Be notified of|
|Obama Administration Names A. Thomas McLellan|
|The Obama/Biden Administration has named A. Thomas McLellan, Ph.D. to the post of
Deputy Director of the White House Office of National Drug Control
Policy. McLellan is one
of the nation's leading drug and alcohol
McLellan got his start in the 1980s as a scientist with the Veterans Administration and University of Pennsylvania where he led development of the Addiction Severity Index and Treatment Services Review, two measurement instruments premised on the then-novel view that addiction was a multi-dimensional condition, with impairments in other life functions that had to be concurrently addressed for treatment to be effective. Eventually, the premise came to be embraced, with the instruments becoming widely used to measure and improve the effectiveness of many forms of treatment.
In 2000, McLellan and three other experts authored a report in JAMA pointing out the similarities between addiction and commonly recognized, chronically relapsing medical diseases like hypertension, type II diabetes and asthma, arguing that like these other illnesses, serious addictive disorders cannot be cured but can be effectively managed. The implications proved to be significant. Today, most experts refer to addiction as a chronic illness and call for longer-term care strategies patterned after medical models.
A firm believer in the transformative power of science, in 1992 McLellan co-founded the non-profit TRI as a translational center that would adapt and engineer promising scientific findings into useful products and services that could be broadly used throughout the field. Over the next seventeen years, McLellan assembled a team of researchers and entered into intertwining collaborations with universities, major treatment and prevention groups, and legal groups. TRI became known for practical models of continuing care and monitoring; criminal justice strategies as an alternative to jailing drug-involved offenders; revitalizing the nation's public system of addiction treatment; engaging doctors and other primary care providers; and helping parents learn skills to protect children from drugs and alcohol.
Beginning in 2006, McLellan recruited policy experts to TRI to help state and local governments promote quality improvement by revamping their purchasing, regulatory, and other administrative structures.
"We're sorry to lose Tom McLellan to higher office, but we're not surprised an innovation-minded Administration would recruit someone like him for national drug policy," said Constance Pechura, Ph.D., TRI's second-in-command who will assume leadership of TRI. "With his presence, the Administration has created a formidable drug control team predisposed to evidence and policies that 'work,'" she said.
"Tom McLellan has been a leader in advancing the science of addiction treatment and improving access to effective care," said Carolyn Asbury, Senior Consultant to the Dana Foundation and Chair of the TRI Board of Directors. "He has pioneered the translation of research into more effective clinical practices that have helped to achieve better outcomes for individuals and their families. No one is better equipped to help transform the nation's response to its drug problems," she said.
ONDCP was established in 1988 to advise the President and Vice President on a drug control program for the nation, coordinating the activities of multiple federal agencies toward that end. With Gil Kerlikowske, the President's pick for ONDCP Director, McLellan's appointment signals a shift to science-based treatment and prevention strategies - including what McLellan calls "a long-overdue national look at our prison policies; collaborative strategies among the prevention, treatment, criminal justice, healthcare and education fields, and continued modernization of specialty treatment and prevention centers."
The Treatment Research Institute is a non-profit research and development organization specializing in science-driven reform of policy and practice in substance use and abuse.
For more information contact Bonnie Catone, TRI Director of Communications,
Methadone-Associated Overdose Deaths
|April 5, 2009
You will find the long awaited GAO Report on Methadone-Associated Overdose Deaths below, which was forwarded to Senators Kennedy and Rockefeller on March 26, 2009. The Report was released to the public a couple of days ago. Feel free to distribute this to your associates throughout the country...or send them the link here.
The cover sheet indicates an important finding. “Although information on methadone-associated overdose deaths is limited, available data suggest that methadone’s growing use for pain management has made more of the drug available, thus contributing to the rise in methadone overdose deaths.”
You should also reference Table 2 on page 19, which lists methadone distribution by type of business from 2002-2007. The critical point of the Report follows the table on Page 19. “Most officials from federal and state agencies, as well as experts in addiction treatment and pain management that we spoke with, cited the increased availability of methadone due to its use for pain management as a key factor in the rise in deaths, while some added that addiction treatment in OTPs was not related to increased deaths.”
Another salient reference is on page 22 of the Report following Table 3, “Top Five Drugs with Highest Percentage Increases in Analyzed Drug Items Seized By Law Enforcement from 2002-2007.” You should note the steady increase in the numbers for all drugs, including methadone, hydrocodone and oxycodone, during this reporting period.
Finally, the Report underscores a critical finding on methadone thefts. “Likewise, DEA data on drug theft and loss showed that methadone thefts nationwide more than doubled, from 176 in 2000 to 393 in 2007. For the five states we reviewed [Florida, Kentucky, Maine, New Mexico and West Virginia], the data showed that most thefts were reported from pharmacies, while no thefts were reported from OTPs in four of these states during the same time period.”
