

• Proposed Change: Provide competitive grants to states and community organizations to educate consumers and communities about safe and appropriate use of prescription pain relievers, including methadone.

• Reason for Change: Consumers need to know how to understand the dangers of prescription drug misuse as well as how to safely use controlled substances when prescribed for them. For example, methadone has a long half-life of between 8 - 59 hours, however, the analgesic effect is usually only felt for between 6 - 12 hours. This long half-life coupled with a significantly shorter analgesic effect means that is possible for dangerous levels of methadone to accumulate in the body as consumers take additional methadone seeking pain relief. High levels of methadone can lead to respiratory distress, cardiac arrhythmia and even death.

PROBLEM: LACK OF WIDESPREAD CLINICAL GUIDELINES

Solution: Controlled Substances Clinical Standards Commission

• Background: There is widespread agreement that prescribers need better information and guidelines for safe prescribing of controlled substances including methadone and other opioids, and that health care professionals face significant challenges when trying to balance the need for legitimate pain relief with the need to prevent misuse of opioid pain relievers -- yet widely agreed-upon clinical guidelines are not in use.

• Proposed Change: Create the Controlled Substances Clinical Standards Commission to establish patient education guidelines, appropriate and safe dosing guidelines for all forms of methadone, benchmark guidelines for the reduction of methadone abuse, appropriate conversion factors for transition patients from one opioid to another, guidelines for the initiation of methadone for pain management, and consensus guidelines for the treatment of pain management with prescription opioids. In creating such guidelines, the Clinical Standards Commission would be required to collaborate with outside experts, health care professional societies, patient representatives, and others.

• Reason for Change: As the number of methadone prescriptions has significantly increased in recent years, so has the number of methadone related deaths. A standards commission will compliment the current oversight structure by providing evidence-based information to improve guidance for the safe and effective use of opioid pain relievers as well as methadone for both pain management and opioid addiction treatment.

Solution: National All Schedules Prescription Electronic Reporting Act (NASPER)

• Background: Currently 38 states have enacted legislation requiring prescription drug monitoring programs (PMPs), and many states were able to fund these initiatives in part from grants available through the Harold Rogers Prescription Drug Monitoring Program. A second program created in 2005 through the National All Schedules Prescription Electronic Reporting Act (NASPER), would provide even more assistance, but has only recently been funded with $2 million in each of FY2009 and FY2010.

• Proposed Change: This legislation would appropriate $25 million a year for NASPER to establish interoperable prescription drug monitoring programs within each state.

• Reasons for Change: The Harold Rogers Prescription Drug Monitoring Program allows states to establish their own requirements with regard to controlled substances monitored and information shared between states. NASPER goes a step further in mandating that all state prescription drug monitoring programs submit data for Schedule II, III, and IV drugs and requires interoperability between states to reduce diversion and doctor shopping across state lines.


PROBLEM: NO UNIFORM REPORTING SYSTEM FOR OPIOID-RELATED DEATHS

Solution: National Opioid Death Registry

• Background: There is no comprehensive national database of drug-related deaths in the United States, nor is there a standard form for medical examiners to fill out with regard to opioid-related deaths.

• Proposed Change: Create a National Opioid Death Registry to track all opioid-related deaths and related information. Also, establish a standard form for medical examiners to fill out which would include information for the National Opioid Death Registry.

• Reasons for Change: Since there is no comprehensive database of methadone-related deaths, the number of deaths may actually be underreported. In order to truly reduce the number of methadone-related deaths, quality data must be collected and made available.

MISCELLANEOUS PROVISIONS

• Improving Patient Safety: Opioid treatment programs will be required by law to make acceptable alternative arrangements for the safe distribution of methadone for patients who are not permitted take home doses on days where the clinic is closed.

• Moratorium on 40-mg Methadone Diskettes: For two years, no provider may prescribe and no pharmacy or opioid treatment clinic may distribute 40-mg methadone diskettes unless the prescription or dispensation is consistent with DEA policy.

• Annual Report on Effectiveness: No later than September 30, 2012 the Secretary will report to Congress the effectiveness and evaluate the success of efforts to reduce opioid addiction and methadone-related deaths including the impact of health care provider and patient education.

