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Methadone Today

Methadone Today

The printed newsletter contains crosswords and other items of interest which will not be included here. This will be limited to articles only. To subscribe to Methadone Today

Volume One Issues 10 - 8 (November-September) - Most recent first
Methadone Maintenance and Pregnancy
Methadone Consumers' Meeting & Harm Reduction Conference
Medical Maintenance
Depressive Episodes in Methadone Detoxes
Drug Policy Foundation Grant
The Use of Insulin in the Treatment of Diabetes: An Analogy to Methadone Maintenance
Hair Testing for Drugs--A Case for Discrimination
Buprenorphine vs Methadone

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by Beth Francisco

In the September issue of Methadone Today, the National Alliance of Methadone Advocates' (NAMA's) Methadone Awareness question was regarding pregnant women and methadone. At that time and as a result of the article, several questions were raised, so I have decided to expand on the topic to try to answer them.

The following information and quotes come from the U.S. Department of Health and Human Services (DHHS). This publication can be obtained at no charge by calling 1-800-729-6686 and asking them to send "(SMA) 93-1988" (Pregnant, Substance-Using Women) or more simply, "TIP 2." The information contained in TIP 2 comes from a rather lengthy 90-page booklet with a full two-page list of contributors known as the Consensus Panel. There is also another full page of Tip Field Reviewers who "were selected to review and comment on the draft document based on their knowledge of and concern for the special needs of pregnant, substance-using women."

The consensus is that methadone maintenance "is a well-documented approach to improve outcomes for both the woman and her fetus [and] is strongly encouraged for all pregnant, opioid-dependent women [emphasis mine]. It provides the following advantages:

  • Reduces illegal opioid use as well as use of other drugs.

  • Helps to remove the opioid-dependent woman from the drug-seeking environment and eliminates the necessary illegal behavior.

  • Prevents fluctuations of the maternal drug level that may occur throughout the day.

  • Improves maternal nutrition, increasing the weight of the newborn.

  • Improves the woman's ability to prepare for the birth of the infant and begin homemaking.

  • Reduces obstetrical complications.

Medical withdrawal of the pregnant, opioid-dependent woman from methadone is not indicated or recommended [emphasis mine]. Few women will have the motivation or the psychosocial supports to accomplish and maintain total abstinence. The goal, therefore, is to achieve the best therapeutic dose possible with which the woman feels comfortable. The neonatal abstinence syndrome can be treated with minimal complications.

Despite the above caution, at times, medical withdrawal may need to be considered due to logistical or geographic barriers. In these cases, the decision to undertake such a program must be a joint decision between the obstetrician, the woman, and her counselor, with the understanding that few women will be appropriate candidates for this approach [emphasis mine].

The woman should understand that she must prove she is a candidate for medical withdrawal by complying with prenatal and therapy appointments and supplying clean urines. If at any time the woman is unable to comply with these requirements, no further decrease in dosage of methadone should be ordered. . . .Patients should be allowed to discontinue withdrawal at any time, for any reason, without feelings of guilt [emphasis mine]. They should be then be placed into a methadone maintenance program at a therapeutically sound dose. Clinicians need to be particularly aware that a decrease in methadone dosage could precipitate a relapse to drug use. Patients in continuous treatment who return to illegal drug use should be placed back on methadone. Methadone is preferable to the use of illegal street drugs.

. . . .Medical withdrawal from methadone is usually done in decrements of 2 to 2 mg every 7 to 10 days. This procedure should only be done in conjunction with an obstetrician who can monitor the effects on the fetus. Intrauterine demise (death of the fetus in utero) has been documented as a complication of medical withdrawal even when done under optimal conditions, such as hospitalization and close fetal monitoring" [emphasis mine].

It is clear that the consensus is that pregnant women who are dependent on opiates should be placed in a methadone program as soon as possible and should not be detoxed during the pregnancy. The dosing guidelines are the same for pregnant as well as nonpregnant substance users. "Based on current and emerging research, the National Institute on Drug Abuse (NIDA) suggests that maintenance doses below 60 mg are not effective and hence not appropriate. Arbitrary low-dose policies for pregnant and nonpregnant patients is often associated with increased drug use as well as reduced program retention. Based on current informed consensus, the most prudent course is to rely on individually determined methadone dosing that is measured by the absence of subjective and objective abstinence symptoms and the reduction of drug hunger." If you are pregnant and an opiate user, it is crucial that you find a program that will maintain you on methadone for your health and that of your developing fetus.

New Hampshire is one of the few states that does not have methadone maintenance, but they recently passed a bill (June 1996) that would allow pregnant opiate users access to methadone. The downside is that there is a stipulation that "the length of time for methadone use after birth shall not exceed 3 months." The months following birth of the child should not have the added stress and complication of a methadone detox. If these women are not ready for detox, they will most likely return to drug use instead of using the respite from drug chasing to enjoy their child. If they were allowed to remain on methadone maintenance, this could be avoided.

The good news is that a former legislator (see story on page 2--Harm Reduction Conference) is researching methadone and running for office again this year. Advocate Dan Sundquist is on the job also. Thanks for the information, Dan.

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Methadone Consumers' Meeting & Harm Reduction Conference


Methadone patients and advocates from across the United States met in Oakland, California on September 17, 1996 to set up a Methadone Consumers' Advocacy Agenda. These patients and advocates are doing something to change treatment back to Dr.'s Dole and Nyswander's caring model instead of resigning themselves to the current prohibitive policies of methadone treatment in the United States.

