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Volume II, Issue 10 (October 1997)
The History of Methadone and How the USA Grabbed the Glory -
Judith Ostergard (AMMO)
Researcher, Andrew Preston
The Good News Is. . . .
The Bad News Is. . . .
Methadone Treatment in Jail - "A Decade Into It" -
Ignorance - by Beth Francisco
Response to "Diversion" (Odus Green) - By Nancy Rose
- Secretary of DONT
Briefly Speaking - Short items about drugs in
Back Page - Philosophy of Methadone Maintenance: From A Counselor
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The History of Methadone and How the USA Grabbed
Judith Ostergard (AMMO)
Researcher, Andrew Preston
Methadone's prehistory began with its chemical ancestor pethidine. Created in
1937 by two German scientists, Max Eisleb and Gustav Schaumann, pethidine still
soothes the labor pains of thousands of mothers-to-be in Europe.
worked for the German chemical conglomerate, I.G. Farbenindustrie, in the same labs
which turned out the process of changing opium into heroin. The company's factory
was at Hochst-am-Main, so pethidine was given the serial number Hochst 8909. Later
it was christened Dolantin.
Practically since addiction was recognized, the
Holy Grail of drug chemists has been the search for the "non addictive"
analgesic--a drug which kills pain without being so good that people won't want to
stop taking it. They thought pethadine was it, but as with heroin before and Temgestic
since, pain and pleasure proved difficult to disintangle and the search continued.
Eisleb and Schaumann's colleagues, Drs. Max Bockmuhl and Gustav Ehrhart, continued
juggling the atomic constituents of Dolantin hoping to create a painkiller sufficiently
unlike morphine to sidestep tough curbs on opiate precribing. Among their 300 creations
in 1938, the atoms of carbon, hydrogen, nitrogen, oxygen and chlorine fell into the
concellation we know as Methadone. Max and Gustav labeled their creation Hochst-10820,
and later the company dubbed it Palamidon.
It was not an instant hit. The
agreement that ended the war forced Germany to hand over its industry, with all its
patents and trade names, to the allies. The Hochst factory fell to U.S. victors,
and the U.S. sent a team of four men to investigate the plant's war-time work.
In 1945, the U.S. Department of Commerce put out its first publication documenting
the effects of Methadone. It pointed out that though chemically different, the drug
closely mimicked morphine's pain-killing properties.
U.S.A. Grabs the
Hochst's cache of chemical creations was raided by U.S. victors
and the recipes broadcast free to chemical companies around the world, giving methadone
and other products an economic head start in the drug market. Recipients were free
to choose their their own brand (or trade) names.
For Methadone, the U.S.
company, Eli-Lilly, chose Dolophine, the name widely held to have been derived from
Adolf Hitler's Christian name. It is most unlikely that Eli's name makers were
closet Nazis commemorating the Fuhrer. Probably the name was welded from the French
words, "douleur" (pain) and "fin" (end).
a little-used option in medicine's analgesic armory until 1964. U.S. Drs. Marie Nyswander
and Vincent Dole decided they would try a new role for the drug. What they sought
was an was an opiate-type drug which worked when taken by mouth and which didn't
need ever-increasing doses to stay effective. Their initial trials with Methadone
soon gave it a new lease on life, and the rest is history.
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THE GOOD NEWS IS.
. . .
I wanted to comment on the article in last month's newsletter, by Nancy R. Here
in La Crosse, WI, we have no problem in getting our doses promptly if a patient should
become incarcerated at the County Jail. The reason is that the director of the methadone
clinic in our city is also the jail doctor. He is a very understanding man when
it comes to most issues involving opiate addiction. He also heads the chemical dependancy
program at the hospital where the clinic is located. He sends the doses down via
the jail nurse or, if need be, will personally bring them to the jail.
only problem is, if the reason for a patient's incarceration is a drug or alcohol
offense, most likely that patient will find him/herself quickly terminated from the
methadone program. That means a quick detox and, in some cases, I've heard painful.
They (meaning the nurse and other counselors) can make the detox as fast as they
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THE BAD NEWS IS. ..
Patients are supposed to be protected from job discrimination when they are
legally medicated with methadone. Although the Americans with Disabilities Act (ADA)
prohibits denying employment to methadone patients because of the medication they
are taking, some methadone patients are denied employment and/or are fired for this
sin! If this happens to you, don't stand for it. File a complaint with the Equal
Employment Opportunities Commission (EEOC).