Download Legislation

Download FACT SHEET

Lisa Mojer-Torres (1956-2011)

National Alliance for Medication Assisted Recovery
Press Release
Contact Persons:
Roxanne Baker, President, president@methadone.org
Joycelyn Woods, Executive Director, edirector@methadone.org
Phone/Fax: 212-595-NAMA

 

It is with great sadness that the Board of Directors of the National Alliance for Medication Assisted Recovery (NAMA Recovery) announces the passing of our friend and member of the board Lisa Mojer-Torres, Esq. We will miss her deeply.

Lisa Mojer-Torres, 54, of Lawrenceville, NJ lost her battle with ovarian cancer April 4, 2011. Daughter of the late Joseph R. Mojer, Lisa is survived by her beloved husband, Rolando Torres Jr.; her two loving sons, Matthew and Liam Torres, and her mother, Gwendolyn Walters Mojer. Also surviving are her brothers, Steven Mojer and his wife Maryjane and Michael Mojer and his wife Kim; a sister-in-law, Vivian Torres; nephews, Tyler and Jessie Mojer and nieces, Heather and Leah Mojer and Emily Jordan.

She received her B.A. from Boston University and her J.D. from the University of New York. Lisa was licensed to practice law in both New York and New Jersey. She passed the bar exam for both states the first time and months apart an incredible accomplishment for any student of law. However upon passing the bar exam she was informed that because she was taking methadone she would have to be supervised. Lisa was incensed because she had done nothing wrong. She challenged the decision and won the right to practice law in both states without supervision. This experience was the motivating force for her decision to use her knowledge of law for advocacy.

Lisa served as the recovery advocate for the New Jersey Division of Addiction Services (DAS). She was proud of setting up the Citizens’ Advisory Council (CAC) whose purpose was to involve consumers and families in improving the current system of care.

She served on the board of NAMA Recovery (formerly the National Alliance of Methadone Advocates) three times. As 2nd Vice President she was one of the founding directors of NAMA Recovery from 1992-94. She was part of the Interim Board in 1998-99 and assisted in NAMA Recovery's re-organization. This past fall she joined the board for a third time to provide her legal expertise.

But her greatest contribution and life's work was helping medication assisted treatment (MAT) patients with legal issues. It was mostly Pro Bono. There are hundreds, probably thousands of MAT patients and their families who benefited from these cases because agencies were educated about the benefits of MAT.

In 1993 she was a member of the Committee to Study the Federal Regulation of Methadone Treatment that resulted in the 1995 Institute of Medicine's report, Federal Regulation of Methadone Treatment. From 1998 to 2002 she served on the SAMHSA Center for Substance Abuse Treatment’s National Advisory Council. She served as a founding member and first chairperson of the Faces and Voices of Recovery (FAVOR) and was one of the persons responsible for insuring that persons receiving MAT were considered "in recovery". In 2005, Lisa participated in her third Institute of Medicine of the National Academies Committee Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. This Committee’s findings are published in the 2006 National Academies Press, Improving the Quality of Health Care for Mental and Substance-Use Conditions.

Lisa was the recipient of many national awards for her advocacy work. In 1996, she received the first Public Service Award presented by the National Institute of Drug Abuse (NIDA) for her efforts to educate others about the effectiveness of methadone treatment. In 2006, she received the Johnson Institute's Award, America Honors Recovery. And this past fall, she received the Richard Lane and Robert Holden Patient Advocacy Award at the American Association of Opiate Addiction Treatment Conference (AATOD).

Her most recent work was the article on Recovery Orientated Methadone Maintenance co-authored with William L. White, M.A.

FAVOR will be creating a page on their website to commemorate her life and incredible contributions to our recovery advocacy movement. Please email Whitney O’Neil at woneill@facesandvoicesofrecovery.org with any pictures, stories or remembrances that you would like to share.

