MMT

Aware of my advocacy efforts with methadone and medically assisted recovery for opioid addiction, JamezD of the Island Recovery Centers asked about my stance on Buprenorphine.

There's certainly some history around this (there always is)
that we're simply not aware of, but our addiction docs
seem to think that "Bup" is a superior approach to dealing
with opioid dependence… ~ Misleading on Methadone

Both drugs are used in treatment of heroin and pain killer addictions. Methadone and Buprenorphine work in a similar fashion but are usually administered and dosed differently to block opioid receptors in the brain to prevent withdrawal symptoms. Neither of the drugs produces the meteoric euphoric high that accompanies heroin and pain killer opioids and in fact cancel out the high of other opioid drugs taken during treatment. I feel Suboxone® is a superior form of Buprenorphine because of the additive naloxone which prevents misuse and abuse by injection and intranasal ingestion (snorting).

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Contrary to my blogging nom de plume, I am most active in meetings and as a sponsor to opioid addicts. They are patients at a methadone maintenance treatment (MMT) clinic where I hold a weekly recovery class. In fact, tomorrow I will testify in a certificate of need hearing for a proposed MMT center for a nearby county. Other than being prepared to answer the questions presented to me truthfully, I really don’t see the need for any preparation but a post on the subject matter certainly seemed timely.

It was in search of a photo to accompany this entry that I ran across this story from USA Today. Yeah it’s a little dated, but it seemed like a good way to concentrate on a singular issue instead of taking on the comprehensive subject. I’m also too lazy tonight to find something more current and this article really serves as a great example of why MMT is often misunderstood. Read the article, notice in particular that every fact and figure on overdoses given in the text is related to prescription methadone prescribed by doctors for pain management. Yet the big pretty picture of methadone offered along with the story is accompanied by this caption:

A plastic cup holds a dose of methadone at the Southern Indiana Treatment Center in Jeffersonville, Ind. Methadone deaths as a percentage of all drug overdose deaths has increased from 4% in 1999 to 13% in 2004, according to the National Center for Health Statistics.

Not exactly a relevant picture is it? I am not sure if the author was biased or just ignorant of the subject matter, it’s misleading regardless.

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My regular readers know that I am an advocate of methadone maintenance treatment (MMT) even though being a recovering alcoholic I have never personally participated. I became involved with my local methadone clinic after being asked to do a story on the facility by my local newspaper. At the time, I knew very little about MMT but the owners and the administrators were very open and informative about their program. I learned enough that I returned at their invitation to lead a weekly recovery group that continues to this day.

I have been batting around the idea of formalizing our meeting into a Methadone Anonymous Group (MA) because of several reasons. The first is that I would like to see those that attend my groups begin to take ownership. This will insure that if I ever lose the ability to host the groups that they will have others that can. Another reason is that it would allow for more meetings and flexible schedules so that more could attend. And finally, the clinic will open a sister establishment in the neighboring county soon and they will need a similar program.

So I have been perusing the Methadone Support site (link logo above) and speaking with the clinic counselors about setting this up. I am not fully convinced that the MA route is best and have struggled with just sticking with the general recovery meeting style mixed with a clinic approved program for tapering off MMT. Regardless of what we do, I think there will be many more recovery opportunities when they take ownership of their own program. I plan to continue my meetings, but I hope soon to see the others follow my lead.

A drug addicted elephant has given the park authorities at Hainan a plus sized problem. Apparently the elephant had been captured by illegal traders who then kept the animal drugged up on heroin so they could make him lead the herd where they wished. The traders were eventually caught by Chinese authorities, but not before the elephant named “Big Brother” had developed a heroin addiction that was proving both dangerous to him and the humans who were trying to help.

“Dangerous to himself and those around him” why does that sound oddly familiar?

”By that time Big Brother had developed a raging heroin addiction and posed a danger to people if denied his fix, the paper said. A drooling Big Brother was taken to a park on the island of Hainan for treatment, after cold turkey was so unbearable even his chain could not hold him. Park authorities spent a year treating him with methadone, regular bathing and massage”~The Scotsman

Too bad the park authorities didn't have access to a plus-sized church!

The proposed methadone clinic in Chilton County looked as if it was going to kick off operations with little resistance until the politicians figured out it could get them media attention when they voiced a negative opinion. Now that the vote vultures are circling the clinic, it seems there is a whole pack of opponents trying to outdo each other with their hysterical antics and comments.

This latest comment from the letters to the editor of the Clanton Advertiser was made, if you can believe it, by a nurse of all people.

The answer is God. Life isn't going to a bed of roses with God, but you will have someone to help you through the hard times and give you strength to resist the temptation. Drug addiction is the same thing as alcohol addiction. I know a lot of alcoholics that have given it to God at the alter[sic] and never taken another drink. Chilton County is a dry count [sic]. We continue to vote against the county going wet over and over again. Give us a chance to vote on your clinic and it will not be coming to Chilton County. To the patients of the methadone clinic I will be praying for you.
God and a church body to help you through this is the only clinic that you need. Everyone was a church within 10 minutes of their home. We don't need your methadone clinic in Chilton County or Shelby County.