Methadone patients have also
had probation officers violate their probation because they are on methadone. Other
patients are told to detox or they will be violated. Don't let this happen to you.
We must not accept these decisions from non-medical personnel, and we must
not accept being denied employment simply because we are taking this life-saving
medication. We must not accept injustices of any kind.
If any of these
things happen to you, your counselor or program should help you. If not, contact
your patient advocacy group. If you do not know who that is, contact Methadone Today,
P.O. Box 164, Davison, MI 48423-0164; call (810) 658-9064 or (810) 756-5938), and
we will put you in touch with an advocate in your area. If there is no advocacy
group in your area, we will do what we can to steer you to the right agencies for
help with the problem.
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Methadone Treatment in Jail
- "A Decade Into It"
Advocates of Methadone Maintenance
of Omaha (AMMO)
The Key Extended Entry Program (KEEP) was started almost one decade
ago at New York City's "Rikers' Island Facility" and is the nation's only
in-jail Methadone Maintenance Program.
The prison runs the program to help
prisoners who are addicted to narcotics in the United States. About 3,000 persons
ingest methadone daily at Rikers. KEEP is funded by the New York State Office
of Alcohol and Substance Abuse Center (ASAC) and operated by Montefiore Medical Center.
KEEP is run through a grant from the National Institute of Drug Abuse (NIDA).
The research focuses on outcomes for KEEP. Participants who had not been
enrolled in a community methadone program will get their chance to clean up. At
the time of their arrest, any one prisoner with obvious drug problems are turned
over to KEEP. KEEP is successful in routing out untreated narcotic
users into treatment after release from Riker's Island In an interview sample, 85%
of KEEP methadone participants who were not in treatment at arrest applied
for Community Methadone Treatment once released.
Cartoon by Ken Thompson
KEEP is the only outreach effort in New York City which has been shown by
controlled evaluation to increase community drug participation. As good as the numbers
look, the KEEP program has had to fight each year for fiscal survival and
has received little recognition from state and municipal agencies covered with public
Why KEEP remains so marginally supported despite its potential
for even greater contributions to public health is exactly what a "NIMBY"
refers to--not in my back yard. Efforts against AIDS, Hepatitis C, B, A, etc. are
questions to ponder. Charles La Porte and Richard Marx were instrumental in conceptualizing
and implementing KEEP while both were working at the Division of Substance
Abuse (DSA) in New York City.
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Response to "About Diversion"
(by Odus Green)
Nancy Rose (Secretary of DONT)
I felt it was important to respond to last month's article, titled "About
Diversion", by Odus Green (Vol. II, No. IX, Sept. 1997). I agree with much
of his article, but another side must be given lest the article needlessly worry
In his article, Mr. Green writes that he believes that the
"predominant means of illegal mass distribution of [methadone] is. . .by the
very agencies that are charged with its proper dispersal." He goes on to say,
". . . a nurse could easily steal enough of the drug. . . .an underpaid LPN
who makes up 250 doses a day and who wants to make a little side money [could]. .
. .If s/he takes just 5 mgs. from each [patient's] dose,. . . she has 1250 mgs. To
[sell] to the street each day." He also explains that the majority of patients
need their entire dose and can ill afford (physically) to sell any of their take-home
bottles. Not only do they face withdrawal, but they are selling clean, unadulterated
medicine to do what?. . . .buy a street drug that is cut with who-knows-what?
I must respond! I agree that most patients need their dose and do NOT sell their
methadone. But, most nurses are dedicated professionals who word hard and are honest.
Besides, every milligram of methadone dispensed must be accounted for. Clinics
are heavily regulated by the state, the feds, the DEA, etc. They have inspections
on a regular basis.
I tend to think it would be extremely difficult for a nurse
to steal methadone without being caught. Plus, the nurse would have to find "buyers",
then risk getting caught, being fired, ruining his or her career and reputation,
and being charged with a crime, risking his or her very freedom! Do you really think
there are that many nurses willing to risk everything for some extra money?
On the other hand, I like Mr. Green's suggestion about abolishing the present clinic
system and having methadone patients treated by a private physician and picking up
their prescription methadone at a pharmacy like any other medicine. But, Mr. Green
offers this partially as a solution to the problem of methadone being stolen by clinic
staff. Couldn't pharmacy staff also conceivably steal in this manner?