You can read William White's interview with Lisa at:
Lisa's Interview

The paper by William White and Lisa Mojer-Torres Recovery Oriented Methadone Maintenance can be downloaded at:
www.williamwhitepapers.com

The family strongly suggests that in lieu of flowers, memorial contributions in Lisa's memory be made to Hospital at the University of the Pennsylvania, Ovarian Cancer Research, 3400 Spruce Street, Philadelphia, PA. 19104.

NAMA Recovery Announces Two More Directors to Join the Board: Lisa Mojer-Torres Esq and Nanette Wollfarth CMA

National Alliance for Medication Assisted Recovery
Press Release

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

 

It is with great pleasure that NAMA Recovery announces the addition of two additional new board members Lisa Mojer Torres and Nanette Wollfarth. Like our other recent additions to the Board they bring with them years of experience working in advocacy and making treatment and recovery a reality for thousands. Lisa Torres recipient of this years’ Richard Lane/Robert Holden Advocacy Award has served the NAMA Recovery Board twice before with her legal skills. Nanette Wollfarth is the Chapter Coordinator and brings her knowledge of national and international issues.


This brings the current Board of Directors to:

Roxanne Baker, C.M.A., President
Donna Schoen, C.M.A., Vice President
Kerry Wolf, B.S.N., C.M.A , 2nd Vice President
Jo Sotheran, Ph.D., C.M.A., Treasurer and Secretary

J.R. Neuberger, C.M.A. Parliamentarian and Newsletter Editor
Chris Kelly, Advocates for Recovery though Medicine
Ira Marion, M.A.
Lisa Mojer Torres, Esq
Nanette Wollfarth, C.M.A., Chapter Coordinator

MARS Project Receives Funding for Another Four Years

National Alliance for Medication Assisted Recovery
Press Release

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


The MARS Project (Medication Assisted Recovery Services) the only Peer to Peer Recovery Services Center has received a second grant to continue the project. It is a proud moment for NAMA Recovery because over 220 proposals were submitted and only 5 grants awarded. It is confirmation that a small patient run organization can compete with the big guys and win. The proposal was also the only one to receive continuous funding.

The MARS Project is a new way of thinking for providers and patients of Medication Assisted Treatment (MAT). It is not a part of the program but instead works alongside programs and is managed entirely by patients for patients to have a safe and supportive place to go to. NAMA Recovery has learned that patients want information and to learn about their medication, addiction and regulations. Peers at MARS receive the Core Training that consists of (1) Advanced Addiction that covers psychopharmacology, neuroscience, biochemistry and addiction science, the (2) Education Series deals with many diverse issues from history of methadone to confidentiality and (3) Recovery completes the series since it is a new concept for most patients.

Unlike many recovery centers MARS is not a place to house 12 step meetings. There is only one weekly 12 step meeting and another group on spirituality and recovery. Most of the groups change over time as peers find new interests. Some groups are for socialization and fun like the Book Club and Arts and Crafts while others are discussion groups like Women’s or Men’s Issues and some groups cover practical topics like Taking Care of Your Heath and Relapse Prevention.

NAMA Recovery Announces Two New Directors to Join the Board: Chris Kelly and Ira Marion

National Alliance for Medication Assisted Recovery
Press Release

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

For Release:
September 26, 2010

NAMA Recovery Announces Two New Directors to Join the Board:
Chris Kelly and Ira Marion

It is with great pleasure that NAMA Recovery announces the addition of two new board members Chris Kelly of Advocates for Recovery through Medication and Ira Marion of Albert Einstein College of Medicine. Both bring with them years of experience working in advocacy and making treatment and recovery a reality for thousands.

This brings the current Board of Directors to:

Roxanne Baker, C.M.A., President
Donna Schoen, C.M.A., Vice President
Kerry Wolf, B.S.N., C.M.A , 2nd Vice President
Jo Sotheran, Ph.D., C.M.A., Treasurer and Secretary

Barbara Finger, C.M.A.
J.R. Neuberger, C.M.A. Parliamentarian and Newsletter Editor
Chris Kelly
Ira Marion, M.A.