I urge you to read through the entire Report. As a lot of you know, this is the 4th major federal report to be published on the topic of methadone-associated mortality, beginning with the CSAT/SAMHSA Report of 2004 and the CSAT/SAMHSA Reassessment of 2007, in addition to the Department of Justice National Drug intelligence Center Report of 2007. Mark Parrino of AATOD's view is that the findings are remarkably consistent.
Here is the report in it's entirety......
GAO Report on Methadone-Associated Overdose Deaths
|Petition to the Government of Iran|
|Physicians for Human Rights is urging the Iranian government to end the incommunicado detention of Drs. Arash Alaei and Kamiar Alaei, two Iranian physicians who have reportedly been detained in Iran by Iranian authorities. The physicians, who are brothers, were apparently arrested at the end of June, 2008 and their current whereabouts are unknown. The doctors are experts on HIV/AIDS and have worked for many years on HIV/AIDS prevention and treatment activities in Iran and internationally. PHR calls on the government of Iran to disclose their whereabouts, provide them access to lawyers and family, and either to charge them with an internationally recognized crime or release them immediately.
Physicians for Human Rights is urging the Iranian government to end the incommunicado detention of Drs. Arash Alaei and Kamiar Alaei, two Iranian physicians who have reportedly been detained in Iran by Iranian authorities. The physicians, who are brothers, were apparently arrested at the end of June, 2008 and their current whereabouts are unknown. The doctors are experts on HIV/AIDS and have worked for many years on HIV/AIDS prevention and treatment activities in Iran and internationally. PHR calls on the government of Iran to disclose their whereabouts, provide them access to lawyers and family, and either to charge them with an internationally recognized crime or release them immediately.
Dr. Kamiar Alaei is a doctoral candidate at the SUNY Albany School of Public Health and is expected to resume his studies there this fall. In 2007, he received Master of Science in Population and International Health from the Harvard School of Public Health.
His brother Arash is the former Director of the International Education and Research Cooperation of the Iranian National Research Institute of Tuberculosis and Lung Disease.
Since 1998, Dr. Arash Alaei and his brother, Kamiar Alaei, have been carrying out programs dealing with HIV/AIDS, particularly focused on harm reduction for injecting drug users in the war-torn province of Kermanshah, on the West Coast of Iran.
Since 1986, the Alaei brothers have sought the integration of prevention and care of HIV/AIDS, sexually-transmitted infections, and drug-related harm reduction, into Iran's national health care system.
In addition to their work in Iran, the Alaei brothers have held training courses for Afghan and Tajik medical workers and have worked to encourage regional cooperation among 12 Middle Eastern and Central Asian countries. They were key organizers of a tri-national meeting in 2004 in Tehran to discuss harm reduction and substitution treatment in Iran, Tajikistan and Afghanistan. At that meeting, Iran's programs proved to be inspiring role models for the region, according to medical experts who participated in the meeting. The Drs. Alaei's work has addressed the most disadvantaged populations and patients in the country.
You may access the petition at http://22.214.171.124/~iranfree/. Please sign it and distribute it broadly.
The following announcement was sent by the Canadian Harm Reduction Network. Please visit their website, check it out and support them by becoming a member.
One of our more immediate concerns is the state of Indiana. The Indiana Legislature is proposing laws/regulations that will make it near impossible for some people to be in treatment! The committee on public health has already voted 11-0 unanimously on Indiana Senate Bill #157. Some of the more frightening proposed language in that bill are as you see below.....
Here is a link to the bill itself Indiana Senate Bill #157
Take note starting #13 on the 2nd page.....
[EFFECTIVE JULY 1, 2008]: Sec. 2.5. (a) An opioid treatment
program must periodically and randomly test a patient for the
following during the patient's treatment by the program:
(8) Any other drug that has been determined to be abused in
the program's locality or any other drug that may have been
abused by the patient.
(b) If a patient tests positive under a test described in subsection
(1) a controlled substance other than a drug for which the patient has a prescription or that is part of the patient's treatment plan at the opioid treatment program; or
(2) an illegal drug other than the drug that is part of the patient's treatment plan at the opioid treatment program; the opioid treatment program must administer an administrative medical detoxification program not to exceed fourteen (14) days.".
(yes...you read that right! That means that ANYONE who tests positive for ANY of those substances...even ONE time will be given a medical taper over a TWO WEEK PERIOD! We all know that people just starting on treatment sometimes take awhile to begin their recovery, I know that *I* did! So we can almost forget new patients if this passes!)
