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There are crosswords and other items of interest in the printed version of Methadone Today, but we will just print the articles here. To Subscribe to Methadone Today
Volume I, Issues 1-3 (December 1995 - August 1995)
Medicaid, Methadone, Managed Care & Budget Cutbacks
- by Beth Francisco
Reporter Skews Ritalin Story - by Jon
Methaphobia - by Ira Sobel
Counseling and Compulsiveness - by Michelle
Urinalysis Policies - by Beth Francisco
Clean, Depressed, & Confused - by Rose
Principles vs. Personalities - by Beth Francisco
First Advocacy Meetings Held - by Jon
DONT Ignore Patient Advocacy in Michigan - by Jon
Take Home Policies: What Is Fair? - by Nancy R.
Perception - by Beth Francisco
Medicaid, Methadone, Managed Care & Budget
Cutbacks
by Beth Francisco
As promised at the voter registration drive in Pontiac, I have been looking for
information regarding the effect of the new Republican Congress' policies concerning
Medicaid and managed care and what that means for methadone patients. From what I have
been able to discover, it doesn't look good. The Republican "Contract [ON]
America" wants to "cut federal entitlements, and instead give block grants to
the states."1
Republicans say they want block grants instead of entitlements for flexibility because
they believe they "would have more discretion over the way the money is spent."2
This is not terribly encouraging in Michigan with the governor we have, as we all know
Engler is not exactly concerned about the poor, minorities, women, or addicts. The only
reason any of these groups have gotten any relief is because of federal entitlements--with
one of his first strokes of the pen, he did away with many needed programs.
One of the first federal cuts for addicts is from "The House Ways and Means Committee
[since it] is removing substance abuse as a disability under the Supplemental Security
Income (SSI) program. Just last year, Congress enacted a new law which limits SSI payments
for addicts and alcoholics to three years. Under what the House is proposing for welfare
reform, those on SSI might be cut off altogether. Worse still, the committee has decided
that these people...would not only lose their SSI, but would become ineligible for
Medicaid"3 If addicts are cut from Medicaid, it will be suicide, especially for those
who depend upon it to pay for their methadone maintenance.
We are so concerned with saving money and cutting the federal budget that it is absolutely
illogical (and downright stupid) to cut addicts off from the one thing that keeps many of
them out of prison. It costs about $2,600 per year to maintain an addict on methadone, and
it costs ten times that much to "treat" addiction by throwing the addict in
prison. When addicts cannot afford methadone treatment, there is always the threat of a
return to the streets where an addict can easily be 100 times the drain on society when
s/he has to return to larceny and burglary to maintain their habit.
The question is, "How can the addict afford the price on the street if s/he can't
afford the methadone clinic?" When the addict is maintained on methadone, s/he is
usually making improvements in their life--getting an education, working to support self
and family, and improving relationships. The addict has neither the time or inclination to
engage in negative behaviors such as larceny, burglary, or any number of other things the
addict has to do just to "maintain" on the street. The addict maintained on
methadone is not exposing him/herself to AIDS on a regular basis as they were when
exchanging needles. The price of one case of AIDS in money alone is a thousand times the
cost of yearly methadone maintenance, not to mention the human misery. In plain language,
when the physical and/or psychological addiction is taken care of, the addict is just like
any other person who wants to improve his life conditions. As we all know, when the addict
is on the street, nothing matters except the next fix.
What is really idiotic is the price of methadone maintenance in the first
place. It doesn't have to cost $2,600 per year; the reason it does is because of the
governmental regulations on it. According to Substance Abuse Report Newsletter:
Methadone regulations are too restrictive and should be relaxed in favor of clinically
useful guidelines, according to a report by the Institute of Medicine [IOM]. While
stopping short of recommending abolishing the regulations altogether, the report, released
December 21, calls for making methadone easier to use for treatment facilities and
patients alike.4
When regulations call for arbitrary rules and regulations from somewhere in the great
beyond that has nothing to do with real life and real people, costs rise. The doctor,
counselor, and addict are in the best position to know how to treat the addiction--not
some senator in Washington or Lansing and not some program director who doesn't know us
and probably never will.