Administration
Joycelyn Woods, M.A., C.M.A. Executive Director
Nanette C. Wollfarth, C.M.A., Chapter Coordinator Claude Hopkins, R.M.A., C.M.A., Grievance/Compliment Coordinator Herman Joseph, Ph.D., C.M.A., Ambassador At Large Norma Alexander, C.M.A., Publicity and Special Events Coordinator
Walter Ginter, C.M.A., Director of Training & Recovery Services & MARS Project

Methadone Under Attack in Pennsylvania Voice Your Opposition to Pennsylvania’s Methadone Accountability Package

National Alliance for Medication Assisted Recovery
Press Release


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

Ericka Lear PA NAMA 814-695-1014

For Release:
July 26, 2010

Methadone Under Attack in Pennsylvania Voice Your Opposition
to Pennsylvania’s Methadone Accountability Package

In May Pennsylvania legislators announced at a press conference a number of bills that would be introduced. They claim that the intent is to increase safety, fiscal accountability and reduce the use of illicit methadone in an effort to reduce methadone overdose deaths the legislation is based on prejudice and ignorance. Methadone treatment is already strictly regulated at both the federal and state levels more than any medication or medical treatment. Nevertheless as in the past opioid treatment programs are the focus.
Here is what the legislation would do:

- Patients would need a designated driver when starting methadone or increasing dosage and get tested more often for other drugs that in combination with methadone impair driving.
Response: Numerous studies have reported that stable patients can perform as well as any non methadone patient driver. Federal and state regulations already require toxicology tests that are sufficient.

- Driving with more than the prescribed dose of methadone would constitute driving under the influence, and driving with methadone in combination with alcohol or other drugs would constitute "high-impairment" DUI.
Response: How would one determine if a patient has taken more than their required dose? There is no way.

- Methadone clinics must be open seven days a week - up from six - to curtail selling of "take home" doses.
Response: This is an unnecessary expense and should be decided and based on each individual OTPs needs.

- Clinics must give all startup patients an opioid antagonist drug The Antagonist Challenge Test.
Response: This is a barbaric practice that was used by a few states over thirty years ago. It is dangerous and most certainly will result in deaths.

- Clinics must test for a certain type of sedative and dispense methadone to patients only if a psychiatrist attests to its necessity.
Response: This is already a federal requirement and unnecessary.

- Patients couldn't take home doses for six months - up from three.
Response: Take home doses should be based on a patient’s responsibility and both the federal government and state have requirements that patients must meet which are quite rigid.

- The industry would need to create protocols to determine when patients are no longer benefiting methadone and clinics would discharge these patients.
Response: All patients benefit or they would leave.

- Patients would have funding for one year.
Response: Excellent if this applies to all patients encouraging persons to enter treatment.

- Patients would need to patronize the nearest clinic, to reduce alleged abuse of transportation subsidies.
Response: Most patients already do this.

- The state's methadone support system would be audited.
Response: The state already inspects, licenses OTP and responds to complaints in addition to SAMHSA accreditation and licensing and DEA requirements.

- The state would create a Methadone Death Review Team to gather data and figure out how to reduce the number of fatalities.
Response: NAMA Recovery would be in support of this. The team should include professionals, policy makers and patient advocates. Standards need to be developed about what constitutes a methadone death and those in combination with other substances.

- The state would develop screening standards for methadone candidates.
Response: The federal government and state already have requirements.

- The state would standardize intake procedures, warn potential patients of the risk and advise them of alternative strategies.
Response: The federal government and state have standard intake procedures.

- Treatment plans would lay out a schedule for getting off methadone within two years, unless there's good reason.
Response: Treatment plans should be focused on recovery getting one’s life together not a schedule to get off.

- Patients would get a minimum two hours counseling per week.
Response: OTP caseloads are greater than other types of addiction treatment. Counseling needs to be on using a who needs it basis. Forced counseling requirements diverts the counselors attention from patients that need their time thus insuring that nobody gets what they need. A counselor with the standard 50 patient caseload would have to work 100 hours a week.

- Clinics would screen patients for other drugs at the start and every two weeks.
Response: Regular screening is already part of the federal and state regulations. Every two weeks is costly and unnecessary.