The next point of concern starts at #38....
"(E) A statement to be used by opioid treatment facilities that:
(i) acknowledges that the patient will be driven from the facility by another responsible person after receiving opioid treatment medications; and
(ii) is signed by the patient and person who will drive the patient at the time the patient arrives to receive opioid treatment medications.".
*and yup....you may NOT WALK to the clinic...you may not take a bus to your clinic. You MUST have a designated driver! They are comparing a person on MMT to a person that has just had surgery and been put under general anesthesia, sigh.
Let me repeat myself here, my friends. IF you do not live in Indiana, do NOT get too comfortable because YOUR state could be next! Below please find some links for form letters etc. that you can send to your lawmakers AND help out those in Indiana! All of the addresses for the lawmakers in IN are also below. WE NEED YOUR HELP!!!!
Driving Article Abstracts
Patient Info Sheet on SB #157
List of Reps for different clinic areas of Indiana
Phone Script for Designated Drivers
Who to write
** 3/22/12 ** - Tennessee is now added to the mix, darnit....going thru the same issues!
WHEN LEGISLATORS SEEK TO PRACTICE MEDICINE
by Dr. Robert Newman
A proposed bill (Senate 157) is currently under consideration in Indiana that would severely constrain clinical judgment through legislative fiat. It deals with the use of medicines – methadone and the more recently introduced medication buprenorphine – in the treatment of addiction to heroin, oxycontin and other legal and illegal narcotics.
For many years it has been widely recognized that addiction is a chronic, relapsing medical condition. This view has been expressed consistently by the US National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Institute of Medicine, the World Health Organization, and academic and clinical authorities throughout the world. Unfortunately, addiction – to date – is not curable, just as dependence on alcohol is not curable (just ask an Alcoholics Anonymous advocate when and under what circumstances someone can be pronounced “cured” of alcoholism). Indeed, inability to cure is precisely what defines chronicity, and it is a frustrating reality to providers and patients alike with regard to a long list of diseases, including diabetes, most forms of heart and lung ailments, many neurological conditions, etc.
Incomprehensively, it is only in the case of addiction that the documented reality of “treatable but not curable” is rejected. In all other chronic illness this limitation is accepted as a fact of life, and viewed as both a challenge and an opportunity. The challenge is to continue the search for a better understanding of the cause(s) and, ultimately, the cure for the condition; the opportunity is to seek to provide the very best treatment available to all those who want and need it to lead a healthier, more self-fulfilling, more productive and longer life. In pursuit of all of these vitally important therapeutic goals, no treatment has been proven as effective as “maintenance” with methadone and, more recently, buprenorphine. Today, over one million people in 65 nations receive this form of care.
As just one of the unprecedented demands of the proposed legislation – one which is illustrative of the strongly pejorative view towards providers and patients, and the illness and treatment under consideration, consider what is required with respect to laboratory testing for evidence of drug use. The demands that urine tests be performed “periodically and randomly” on all patients, regardless of length of time in treatment, clinical course or other considerations. It insists that urination be “in an observed manner” – i.e., that the patient be observed by a staff member while urinating into a cup. If urine test results are “positive” for any of a host of substances (a partial list is spelled out in the bill), referral procedures are required, and a “clinical evaluation” made that “…must recommend a remedial action of the patient that may include discharge . . . “ Imagine – a law that imposes on clinicians the obligation to consider terminating treatment for the simple reason that the patient is showing evidence of the disease being treated (in this instance, drug dependence). It should be noted that evidence of use and/or misuse of drugs, whether legal or illegal, would never be cited as grounds for abandoning patients needing treatment for thyroid disease, or asthma, or kidney failure, or HIV-AIDS, or any other disease; nor is it imaginable that a doctor would abandon a patient with such diseases if they showed poor response to the medication prescribed, or exacerbation of the condition (either as a result of natural progression or, perhaps, due to failure to comply with the prescribed regimen of diet, exercise, smoking cessation or whatever). It is simply unconscionable to obligate, by law, doctors to consider that which would be unthinkable – and unethical – in all other areas of medicine!
There are other aspects of this proposed legislation that are also without parallel in the practice of medicine in America. Thus, “The Division [of Mental Health and Addiction] shall adopt rule … [that] must include provisions relating to … regular clinic attendance by the patient; specific counseling requirements; stable home environment of the patient . . .” Also required is mandatory reporting to the State of patient information, including length of time in treatment, number of patients whose treatment has ended during a given time period, the cost of the treatment, etc. Another provision for which there is neither logical support nor precedent is that “the division” must approve in advance “take-home” medication for any individual patient for more than14 days (Federal regulations for many years have approved up to 30 days of “take-home” medication for patients the provider believes are responding well to treatment).