Well John Lennon said all you need is love; apparently this Chilton County nurse thinks all you need is God. I wonder if she also tells that to her heart disease and cancer patients? Maybe she thinks this is just a moral problem, even so I wonder if she would consider going to Church as the only solution necessary in cases of spousal and child abuse or infidelity? These are definitely not diseases, but why file for divorce or protection with the authorities when all you need is a church? So please excuse my title, I meant no disrespect to any religion yet I feel its important to make this distinction:

She titled her letter God is the Answer to Methadone, while God may most definitely be the answer, she fails to realize that methadone and MMT aren’t the problem in the first place.

The problem is drug addiction, and it just so happens that maybe God has provided MMT as part of the answer which also should include other support and recovery programs (many provided in church, although people like this women often cause those in MMT to avoid such programs). I think this is particularly heinous because I cannot see how someone in the medical profession could say this, or even worse be so misinformed that they cannot distinguish between drug abuse and MMT. Does this Nurse get regular updates from God telling her which diseases of man require professional help and those that are cured by kneeling at the altar? Maybe she just missed this latest press release from God because she was so busy at the hospital practicing her faith healing.

Many of my regular readers know that I am a passionate advocate for methadone maintenance treatment (MMT), so it will come as no surprise that I have voiced my support for the establishment of the new Chilton County Treatment Center. I base my support on personal knowledge of the operation by the same owners in nearby Shelby County. I know the doctors, nurses, counselors and patients… I have seen the good work of the people there who care and I have seen the lives saved by what they do. I am there every week leading a recovery group… I know these things for a fact.

Unfortunately, facts are often hard to come by when MMT is discussed in the public forum. For instance take the recent letter by District Attorney Randall V. Houston addressed to the State Health Planning and Development Agency stating his opposition to the center, it’s at best misguided and by all means not factual.

“I see this methadone treatment facility as an opportunity to foster the addiction of prescription narcotics and have a negative impact on the local community.”

The patients who come to the clinic are already addicted to prescription narcotics and illicit substances. The facility is being established to treat a problem that ALREADY exists and if it helps even a small percentage it will be a positive influence in the community.

”…my office has seen an explosion of Grand Jury cases where citizens are addicted to methamphetamine, Lortab, Valium and methadone, to name a few. The heroine [sic] addiction, which this facility claims to treat, has not been a serious problem for law enforcement in my judicial circuit. However, the addiction to the very drug this facility administers is cause for alarm to me.”

Although the facility will not actually treat those addicted to mythological and legendary women (no Lara Croft addicts) MMT is an effective therapy for heroin and also the prescription pain pill addiction scourge that the DA has pointed out as a significant problem.

”As I see it, the establishment of a methadone facility in Chilton County will do nothing but compound the problem and give addicts an addition source for acquiring this drugs”

So what’s the next step… shutting down all the doctors and pharmacies that are the current source of these narcotics, and yes even most of the methadone? The US Substance Abuse and Mental Health Services Administration (SAMHSA) conducted a recent study that overdose deaths attributed to methadone correspond to the increased supply prescribed for pain, not addiction treatment!

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Many of you know Bill Watterson’s classic comic strip about a boy and his tiger, Calvin and Hobbes, has been a favorite of mine since the early days of my sobriety. If there is a reckoning of time spent when I pass away, I can just imagine St. Peter with an accusing glare, “Spent an entire week of your life reading about a stuffed tiger?” Of course when I think of how hard I have laughed I will honestly be able to reply, “It was time well spent!”

Last night I ran across, Calvin and Hobbes Hideout, a site that showed how the strip was presented in other countries. Even in a foreign language, I still found myself laughing at the panels all except for one presented in Chinese (Calvin and Hobbes is Kaiwen yu Hubuo in Chinese as shown above). I got a little frustrated that even with my vast knowledge of all things C&H, that I didn’t get this one. Sure the facial expressions were mildy amusing, but I knew there something very funny here that I was missing. I saved it as a favorite figuring that one day it would hit me and I would be glad for the opportunity to go back to it. Less than 24 hours later, I am featuring the strip in my blog not because the meaning came to me overnight but because of a very similar frustrating experience.

This morning after I had finished with the recovery meeting I hold at the methadone clinic it occurred to me that there were so many more in the MMT program that were missing out on a recovery program. For those of you who don't know, many times people in MMT are often shunned by 12 steppers in other recovery programs as "trading one drug for another". Also from what I have seen, most clinics do not have active recovery groups beyond the counselors that concentrate more on maintenance than recovery. So the culture of the clinic has goals oriented not toward a strong recovery but more toward phases like "take-homes" and "counselor-free" administration. Now relative to the alternative illicit drug use, these are admirable goals and good things. But there is no reason there couldn't be so much more if there was a strong recovery group advocating a recovery beyond taking a weeks worth of methadone home. It's like all they have is the Chinese version of C&H, yeah its still mildly amusing but there is so much more that is missing.

I hope that one day our recovery group will become more encompassing, that some of the MMT patients will take it up on their own to have TDA-less meetings. That we can get those that have weaned off methadone (they are rare) to come back and speak to the groups. Begin to set the bar higher than just phases and change the culture of the clinic toward recovery instead of just maintaining.

Now that would be time well spent!