- Patients couldn't drive for the first two weeks - or a month, if they test positive for other drugs.
Response: This would mean that no patients could not drive for the first 2 weeks since they must test positive for drugs at admission.

- Clinics must develop plans to curtail illicit sale of methadone by patients.
Response: The federal regulations already require this of each program as well as most states.

- Patients may take home doses only if it's consistent with a treatment plan, there's minimal risk of abuse, it would help in treatment and the client hasn't abused take home previously.
Response: Actually federal and state requirements already require this and including an additional 6 requirements.

- Programs could discharge patients who sell doses or who threaten or commit violence.
Response: These are the two reasons that programs already administratively discharge patients.

Sources: State Sens. John H. Eichelberger Jr., R-Blair, Mike Stack, D-Philadelphia, and Kim Ward, R-Westmoreland.

Methadone maintenance treatment has been thoroughly researched and carefully evaluated for over four decades. It has received more scientific scrutiny and evaluation than any other medical treatment or human service program. Most evaluations have shown that, when correctly implemented, the treatment is capable of producing remarkable improvements in patients who were previously dysfunctional heroin addicts. Methadone maintenance patients throughout the world have been restored to productive lives, relations with families and children have been reestablished, many have furthered their educations, obtained employment and improved their physical and mental health. Nevertheless, contrary to scientific evidence, methadone maintenance treatment remains a controversial issue among substance abuse treatment providers, public officials and policy makers, the public at large and the medical profession itself.

Download the following:

Copy of this press release
Letters sent by NAMA Recovery
Announcement the Methadone Accountability Package
What Can You Do? and Sample Letter
List of Pennsylvania's House Represenataives & Addresses
List of Pennsylvania's Senators & Addresses

Sign the Petition Opposing the Methadone Accountability Package

Help Identify What Patients Do To Make Recovery Work

February 28, 2010

Stabilized patients who have been in methadone maintenance for more than one year (with negative urinalysis tests for all illicit substances except methadone).

Have you ever considered your status as a long term methadone patient, AKA elite methadone patient to be an achievement worth celebrating? I do and so do many others. And, it is! One problem is that fewer patients remain in methadone maintenance for longer periods of time. It took me several episodes of treatment before I began to understand and distinguish the differences in value between the medication (methadone); the modality (methadone maintenance); and the way methadone is dispensed (the methadone program or clinic system). So, I became an advocate for better and more information to patients about how methadone maintenance works and involved on several levels in improving the way methadone is dispensed; the clinic system.

About me:

My name is Lisa Mojer-Torres and I have been a patient for 20 years. I tried to withdraw from methadone maintenance three or four times before learning about its pharmacology. Since stabilizing on my optimal dose, I have become a practicing attorney, (admitted in NY and NJ) and an advocate for methadone maintenance as a modality and methadone patients as victims of stigma and discrimination. I have a life that includes rewarding employment, a beautiful family, and our own home.

This project:

Currently, I am writing an article with leading recovery expert that analyzes methadone maintenance as a legitimate path into and through “recovery” from active addiction to heroin and other opioids. There are several uses for methadone and even different stages within methadone maintenance pharmacotherapy. However, once a patient and his/her doctor identify the patient’s optimal dose of methadone (the particular dose that affords the patient the maximum benefits methadone offers in managing the chronic disease of opioid addiction), the patient remains on that dose with the exception of a rare taper. The patient has achieved “optimal dose stabilization”. Without the distractions of withdrawal symptoms, or the obsessive cravings for opioids (and an opioid blockade as well) the patient is in the strongest position to leave the life of active opioid addiction behind, transitioning from treatment to recovery. It is this transition that I am interested in documenting.

Why I am reaching out to you:

In order to document the transition from treatment to recovery, I believe it is imperative to go directly to the source and seek information from those patients who’ve succeeded with methadone maintenance about how they succeeded. I am also interested in learning what resources would have made your experience easier. I am interested in learning what and whether you think achieving optimal dose stabilization has played any role in your life and/or the lives of other patients. The three-part article will conclude with a statement that opioid addicts who achieve optimal dose stabilization with methadone are on an equal par to alcoholics who stop drinking and others who stop using, etc. Mostly, I am interested in learning the various skills you used in overcoming ignorance about methadone and how you managed to sustain recovery.

