Greetings!  Summer has definitely arrived.  I can't believe how unpredictable the weather is.  We have experienced our share of tornados in Georgia but they skipped over us.  Saturday, my heart skipped a beat when the phone rang and I discovered one had touched down in Wisconsin. My partner lives there and if anything was to happen to her, I just could not continue. Most of you already know who I am speaking of if you have  visited our forums.  Her contribution to our work is more valuable   than gold.  God's protection certainly was evident because none of us were injured but we lost the use of our electricty. It is annoying but when you think about what could have happened...it is but a small price to pay.

Has anyone else noticed how strange our weather has been?  Maybe  it is only me.  I am beginning to believe there is validity in "Global Warming."  We have many more issues confronting us like the price of gasoline.  Never, has it ever been so high in my life-time. I can't change the price of gasoline but I have some good news for some of you.  We receive many calls every day asking if there is any financial assistance available to help them pay for their Suboxone.  There just may be some if you meet the criteria. If you are one of those in need of help, please call 1-877-782-6966 toll-free  to see if you qualify.  It is the best I can do presently.  I want to wish all of you the very best .      

  Buprenorphine To Draw Closer Scrutiny

United States to start tracking deaths of those on addiction treatment.

The addiction treatment drug buprenorphine will come under closer scrutiny through a new federal initiative to track the deaths of opiate addicts taking it or methadone.

U.S. Substance Abuse and Mental Health Services Administration officials hope the new tracking system will significantly improve the safety and quality of drug treatment for more than 400,000 addicts across the country, including thousands in Baltimore.

A series of articles published in The Sun in December showed that while buprenorphine can be a highly effective addiction medicine, misuse of the drug is on the rise. Some people have died when taking buprenorphine with other drugs. But the number of deaths is unknown, because medical examiners in Maryland and most other states don't test for buprenorphine in overdose deaths.

Federal officials disclosed the data collection effort in a Jan. 2 notice in the Federal Register. Drug treatment programs will be asked to voluntarily report information about deaths. 


The system will help policymakers identify "preventable causes of deaths, and ultimately take appropriate action to minimize risk and help improve the quality of care," according to the notice.

"We're doing this to get a better handle on any trends," Nick Reuter, a senior public health analyst with SAMHSA, said yesterday. "There's no central repository for that information."

Health officials stress that both methadone and buprenorphine are safe when taken properly and help ease cravings addicts feel for opiates. Using illegal drugs such as heroin or cocaine poses far greater dangers of death or injury, they say.

Methadone has been the nation's mainstay addiction therapy since the 1970s. It is dispensed by about 1,100 clinics to roughly 250,000 people nationwide. To stem abuses, methadone clinics initially require addicts to appear daily for their doses. About 60 percent of the methadone clinics also use buprenorphine for some patients, according to Reuter.

While reliable national figures are difficult to obtain, some states have tied an alarming overdose death toll to methadone. Medical examiners in Florida, for instance, reported that the drug caused 312 deaths in the first six months of 2006 alone, more than any other drug.

Many drug treatment experts believe the vast majority of patients who have died from methadone overdoses were taking the drug for pain and often took it with other drugs.

"We don't anticipate there are many deaths [in methadone clinic patients]," said Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence. "We're very happy to cooperate."

How much information the government will be able to garner about buprenorphine is less clear.

Buprenorphine, sold mainly under the brand name Suboxone, has been on the market since late 2002. It is prescribed to about 170,000 people, either through clinics or several thousand specially licensed doctors, who would not be part of the reporting system.

Federal officials consider buprenorphine much safer than methadone and are encouraging more private physicians to begin using it to treat addicts. Though it also can suppress breathing if abused, Suboxone has a ceiling effect that limits the danger of overdose as more is consumed. But that effect diminishes when the drug is taken with tranquilizers and other drugs.

Buprenorphine enjoys wide political support. That's especially true in Baltimore. Earlier this week, Mayor Sheila Dixon requested $5 million from the Maryland General Assembly to greatly expand buprenorphine treatment.

Yet Maryland authorities have paid little attention to the drug's emergence as a street commodity.

Some patients illegally sell the orange, hexagonal tablets after receiving them to take at home. Some abusers use the pills to get high or to tide them over when they can't find heroin or other opiates.

Deaths from mixing the pills with other drugs also are likely to escape scrutiny in most states, including Maryland, where medical examiners lack the lab equipment to detect the drug.

The Sun series reported that the drug's manufacturer knew of 13 deaths since the start of 2005 from taking buprenorphine in combination with other drugs. The newspaper uncovered two such deaths the company didn't know about. They occurred in Vermont, the state with the nation's highest rate of buprenorphine use.

Reuter, the SAMHSA official, conceded that the new surveillance system is not likely to capture much information from private doctors, who are not involved in the reporting system but are prescribing most of the buprenorphine used to treat addicts.

A few medical examiners around the country are considering adding tests for buprenorphine as overdose deaths related to abuse of the drug begin to surface.

Dr. Steven Shapiro, Vermont's medical examiner, began this month to test for buprenorphine in every suspected overdose death.

"We're the number one per capita prescriber of this drug and we have no clue how much is out there," he said.

Dr. Margaret Greenwald, Maine's chief medical examiner, wants to routinely test for buprenorphine. But she said the $200 cost per buprenorphine screen is prohibitive.