As far as Medicaid managed care, budget cutbacks will definitely be pushing for more of
it. "Managed behavioral health care organizations contract with HMOs or states to
provide Medicaid services. They then turn to their provider panels for cost-effective
care."5 The definition of managed care is:
a system used by groups (including insurance carriers and corporations) to manage costs
while maintaining quality of health and medical services. Specific approaches used by the
payer of services include: pre-certification, utilization review, case management and
medical necessity review.6
The idea behind managed care is to save money by having a primary provider decide what
type of health care you will be allowed under the system. The primary provider decides if
you need methadone treatment, so the bottom line is, before you sign up for anything, find
out how your primary provider feels about methadone maintenance or any other treatment you
now receive on a regular basis.
1"Treatment Providers and State Directors Fear Effect of Welfare
Reform" (1995, March 15). Newsletter: Substance Abuse Report. http://access.
digex.net/ brpinc/ on Internet's World Wide Web. E-mail to info@enews.com
2Ibid.
3Ibid.
4"IOM Recommends Easing Methadone Regulations. (1995, January 15). Substance Abuse
Report Newsletter. http://www.access.digex.net/ brprinc/
5Ibid.
6"Health Policy Glossary." (1993). Health ResponseAbility Systems. America
Online (Downloaded 1995, Oct. 18).
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Reporter Skews Ritalin Story
by Jon
On November 16 and 17, WXYZ, Channel 7 in Detroit, aired a two-part
series on Ritalin, a drug commonly prescribed to children with Attention Deficit
Hyperactivity Disorder (ADHD), Ritalin has long been known as one of the most effective
treatments for the disease. It has been under recent scrutiny due to efforts to ease
restrictions on the drug in Michigan and elsewhere. Proponents of the drug's therapeutic
use believe that its current Schedule II status makes Ritalin unnecessarily difficult for
ADHD patients to obtain. Some believe that relaxed regulation of Ritalin will encourage
abuse.
Ritalin has been abused for more than twenty years by adolescents and adults. Ritalin's
rise in popularity in Michigan may be due in part to the state's strict laws which
prohibit most amphetamines. Ritalin is a stimulant but not technically an amphetamine.
When prescribed properly, Ritalin is not used as an amphetamine substitute. There is no
evidence to suggest that Ritalin is abused any more than other drugs with abuse potential.
Yet, Channel 7's report implies that Ritalin abuse is rampant. Reporter Shellee Smith
proclaimed that "Michigan is quickly becoming one of the Ritalin Capitols of the
world."
Smith's sensationalistic rantings can do nothing to prevent Ritalin abuse. The heavily
biased report focused largely on the negative ramifications of Ritalin abuse but said
little of the therapeutic aspects of the drug and the thousands of children and adults who
benefit from its use. Ritalin patients are stigmatized due to the atmosphere of ignorance
that surrounds mental illness and drug therapies. Deceiving the public with overblown,
misleading information about any public health issue is dangerous. Smith's report may
potentially spread panic among the families of Ritalin patients who have suffered the
hardships of coping with their loved one's ADHD. Shellee Smith seems to be using
sensationalistic tactics to sell her report under the guise of protecting the public from
the "evils" of Ritalin. Who will protect the public from Shellee Smith's
recklessness?
As with any psychoactive substance, Ritalin has abuse potential. Smith drew the focus away
from more significant aspects of the issue in order to exaggerate this point while
employing scare tactics that would appeal to any parent's worst fears. Ritalin abuse among
adolescents and adults does exist in Michigan and elsewhere. All drug problems are
serious, especially when children and adolescents are affected. But Smith falls far short
of proving a Ritalin epidemic in Michigan. Her report provided little hard data and
instead relied on a number of adolescents from an area treatment center who appeared to be
singled out because of their Ritalin dependencies. The appearance of an epidemic can be
easily created if one uses a sample group of hand-picked subjects possessing only those
characteristics that support one side of the issue. This brand of yellow journalism is
nothing new to Shellee Smith. Earlier this year, she did a similar report on methadone.