Confidentiality:

I don’t need to know your name or any other identifying information for this project. At any rate I am restricted by confidentiality laws. Your treatment program was kind enough to cooperate in allowing this notice to be posted in the OTP, but no one is under any obligation to respond. However, unless and until the public becomes aware that there is a significant population of stabilized in methadone maintenance patients in recovery, we will continue to be defined by those still struggling with active addiction. I would be grateful if you would spare a few moments of your time to participate in this anecdotal survey. I promise your time and effort will not be wasted and I will do my best to create a resource that speaks directly to the current generation of opioid addicts who, still stuck in the grips of active addiction have not been unable to maximize methadone’s full potential. It’s my hope that by offering to share our experiential jewels of information, others will believe a life in recovery is possible, even for them.

IF YOU ARE WILLING TO PARTICIPATE IN AN E-MAIL EXCHANGE OR A PHONE INTERVIEW, PLEASE CONTACT ME, Lisa Mojer-Torres VIA E-MAIL @ rtorres605@aol.com OR TELEPHONE at my home/office @ (609) 671-1995 either 7AM-9AM weekday mornings or 7PM-9PM weekday eves. (I work during the day). Call any time over the weekend; I will do my best to hang around the house over the next couple of weekends. But, in the event you reach our voice mail, PLEASE either leave a message providing instructions about how to reach you OR call me back. My goal is to complete interviews by March 7th, latest, so please try and act upon this ASAP. If you wait, we all lose.

Sincerely,

Lisa Mojer-Torres (Using Google, you can check out more information about my advocacy efforts on the national level)
Email: RTORRES605@AOL.COM
Telephone: (609) 608 671-1995
.

Howard Stephen Lotsof (3/1/1943 - 1/31/2010)

National Alliance for Medication Assisted Recovery
Press Release

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

For Release:
February 15, 2010

Howard Stephen Lotsof (3/1/1943 - 1/31/2010)

It is with great sadness that NAMA Recovery announces the passing of our long time board member and fellow advocate Howard Lotsof. He passed away Sunday, January 31, 1010 at 6 PM in Staten Island University Hospital.

Howard was an important part of NAMA Recovery and methadone advocacy. He came to us because of his experience in developing Ibogaine and having to work with methadone programs. They had sure changed since he was a patient many years before. He believed that treatment should be a positive experience and so in typical Howard fashion he could not hold himself back to set things right. He helped a lot of people with issues and problems that they had during the years that he was with NAMA Recovery and his presence will be greatly missed.

But Howard also had another life as an Ibogaine advocate. He single handed -- as a citizen with no background in drug development -- convinced the National Institute of Drug Abuse (NIDA) to provide funding for Ibogaine studies in the US. Only large pharmaceutical companies have the resources to accomplish this -- and of course Howard Lotsof.

The funeral was Friday, February 5, 1010 at Harmon Funeral Home in Staten Island. He will be intered at the Fairview Cemetery, 1852 Victory Blvd., Staten Island.

He was a nobel and inspiring man and we send Norma and his family our most heartfelt sympathy on his passing. We will miss him very much.

Note: His wife Norma Lotsof is asking for assistance for the gravestone. Donations can be sent to: Ms. Norma Lotsof, 46 Oxford Place, Staten Island, NY 10301

Obituary

Howard S. Lotsof, 66, discoverer of the anti-addictive effect of ibogaine, died of liver cancer on Sunday January 31, 2010 in Staten Island.

Mr. Lotsof was the first individual to observe the effect of ibogaine, a naturally occurring plant alkaloid with a history of use as a ritual hallucinogen in Africa, in detoxification from heroin. He subsequently originated patents for the use of ibogaine in treating addictions, including opioids, cocaine and amphetamine, alcohol, and nicotine.