She said two men have died over the past two years of overdoses caused by mixing illegally obtained buprenorphine with other substances. One man, Donald Morin, died on Feburary 16, 2006, after mixing buprenorphine with the tranquilizer Xanax and cocaine. Suboxone pills were found in his pocket, which led to the test, she said. Another man died July 21, 2007, of an overdose caused by mixing buprenorphine with alcohol and two antidepressants, she said.

The Maryland Department of Health and Mental Hygiene has asked the commission that oversees the state medical examiner's office to review possible testing for buprenorphine. The state is spending $3 million to roll out the drug statewide, plus nearly $2 million to pay for prescriptions of low-income patients.

Dr. J. Ramsay Farah, president of the Maryland Society of Addiction Medicine, supports testing.

"If you don't look for something you're not going to find it," Farah said. "You need to look for it."

fred.schulte@baltsun.com    Sun Follow-up [ January 11, 2008] 
doug.donovan@baltsun.com 

Treating Opiate Addiction With Replacement Therapy

* Medications currently available to treat addiction to heroin, OxyContin and other prescription opiates are called replacement therapies.
* This treatment can improve the health of addicted people and reduce the harmful impact of taking illicit drugs.
* Methadone is a long-established replacement therapy.
* A relatively new medication, buprenorphine, has been shown to be effective in helping opiate-addicted people.

New scientific understandings of brain chemistry are paving the way for significantly improved treatments for people who are addicted to heroin, opium, legally manufactured pain relievers such as morphine, OxyContin, Vicodin and Dilaudid and other opiate drugs.

Such improvements can't come a minute too soon. Twelve- to 17-year-olds are the fastest growing group of people in the United States experimenting with such drugs. And opiates are highly addictive - one half of all people who use them recreationally will need formal substance abuse treatment related to this experimentation.

Opiate abuse can bring about significant and long-lasting chemical changes in the brain. These changes cause a person to experience intense cravings and negative emotions when they try to stop. Because of this altered chemical state of the brain, the majority of opiate-addicted people who recover require medication in order to correct these changes, much as a diabetic requires insulin to maintain a more normal blood sugar level. The most commonly used medications for opiate addiction in the United States are methadone and buprenorphine. Health professionals call treatment with such medications replacement therapy.

A common misconception about replacement therapy is that this treatment is really just substituting one drug of abuse for another and that people who utilize medications in treatment of opiate abuse are not really in recovery. This idea fails to recognize that recovering from opiate abuse is not a matter of will power or moral re-examination. It is a physical illness most effectively treated by using medications such as methadone and buprenorphine to assist the person in regaining physical stability and then helping the person address other psychological and spiritual needs.

People with significant opiate addiction are unlikely to recover without some form of replacement therapy as part of their treatment. On the other hand, replacement therapy alone is not nearly as effective as combining it with other treatments such as counseling and self-help groups.

Addiction is a chronic illness like heart disease, high cholesterol or high blood pressure. Persons with these chronic diseases are prone to relapse. The affected person deals with the symptoms associated with their condition throughout the lifespan. Even in the best of circumstances the symptoms of a chronic disorder may reappear periodically. This is particularly true during periods of stress or when a person doesn't closely follow medical recommendations.

Unfortunately the failure to think of addiction in these terms has negatively affected the health of many opiate-addicted people. This type of thinking often leads patients to be discharged from treatment if they relapse. But the approach in the treatment of other chronic medical disorders, such as diabetes or heart disease, is to continue to work with patients even when they do not do well in order to improve long-term treatment outcomes.

As we continue to learn that addiction is similar to other chronic illnesses, treatment programs are beginning to adopt new ways of working with patients, sometimes called the harm reduction approach. Harm reduction approaches emphasize the need to shape treatment toward the individual needs of the patient as opposed to forcing the patient to adapt to the demands of the treatment program's definitions of recovery. Harm reduction is nothing more than:

* using practical treatment approaches to reduce the negative consequences of drug use,
* encouraging retention in treatment and
* improving the long-term health and general recovery of each addicted person as well as promoting public health goals.

Important Facts About Replacement Therapy

 *  Replacement therapy is not short-term; your friend or family member will need to remain on the medication for years in order for it to be effective.
*  Patients receiving methadone will initially need to be present at the program on a daily basis, although as they become more stable the daily visits may take only a few minutes.
*Methadone patients can earn the ability to take home some dose of medication over time if they stop the use of drugs and do well in treatment.
*  Patients on replacement therapy, particularly methadone, may encounter travel restrictions, making it difficult to visit family or take vacations.
*  Methadone and buprenorphine are treatments for opiate addiction and will typically not stop the abuse of other drugs.
*  Replacement therapy is not a "magic bullet" and patients usually have to engage in counseling, mutual help groups, or other forms of treatment to fully recover.
* Methadone side effects such as sedation, sweating, constipation and weight gain usually go away after a person  has been on the medication for a short time.
*  In clinical practice it has been observed that buprenorphine produces few side effects, with headache being the most common. Unfortunately this side effect does not usually fade with time.
*  Clinical experience indicates that Buprenorphine can make some psychiatric symptoms worse and methadone may be a better choice in that situation.

Five Things To Know About Methadone

1. Methadone allows people to function normally by stopping withdrawal symptoms, eliminating craving for opiates, blocking opiate induced euphoria, and correcting the neurochemical abnormalities in the brain caused by opiate addiction.
2. Methadone maintenance is the most effective treatment we have for opiate addiction.
3. Methadone is the most cost-effective treatment for opiate addiction.
4. Participation in a methadone treatment program significantly reduces a person's risk of HIV and Hepatitis C infection.
5. Methadone is the most widely used treatment for opiate addiction in the United States.