The story was shamelessly slanted by employing amateurish editing techniques and other
instruments of deception such as the use of half truths and distortion of facts. She
referred to methadone patients as addicts who "line up to get their fix" at the
methadone clinic. Channel 7 videotaped patients inside clinics and, in some cases, allowed
their faces to be shown. Smith ignored any positive, therapeutic qualities of methadone
treatment while implying that addicts were supporting their habits with hard-earned tax
dollars.
The report seemed to imply that all methadone patients were inner city welfare cheats
getting high for free. Meanwhile, thousands of methadone patients within Channel 7's
viewing area were left to explain to their families that they were not patrons of legal
dope houses. Targeting methadone patients is a cheap way to revive plummeting ratings
which, ironically, are the result of the station's abandonment of its star anchorman who
was at the time receiving treatment for his own addiction. Smith obviously did little or
no research on Ritalin or methadone. Her source for these hatchet jobs is the worst kept
secret in Detroit T.V. news. It appears that she has been relying on her federal
significant other for information instead of doing hard investigative reporting.
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Methaphobia
by Ira Sobel
We are living in a day and age when 12-step programs are known
everywhere as a successful institution for so many people. Alcoholics Anonymous began with
two individuals and it has become the most effective tool used by people in recovery
afflicted with the disease of addiction. People are joining 12-step programs every day by
the number. Lost souls are coming into the rooms on our hands and knees defeated by our
sickness.
For 60 years the goal of Alcoholics Anonymous has been "to stay sober and help other
alcoholics to achieve sobriety." That quote is taken from the preamble that is read
before most meetings. Each 12-step program is based on that one statement. It means that
you are in these rooms to get sober for yourself and to help others all you can to achieve
sobriety. No addict should be turned away who asks for help. This is an
integral part of AA and every other fellowship.
In a sense, the preamble welcomes newcomers to the program, a program where addicts think
more about helping others than satisfying their own wants and needs. It is a selfless
program, a place where an addict can feel safe. It gives the newcomer a sense of
belonging, that he or she has somewhere to go for help. People go to meetings just to be
in the company of other addicts so that they can get better.
There is an underlying tension that exists between people that belong to the Narcotics
Anonymous fellowship and people in recovery on methadone. People that attend NA meetings
regularly consider themselves in recovery and people on methadone programs are not.
Essentially this schism exists because those that attend NA meetings refuse to accept
people on methadone because they feel we are not drug-free, that it would be the drug
speaking. Their policy is that no one can share if they took a mood-altering drug in the
last 24 hours. So the practice has been to not let someone on methadone share or qualify.
NA is wrong. Methadone maintenance is not mood altering if you take methadone as
prescribed. I think they have an extreme case of methaphobia!!!
Methaphobia is a state of mind in which someone or a group displays an intense fear and a
bias against methadone patients and methadone programs. It is very much like people in NA
have built-in forgetters. Those who espouse on NA principles put down methadone as an
institution. Basically, these people like to play God, doctor, lawyer and pharmacist!!!
We are all addicts and as long as I have a desire to stop using drugs, I should be able to
share my experience, strength and hope with a room full of addicts in all phases of
recovery!!! That's because I'm in my phase of recovery. A person on methadone can be going
to a specific NA group for six months without being able to share while another person,
who comes intermittently and has one day back, is allowed to share!!! If the time of the
meeting is 4 p.m. and the person was using "some time yesterday" then we have to
count hours. I mean shit, is there some kind of time table they use in NA!!! It's so petty
that I have to laugh!!! I mean shit, does the NA meeting list have this time table written
on it?? Ridiculous.
I have my own story about how NA didn't accept me as part of the group and how I learned
about methaphobia the hard way. When I was discharged from my last detox in early 1986, I
began going to meetings. At the time, any meeting whether it was a beginners meeting, or a
traditions meeting, or CA or DA was important to my recovery. Meetings, meetings and more
meetings. At the very beginning, I chased recovery like I chased an opiate. I would go to
2-3 meetings a day all over the city. I went to Cocaine Anonymous, Alcoholics Anonymous,
and then I went to Narcotics Anonymous meetings.