Mr. Lotsof’s work initiated substantial research into ibogaine and related compounds in the mainstream scientific community. He provided pilot data to the National Institute on Drug Abuse that became the basis for a program of research on ibogaine that generated scores of peer-reviewed publications and led to the approval by the US Food and Drug Administration of a Phase 1 clinical trial. Beginning with research funding provided by Mr. Lotsof 25 years ago, Stanley D. Glick, M.D., Ph.D., Professor and Director of the Center for Neuropharmacology and Neuroscience Albany Medical College, has produced a body of work on ibogaine and related compounds that presently includes over 60 peer-reviewed publications and has been supported for more than two decades by the National Institutes of Health. Mr. Lotsof himself authored or coauthored scientific papers on ibogaine in respected academic publishing venues such as the Journal of Ethnopharmacology and the American Journal on Addictions. These accomplishments are all the more extraordinary in view of the fact that Mr. Lotsof, a graduate of NYU who majored in film was without a doctoral level degree.

The FDA-approved clinical study was never completed due to contractual disputes, which was Mr. Lotsof’s deepest professional disappointment. Nonetheless, an expanding global context of ibogaine use for the treatment of addiction continues to exist in medical and non-medical settings across the world, and ibogaine continues to be studied as a paradigm for fundamental research and the development of new treatment for addiction.

Mr. Lotsof is survived by his wife, Norma, and two sisters Rosalie Falato and Holly Weiland.

Nominations Open for the Richard Lane/Robert Holden Methadone Advocacy Award

National Alliance for Medication Assisted Recovery
Press Release

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


For Release:
February 15, 2010

Nominations Open for the Richard Lane/Robert Holden Methadone Advocacy Award

Richard Lane 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 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.

Robert Holden was also a recovering heroin user, who later became the Director of PIDARC, an outpatient methadone treatment program in the District of Columbia. He was a friend of Richard Lane and succeeded Richard Lane’s term of office as the Vice President of the American Association for the Treatment of Opioid Dependence. This award was established in 1995 and recognizes extraordinary achievements in patient advocacy.

The following criteria should be applied in making your selection:

• Only one (1) nominee can be submitted to the Conference Awards Committee. There may be a number of nominees, however only one (1) “consensus” nominee may 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.
• For each nominee a Nomination Form must be completed and submitted with two (2) Letters of Support. The Nomination Form is attached to this announcement and can also be downloaded from the NAMA Recovery website http://www.methadone.org/.
• Additional information about the award can be found at the NAMA Recovery website http://www.methadone.org/richard_lane.html.
• NAMA Recovery will be responsible for collecting all the submissions for nomination, selecting a committee of advocates that will decide on the final candidate. The Candidate’s Name, Nomination Form and at least two (2) Letters of Support describing the nominee’s achievements will be submitted to the Awards Committee for the final approval.
• The Deadline for Submission is February 26, 2010. The completed Nomination Form along with at least two (2) Letters of Support should be sent to Joycelyn Woods at edirector@methadone.org.
  
  

Previous Winners of the Award

2001, St. Louis Joycelyn Woods

2007, Atlanta Anthony Scro

2009, New York Walter Ginter

This Award will be bestowed upon the recipient during the Awards Banquet Ceremony of October 26,2010 during AATOD's next National Conference which will convene in Chicago at the Hilton Hotel.

The recipient will be provided with a roundtrip Coach Class airfare in addition to up to two (2) nights in the hotel. The individual will also be able to attend the Conference.


Deadline: Wednesday, February 26, 2010
Email Nominations To: edirector@methadone.org
Joycelyn Woods

If you have any questions about the award contact Joycelyn Woods at edirector@methadone.org or by telephone at (718) 993-3397.

New Chapters Join NAMA Recovery

National Alliance for Medication Assisted Recovery
Press Release
Contact Person: Joycelyn Woods, Executive Director
edirector@methadone.org
1.212.595.6262


FOR IMMEDIATE RELEASE
September 2, 2009

New Chapters Join NAMA Recovery

The National Alliance for Medication Assisted Recovery, or NAMA Recovery, formerly the National Alliance of Methadone Advocates, with 25 chapters across the United States and 15 international affiliate chapters from England to Denmark and India to Australia, is proud to announce the formation of its 26th and 27th chapters in the United States. They are Northern Texas NAMA-Recovery under the guidance of co-directors Terry and Dianne Cox and Georgia NAMA Recovery with Suboxone as Specialty under the leadership of director Angela Fletcher.