Finally, the cost of the entire cumbersome, intrusive, unparalleled bureaucracy that would be established to carry out the provisions of this bill will have to be paid for by the “programs” providing the care – which is to say, by insurers or, in most cases, by the patients. With fees already in the neighborhood of $5,000 per year, and further increases inevitable as a result of the new “minimum staff requirements” the bill calls on the division to promulgate, a great many patients will simply have to leave treatment.
Who benefits from this bill? Nobody! Certainly neither the providers or patients; both groups will have strong incentive to discontinue involvement with treatment of drug dependence. And what will happen to those drug dependent individuals who drop out of treatment, and all those who in the future will refuse to consider even applying? The answer is unequivocal: they will resume or continue their illicit narcotic use, resulting in further destroyed – and lost! – lives. The ultimate losers, though, will be members of the general community – the citizens whose interests the legislators represent. It is society at large that will suffer the consequences of continued rising crime, spread of illness (including HIV-AIDS), the staggering costs of the criminal justice system and the health care required when patients present with acute problems such as overdose and abscesses, and chronic conditions such as AIDS and hepatitis.
Senate bill 157 should be scrapped immediately, and the attention of the Legislature should be directed to determining how most expeditiously and effectively to enable every single person to have prompt access to care that they need and want, and without which many will die.
Robert G. Newman, MD
International Center for Advancement
of Addiction Treatment,Baron Edmond
de Rothschild Chemical Dependency Institute
of Beth Israel Medical Center
PENNSYLVANIA - Calling all patients, advocates and anyone that would like to help! They are talking about designated drivers here as well. Go to this link and read the article, Blair County Residents Hope To Delay Methadone Clinics' Opening
20th District State Sen. John Eichelberger said....
"Two things need to be done that appear to be the methodology for dealing with this issue. One is to restrict the amount of patients that are seen each day so they can (have) closer monitoring. And secondly .... the law needs to require designated drivers,"
Me thinks that Senator Eichelberger needs a course in Methadone 101...AND FAST! This will be happening in YOUR state next if we do not take action NOW.
Aaaand last, but certainly not least...STARTING in Indiana and Florida...and probably coming to your state soon, we have yet more of those vile billboards telling how "Methadone Kills"!
You might remember around May of 2007...a similar billboard was put up in Indiana....by a community mental health agency. Rather then tell you about it....here's the actual article from our homepage....
05/17/07 - CONTROVERSIAL BILLBOARD BEING CHANGED!!
Recent overdose deaths involving Methadone had prompted Kosciusko County officials in Indiana to erect a graphic billboard warning residents of the potentially fatal consequences of abusing the drug.
We of the methadone community have been a little more than upset since we were made aware of this billboard. Methadone SAVES lives for the majority of those that use it correctly and we felt the poster was very misleading. That said....the methadone billboard WILL be changed starting Thursday or Friday of next week!
I spoke this morning to a marketing representative for Bowen Center, a community mental health agency that services Northern Indiana. They specialize in anything to do with mental health...including Chemical Dependency. You can see in the photo above their name and toll free telephone number. The gentleman that I spoke with told me that this particular area of Kosciusko County where the billboard is has had more than a few deaths associated with Methadone. He said the deaths weren't so much from Methadone by itself, but combinations where Methadone was involved. The Indiana Health Department wanted to do something to warn people of the potential dangers. Their intent was good, but it was worded incorrectly. He went on to say that they are NOT "anti methadone" under any circumstances....that they know that Methadone is a wonderful medication for addiction or pain when used CORRECTLY. The verbage on the poster was not meant for "correct users", he said. Due to our "awesome and quick feedback" (his exact words, lol)...they will be correcting the wording to make a "clearer message".
So...on the new poster......in front of "Methadone Kills" it will say, "ABUSE OF"....so it will read, "Abuse of Methadone Kills". Further down...where it now says, "The use of Methadone can lead to respiratory depression, coma and death"...they will add verbage that is more explicit - like..."The Health Department warns that INCORRECT usage and abuse CAN lead to"...and the rest. There will be more billboards over the next 30 days for this campaign, but the new billboards will all reflect the new changes.
I got the impression from talking to this man that this campaign is definitely NOT anti methadone. Their intention was to bring attention to this problem and stop the abuse....and they got a little carried away. They were very forthcoming and had no problem speaking to me at length about everything. The billboard is still more disturbing than I would care to see, but I am happy that they are working to correct it's impact.
Unfortunately, the group behind this billboard will not likely be changing it anytime soon.
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