One of the first things I learned at the beginning was to be rigorously honest. So, I went
to my first NA meeting that was held at Water View Hospital. It was a "big book"
meeting. Since I felt it was my duty to come clean about my detoxing off methadone, I told
people I "was down to 15 mgs." This was a mistake. I was unaware of the
methadone clause of NA. The concept of methaphobia was all new to me. To my naive mind, I
was doing the right thing. You know, it's about being honest today, but because of NA, I
found out that day that, unfortunately, it's not about being stupid!!!
Right there, that instant in time, before the meeting even started, I was blackballed. I
didn't even have a chance at sharing. One girl said that I had a "ticket in my back
pocket." I didn't find the compassion and understanding from NA. It's too rigid. I do
not go to NA meetings. If I can't share and voice how I am doing in one fellowship, then
I've gone to other fellowships for the support I very much need.
To this day, I still have a major resentment against NA. Now, I don't propose a full
boycott of NA meetings. What I do suggest is that if people in recovery need a place to
go, they should attend other 12-step groups. I also hope that people like us on methadone
should attend MA meetings at your program and at other programs. At MA meetings, we share
so honestly about the heavy odds against you and me. People at MA meetings display an
intense desire to get well. It's so exciting when people cheer for someone that shares
about their good fortune. There is an intimacy that exists in MA meetings that I've never
experienced with other 12-step support groups. These meetings are so new and refreshing.
An MA meeting is not filled with aging people that nod out. No, it's about people who want
to get better. In essence, I've let go of my resentment and I've learned not to fight NA
but to go to MA. That's where I want to be. PEACE.
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Counseling and Compulsiveness
by Michelle
My counselor gave me an assignment last week to make a pro and con list
of an issue I was struggling over. In doing so, I began to grasp the beneifts of list
making as a problem-solving tool. So, I made another list for why I should go back to
school now and a list for why I should wait; a list of reasons to tell my family about
methadone and a list of the reasons not to; a list of the things I still miss about drugs
and a list of the things I don't. In short, I reduced the major dilemmas of my life into
several numbered phrases that fit on small pieces of scrap paper. When I brought the
finished product to my counselor's office, he noticed a pattern in the nature of my
"self help." I had compulsively listed the pros and cons about being compulsive
about my compulsions. Everything that I had addressed was based on overdoing something and
the problems that taking everything to the extreme had caused me, yet I had done even this
in excess, producing twenty-some lists.
I remember something I heard long ago spoken by a true substance abuser: "If you
can't be intense about something, why be anything at all?" I took this statement to
heart because it was exactly how I felt. I had to be the most, the worst, the wildest, or
whatever superlative fit the situation. My competitiveness stemmed from a fear of
anonymity but essentially was part of my character makeup. I was, and still am, an
extremest, and it seems inevitible that my ultimate drug of choice would be the
superlative of them all--heroin.
With a personality like mine and a hankering for intensity, I visited the usual spots
(some against my will) and landed here at the clinic where superlative sorts line up every
day. Not all the other patients desire things in the way that I do (borderline nutso), but
we all have had at least a small taste of what it means to be driven. Let's face it, being
an addict takes initiative and know-how. The point that my counselor made after reading my
lists and noticing my compulsiveness was that this energy needs to be used in
productivity. Was this something that I had never heard? No, but for the first time I
considered letting myself be the best instead of the worst. The worst, the baddest, the
meanest, the wildest--that was always a sure thing. the best is something that I'm
definitely going to have to work hard at.
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Urinalysis Policies
by Beth Francisco
Most of us who have been in treatment for any length of time have had
trouble with "dirty urines"--we have either had the problem of the test picking
up a substance that should not be there or of having "no methadone" detected.
There are three things which can cause these instances:
1. An over-the-counter drug caused a false positive.
2. The lab made a mistake.
3. We have "used" something we should not have, or we have not taken the
methadone.
There are many over-the-counter drugs which cause false positives. Steps are being taken
to see that no one is falsely accused of something they did not do. The new lab we will be
using will be saving urine samples for a period of time. If there are any questions, they
can be re-tested. Also, I am supplying counselors with a list of the drugs I am familiar
with that can cause false positives.
These results are not engraved in gold as there is always the possibility of human error.
Again, if you feel there is a mistake, the sample can be re-tested. Talk with your
counselor regarding procedure.