The establishment of the Georgia chapter is a particular milestone for NAMA Recovery as it extends its umbrella to include patients accessing medication assisted recovery through the use of buprenorphine, currently prescribed under the trade name Suboxone. It is the newest of the medications approved by the federal government for the treatment of opiate addiction.

Each of these new chapters can be reached through the NAMA Recovery website at http://www.methadone.org/.

The National Alliance for Medication Assisted Recovery, established in 1988, is the premier patient advocacy organization in the opioid addiction recovery community. It provides information, education and advocacy support to patients in medication assisted addiction treatment world-wide.

Profiles of Recovery Advocacy in Action

Advocacy for Medication-Assisted Recovery

An interview with Walter Ginter by Bill White

"In June of 2009, I interviewed Walter Ginter about the work he and others have done in advocating the legitimacy and effectiveness of medication-assisted recovery. Walter is one of the most skilled recovery advocates in the United States."

Check out the rest of the interview at the FAVOR website.

New Education Series "Making Methadone Safe"

A new Education Series (Number 11) Making Methadone Safe has been developed to help patients -- both addiction treatment patients and pain patients -- keep their methadone safe.

Increase in Methadone Related Deaths by 390%

Methadone related deaths have increased dramatically, from 1999 through 2004 there was a 390 percent increase. Other deaths attributed to opioids have also increased but only by 90 percent, however they constitute a much larger percentage of the total for opioid-related deaths. A SAMHSA report found that the majority of methadone-related deaths involve abuses that were prescribed for pain management. Methadone deaths attributed to Opiate Treatment Programs (OTPs) have not increased.

Unfortunately it is the OTP deaths that make the news and methadone programs have particularily become targets because they are easy to blame.

It is important that all persons taking methadone keep there medication safe and this Education Series was developed to provide resources and ways to keep methadone safe.

You can download the new Education Series at our website.

New Name: National Alliance for Medication Assisted Recovery

National Alliance of Methadone Advocates
Press Release

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

FOR IMMEDIATE RELEASE
APRIL 26, 2009

New Name: National Alliance for Medication Assisted Recovery

It is especially fitting at this AATOD conference in New York that the Board of Directors of the National Alliance of Methadone Advocates, the premier patient advocacy organization in the opiate addiction recovery community, established in 1988 in this very city, announces an important change to its identity. It will now be doing business as the National Alliance for Medication Assisted Recovery, or NAMA Recovery. NAMA Recovery has 25 chapters across the United States and 15 international affiliate chapters from England to Denmark and India to Australia, providing information, education and advocacy support to patients in medication assisted addiction treatment utilizing methadone and buprenorphine.

NAMA Recovery is the umbrella organization for the M.A.R.S. Project, a CSAT (Center for Substance Abuse Treatment) funded Recovery Support Services Grant grantee. M.A.R.S. (Medication Assisted Recovery Services) is a peer recovery project based on the belief that when methadone patients receive training about addiction, its treatment and recovery they will feel better about themselves and do better in treatment and life. It is providing patients of medication assisted treatment education about the science of addiction, information on nutrition and health, peer mentoring, women- and Hispanic-specific recovery services, even a M.A.R.S. book club, all in a location near the treatment clinic where the patient can be mentored and grow. M.A.R.S. is the first truly “peer to peer” recovery endeavor in opiate addiction treatment in the United States with MAT patients educating and mentoring MAT patients with significant accomplishments and successes.

The Executive Director of NAMA Recovery is Joycelyn Woods and the Director of the M.A.R.S. Project is Walter Ginter.

Rokki's NewTube Message

See our President Rokki Baker's NewTube message about Drug Policy.

The message was taped at the IDUD 2008 Meetings hosted by NAMA’s Danish Affiliate, BrugerForeningen (BF).

Check out Rokki's Talk at YouTube.

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.