I think the system should be changed for no other reason than that methadone patients,
having the disease of addiction, should be treated like any other patient on any
other medication. Private physicians prescribe and pharmacies distribute opiates
and narcotic medicines. Cancer patients certainly are allowed to pick up their Dilaudid
prescriptions, and other patients pick up opiate pain medications at their pharmacy.
Methadone patients should not be treated any differently than any other patient
with a disease.
Methadone Today is open, of course, to opinions
of all patients, staff, or other persons interested in methadone treatment and/or
advocacy. Articles such as Mr. Green's may reflect the fears of some patients, which
becomes understandable when we realize that, as patients, we have faced much prejudice,
ignorance, and rudeness over the years. Clinic staff, rather than react angrily
to articles such as Mr. Green's, should perhaps consider why some patients feel this
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The only word that comes to me is "ignorance." "Methadone makes
your hair fall out, and it gets in your bones." Ignorance. I don't mean that
in a derogatory way, but ignorance causes many of the problems we face as methadone
An incident occurred when I was passing out Methadone Today.
A taxi driver, an elderly lady, dropped a patient off at the clinic. I walked over
and offered her a newsletter to read while she waited. She asked me what it was,
and I told her. She said, "I don't need that. I ain't no alcoholic or no dopehead."
"You don't have to be an addict to read our newsletter. It's merely a source
of information about methadone," I told her.
"Well, I don't want
it!" she replied almost angrily, as though I was trying to give her something
that might be catching. Ignorance.
Then we have those people who say, "When
are you going to get off that shit?" Ignorance. Of course, these are the people
who never saw me in the deepest stages of my addiction. They never felt the pain
I felt when I would wake up in the morning and hate to hear the birds singing because
I knew I had not saved anything from the night before so I could get well. I did
not have the luxury of pressing the "snooze" button on the alarm clock;
in those days, there was no "real" alarm clock--only the one in my head.
That same clock in my head dictated every waking moment of my day.
up. Get up and get yourself around so you can get well enough to think about how
you are going to keep yourself functioning today. God, I promise, this will be the
last day. Just please get me well enough today so I can think how to quit. But,
please, God, just let me find something today. Desperation. Can't call a doctor--they
think I'm weak and that all it takes is will power. Ignorance.
Drs. Dole and Nyswander, for methadone.
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1885 - The Report of the Royal Commission on Opium concludes that opium
is more like the Westerner's liquor than a substance to be feared and abhorred (Musto,
The American Disease, p. 29).
1903 - The composition of Coca-Cola is
changed, caffeine replacing the cocaine it contained until this time (Musto, The
American Disease, p.43).
1910 - Dr. Hamilton Wright, considered by
some the father of U.S. anti-narcotics laws, reports that American contractors give
cocaine to their Negro employees to get more work out of them (Musto, The American
Disease, p. 180).
1912 - The first international Opium convention meets
at the Hague and recommends various measures for the international control of the
trade in opium (Szasz, 1975, Ceremonial Chemistry).
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OF METHADONE MAINTENANCE - From A Counselor Manual
The initial goal of methadone maintenance is to free the addict from the periodic
withdrawal that prompts regular use of illicit opiates. A patient who is thus freed
from withdrawal symptoms will, it is hoped, be able to stop this illicit drug use
and dissociate from people and places that involve drug use and crime, deal with
his or her problems, establish a new lifestyle, and enjoy a higher quality of life.
The counselor should provide support and direction to any patient who is interested
in tapering off methadone, but it is not realistic or therapeutically beneficial
to routinely promote the goal of detoxification from methadone. To do so can suggest
that what the patient is doing to deal with his or her heroin addiction is, at best,
only temporarily acceptable. The focus upon getting off methadone maintenance implicitly
conveys a negative attitude about the treatment. The patient who is not ready or
able to withdraw from methadone is then left with the choice of being in a "bad"
treatment or of returning to heroin use.
Source: U.S. Department
of Health and Human Services (DHHS), Technical Assistance Publication (TAP) Series
7, Treatment of Opiate Addiction With Methadone: A Counselor Manual, (Ch. 3, p. 15).
Ordering Information: 1-(800) SAY NO TO; Ask for Tap 7 or SMA94-2061
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