Although false positives and human error are a real concern for us, there are those who
play with the program and use other drugs to supplement their methadone. You know who you
are. It does not make you a bad person, but it does cause problems for the program and,
most importantly, for yourself. If you are using other substances, talk with your
counselor--be honest.
Your counselor should have a pretty good idea if you are telling the truth or not. If your
drug of choice shows up in your urine screen every other time you drop and re-testing
shows the same result, your protests will certainly be suspect. If, however, you are doing
what you are supposed to be doing, you should be taken at your word. That is why it is
important to let your counselor know what is going on with you. If you have been following
your treatment plan but all of a sudden show behavior changes, and then come up with a
dirty urine, you might have some explaining to do. An honest relationship with your
counselor is essential and beneficial to you in more ways than one.
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Clean, Depressed, & Confused
by Rose
Before entering the methadone program, I had no life. I could not
function without a blow, and I believed that nothing could help me. I always said I would
never use methadone. But I went to the clinic out of desperation. the medication helped me
to stop using heroin. I was surprised that I actually enjoyed my counseling sessions.
For two years, I did everything that I was supposed to do. I began to like myself. My
appearance improved, I gained weight, and I felt good. My clinic's doctor and my counselor
recognized my progress and granted me take-home privileges. I was beginning to live again.
Just when I thought that things couldn't be better, a terrible thing happened. The man
whom I loved for fourteen years died. It hadn't occurred to me that I might have to cope
with being alone. I was half crazy out of my mind and felt I had nowhere to turn. . .I
relapsed.
I don't think that I believed I would find the answers I was looking for by returning to
heroin. I was running from my problems as I had in the past. The help I needed was right
under my nose. I told my counselor the truth about my relapse and started attending group
therapy at the clinic. I had the solutions I needed within me. The support I received from
my counselor and the group helped me to find them.
I was back on the right track and doing well. I had nearly ninety days clean again. Then I
saw the clinic doctor for a routine medical exam. The doctor asked why I suddenly had
several opiate urine reports after having a clean record. I explained the circumstances,
but she revoked my take-home privileges anyway. To make matters worse, she said that my
privileges would be restored ninety days from that day instead of ninety days after my
most recent positive urine report.
The story doesn't end here. I was feeling depressed about what had happened to me. I
didn't think there was anything left to go wrong. Then I got the news: Another urine
report was positive for opiates! When I relapsed, I was honest with my counselor and
admitted to using heroin. But this time, I was clean! I realize that this might arouse
suspicion in some people, but I have no reason to be dishonest. Something must have gone
wrong at the lab--maybe the samples were switched. My counselor said that nothing could be
done. I would have to wait ninety days again before I would get my take-home
privileges. I believe that my clinic and the lab that they hire should work harder to
eliminate error. It's difficult enough to fight a drug problem without being penalized for
the mistakes of others.
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Principles vs. Personalities
by Beth Francisco
Many of us are familiar with the term "Principles before
Personalities" from Twelve-Step meetings we have attended in our attempts to be free
from drugs and/or alcohol. The 12th Tradition states, "Anonymity is the spiritual
foundation of all our traditions, ever reminding us to place principles before
personalities." The definition of principle is "an essential truth upon which
other truths are based", or "a rule by which a person chooses to govern his
conduct, often forming part of a code." The definition of personality is, "the
totality of characteristics which make up a person."
Addicts are not the only ones guilty of breaking this tradition. One of the most egregious
expressions of putting personalities before principles is the double-standard by which
Harry Anslinger, the first commissioner of the Bureau of Narcotics, treated street addicts
as opposed to those with good connections. Senator McCarthy was of "sufficient
prominence" to have had the protection of the commissioner while he obtained his
narcotics from a Washington pharmacy without interference from Bureau agents. However,
Anslinger was opposed to any treatment which supplied narcotics to addicts on the street,
and he rigorously enforced laws against them. He depicted those who smoked marijuana as
monsters, and his campaign against it was liberally strewn with ads about them as
wild-eyed drug fiends who butchered whole families. If Anslinger's principles truly
opposed drugs instead of the people he slandered, McCarthy's narcotic use would have been
included in his opposition. This preferential treatment is clearly a violation of
"Principles before Personalities."
We can all learn from this by asking ourselves in any situation, "Are my values
consistent? Do I treat everyone in a consistent manner, or do I give preferential
treatment?" If you recognize yourself breaking the rules, ask yourself
"Why?" Do you break the rules for people you like and apply stricter rules to
those you don't? Sometimes we don't listen to what a person has to say because we don't
care for him/her personally, and often that is the very thing we need to hear. I would
often sit in a meeting listening intently to what each person said, then at the point that
a certain "personality" spoke, I would tune her/him out because I didn't like
that person. That's a red light, bell-ringing situation for me.
Finally, "Principles before Personalities" means that we watch out for that
intruder, the ego. We all want recognition; we all need recognition, and
there's nothing wrong with that. However, when working toward our common goal of recovery,
it's not about you, and it's not about me; it's about us. Recovery is a journey; we all
have something to offer on that journey, and none of us can do it by ourselves, contrary
to what the ego tells us.
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First Advocacy Meetings Held
by Jon
DETROIT - The first methadone patient advocacy meetings took
place in Detroit and Roseville last month. Interest in patient advocacy has spread rapidly
throughout the state. Though it is largely centered in the Detroit metropolitan area,
inquiries have come from as far away as Grand Rapids and Muskegan. Patients from Flint and
Toledo, Ohio have also expressed an interest in the movement.
Back issues of Methadone Awareness, the newsletter of the Philadelphia and
Atlantic City chapter of the National Alliance of Methadone Advocates (NAMA) have been
circulating around Detroit for several months. A group of Detroit patients were already in
the process of forming an advocacy group when they became aware of NAMA through Methadone
Awareness. Meanwhile, a counselor at a Detroit clinic read about NAMA in Addiction
Treatment Forum. Soon, another newsletter, the M.A.L.T.A. Messenger
began circulating around clinics in Detroit. Methadone as A Legitimate Treatment
Alternative (MALTA) is a NAMA affiliate in California.
Detroit patients were infuriated this year by malicious attacks on methadone by the local
broadcast media. Two of Michigan's largest clinics were targeted, but all of the state's
methadone programs have felt the impact of the heavily biased reports. Patients were left
to try to explain to their families and employers that methadone is not legal dope. Some
were pressured by their spouses to detox.
In Lansing, attempts are being made to limit public assistance benefits to methadone
patients. Patients have been harassed by government officials attempting to persuade them
to go into 28-day inpatient programs. These are only a few of the problems with being a
methadone patient in Michigan. These and other issues have prompted the formation of the
organization, Detroit Organizational Needs in Treatment (DONT). The first meetings have
been successful. DONT is in the process of becoming a chapter of NAMA.
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DONT Ignore Patient Advocacy in Michigan
by Jon
Detroit Organizational Needs in Treatment (DONT) is the new methadone
patient advocacy organization in Michigan. there is a critical need for methadone patient
advocacy in Michigan. There is a critical need for methadone patient advocacy in Michigan.
Negative media coverage, harassment from the government, and clinics with inhumane
policies are some of the problems we face. Together, we can form a strong voice so that
our pleas can he heard. DONT will create avenues of communication between patients,
givernment officials, and program administrators. We must find a middle ground where we
can come together to strive for understanding of one another.
We cannot continue to lay quietly in the background while officials in Washington and
Lansing make decisions about our lives. We cannot endure policy changes without our
consultation. Many of us are registered voters. DONT members who are not registered to
vote will register. Most of us have the power to choose the clinics where we
receive treatment. As individuals, we had little impact when quitting programs to express
dissatisfaction. And, all too often, we left one program only to find more dissatisfaction
at another. As a group, we have power and discourage members from remaining in programs
with unreasonable policies.
Unfortunately, some of us are beginning to lose the right to choose. Patients with
Medicaid are being ordered out of their programs and are forced to enroll in whatever
program the state decides they should be in.
It is not our intent to make irrational demands. We simply wish to be treated with the
respect and dignity afforded to patients receiving other kinds of medical treatment.
Methadone is an effective treatment for our disease. Those of us who are successful in
methadone treatment are serious patients. We feel that we get inadequate recognition or
none at all. Thos few patients among us who are not interested in treatment get a
disproportionately high level of attention. It is those very few who make no attempt to
seek recovery who tend to loiter near clinics or divert their medication. Yet, these few
patients are given the spotlight when politicians need a cause to promote their own
self-serving agendas. These are also the patients whom the media portrays as
"typical" methadone patients. Cancer patients have diverted medication. Yet
there are no known cases of cancer patients being refused treatment for diverting or being
portrayed as typical by the media or government.
We intend to begin communication with clinics and government officials by wiping the slate
clean. We are concerned with the present and the future. We invite the State of Michigan,
CSAS, and all methadone programs to work with us, to hear our concerns. We know that we
are not on a one-way street. What do you need from us? We will work with you to eliminate
the negative appearance of methadone treatment. We will help to eliminate diversion and
abuse. In return, we simply ask that you hear our pleas--we must have the respect and
dignity we deserve.
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Take Home Med Policies: What Is Fair?
by Nancy R.
I have been on methadone for over twenty years. I continued using street
drugs such as heroin and Dilaudid for the first ten years of my methadone treatment (1975
to 1985). But during the second decade, 1985 to present, I have used only methadone. My
urines have been negative for illicit drugs. I began to use methadone as it was intended
to be used and turned my life around. I work full time and am taking college courses at
night to complete work on my bachelor's degree. I got married and have reestablished
family ties. I am involved with Narcotics Anonymous and feel that I am growing
spiritually. I credit methadone with saving my life!
So what is my complaint? My concern is with the State of Michigan's regulations concerning
take-home privileges. Under the regulations, methadone patients who have been prescribed
100mg or more per day must receive special permission from state and federal authorities
to have take-home privileges. One time per week take-home medication is out of the
question unless you have a serious medical condition or travel hardship.
I am most comfortable at 150mg. I have been trying to decrease my dosage to below 100mg so
that I can be eligible for once-a-week take homes. I believe that the state should drop
this arbitrary dosage of 100mg for determining eligibility for the number of doses a
patient is allowed to take home. This decision should be left to the clinic's physician.
Dosage and take-home priviliges should be determined on an individual basis. My clinic
doctor and counselor know my ;unique history. They know how much I have improved my life.
They also know that I lead a busy life with work and school. Going to the clinic every day
under these circumstances seems like a punishment. Shouldn't I be able to have take-home
medication while maintaining at a dose that I am comfortable with? Haven't I earned this
privilege?
I feel strongly about this. This particular regulation affects many patients. Our advocacy
group must work together to learn how state regulations are changed in order to provide
more individualized treatment for methadone patients.
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Perception
by Beth Francisco
We are a society of drug takers. We have a pill for everything from
headache to backache, to go to sleep or stay awake, contraceptives or fertility pills, and
we want to feel good right now. The problem is, the government has decided which drugs are
no good for us and which are okay. People can't help but be confused--myself included. It
was okay for me to take narcotics for a long time while addicted under the care of a
doctor. There was no social stigma, they were affordable, and I could function. When I
first started buying drugs on the street, I was taking the same drug that I got from the
doctor, but it was at that point that I became stigmatized as a weak, incompetent person.
What had changed? Not the drug certainly, and I still had the same pain, so what had
changed? My status, overnight, and the fact that I had to buy my drug at such an inflated
price that everything I had saved and worked for became the drug dealer's property.
I was sent to a psychiatrist who diagnosed me as manic-depressive (this was the diagnosis
of the day--now it's called bi-polar), and he prescribed Lithium and an anti-depressant.
"Don't take their drugs--take mine!" was the message I got. I took his drugs,
and I couldn't function. I had to hang on to the walls to walk because I was so
disoriented, and I couldn't write because my hand jerked too badly. When I told the doctor
I could not take his medication, he said, "Well, I'll prescribe another
drug to counteract the other drugs." That makes a lot of sense! If I did
take his drugs, I would not be a social outcast, but I wouldn't be able to function; if I didn't
take mine, I wouldn't be able to function. If I did take mine, I would be an outcast and
a criminal because possession is a crime. This is madness--the addict, just by virtue of
being an addict, is labelled as a bad person.
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