"At the Tuesday Consumer Meeting, we formed a Committee that put together The Methadone Consumers Platform," said Joycelyn Woods, Executive Vice-President of NAMA. "It was read at the Final Plenary and was the only report from groups that got several cheers--more than several in fact. The cheers were for statements like ‘No Blind Dosing', ‘No Discharge without Due Process', and ‘No Discharge for displaying symptoms of our disease' (using drugs). So I think we brought down the house."

Through Joycelyn and e-mail, I met former New Hampshire State Representative, Patricia M. O'Keefe, who was "co-sponsor of both a needle exchange bill and a bill to remove the prescription requirements to purchase syringes and decriminalize possession of such items." Ms. O'Keefe said of the conference, "I thought it was really well organized, and...I came away from it with a much clearer vision of harm reduction. One area really impressed me--some presenters that were on methadone maintenance really blew me away and made me realize that I don't know enough about the treatment, that I had preconceptions of methadone maintenance that were inaccurate and distorted, probably similar (but not so extreme) to those in the legislature that have to be educated about the treatment. I never realized I had these stereotypes in my head until I witnessed these highly functioning individuals. . . .I am kind of embarrassed by my ignorance. . .[but] I look forward to researching the subject and rectifying the situation."

This is wonderful commentary, and Ms. O'Keefe does not need to be embarrassed about not knowing about methadone maintenance treatment. Look at the ignorance in the medical profession regarding substance abuse and methadone maintenance, look at the answers to the many myths we have been publishing, and look at some of the ignorance even in the field of methadone maintenance put forth by counselors and doctors who should be knowledgeable about their business. There is no shame in being unaware--the shame is in staying unaware and the perpetuation of the negative stereotypes of the methadone-maintained patient.

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Medical Maintenance
by Beth Francisco

As with so much about methadone maintenance, I knew nothing of this thing called Medical Maintenance when I first started as a patient advocate in August 1995. The concept, when I first learned of it, fascinated me. But, why should it? Because we have been so brainwashed into thinking that we are criminals, moral degenerates, and undeserving that it just doesn't occur to us think of ourselves as patients. We are told, if not implicitly then at least we are certainly given the feeling, that we are not entitled to this life-saving medication--that it is a privilege. To those of you who read Dr. Payte's, "Insulin Treatment in Diabetes. . .," in September's Methadone Today, apply that last statement to his thesis. It's absurd when applied to insulin for diabetes, but we believe it about methadone. Well, I don't believe it anymore.

D. Novick et al (1988 June 10 JAMA 259; 3299-3302) wrote in "Medical Maintenance: A New Model for Continuing Treatment of Socially Rehabilitated Methadone Maintenance Patients" about the study of the first 40 medically maintained former heroin addicts. These patients are seen in the atmosphere of a doctor's office, with an appointment during regular hours, along with other medical patients. At the visits, the patient submits a urine, takes a dose of medication in front of the doctor or his staff, completes a questionnaire, and is interviewed. He or she may receive up to 28 days' medication at the doctor's discretion. These patients do not receive the counseling that is mandatory in the clinic setting but may be referred to counseling if needed.

Some of the requirements for Medical Maintenance are:

1. Five years in methadone maintenance treatment.
2. Employed or other productive use of time for the past three years and legitimate income.
3. No criminal involvement for past three years.
4. No drug or alcohol abuse for the past three years.
5. Record of reliability in methadone maintenance, i.e. regular attendance at counseling sessions, urine submissions, no requests for replacement bottles of methadone, and have obeyed clinic rules.
6. Decision that long-term methadone maintenance will be necessary, i.e. unsuccessful detox attempts, judgement of patient and doctor.
7. Emotional stability.
8. No socializing with illicit drug users (to diminish diversion).
9. Recommendation from clinic with thorough knowledge of patient's history.
10. Patients must be volunteers and agree to participate in research evaluations.

This study began in June 1983; as of January 1988, "in follow-up ranging from 12 to 55 months, 33 (82.5%) of 40 had remained in medical maintenance, yielding an annual retention rate of 94%. Five (12.5%) patients had been discharged because of cocaine abuse and returned to a conventional methadone maintenance program." Three of the 33 patients had brief incidents of substance abuse but were "resolved with counseling and increased frequency of office visits with urine monitoring. Only four instances of lost medication occurred in the 1381 patient-months of this study. No overdoses of methadone were reported by patients or their families."

Of an additional 37 patients who were added to Medical Maintenance "between April 1987 and May 1988, 36 have remained stable during 1-14 months of treatment, with no documented substance abuse. One patient was transferred back to his previous program after having repeatedly exceeded his daily methadone dose. Thus, of the 77 patients admitted to medical maintenance since its inception, 69 (90%) have remained in treatment as of this writing (June 1988)."

Other patients were added to Medical Maintenance in 1989 to total 100. Patients were followed in Medical Maintenance for a total of 3.5-9.25 years. As of September 1992, the number of patients in good standing was 72. Of the other 28 patients who left Medical Maintenance, only 15 were unfavorably discharged--11 for cocaine use, 3 for misuse of medication, and one (1) was discharged for repeatedly failing to keep appointments.

Patients perceived the benefits to be "that of being treated in a more professional atmosphere. They have reported improved self-esteem from being regarded as medical patients rather than drug abusers, from being rewarded with a degree of trust after many years of excellent performance in treatment, and from no longer being required to receive unnecessary supportive services. . . . Patients have also stated that the 28-day reporting schedule markedly reduced problems in work attendance and maintaining confidentiality. . . Medication in tablets rather than as a liquid which required constant refrigeration also allowed patients to take extended business trips or vacations. Finally, the physician-patient relationship is improved, since treatment decisions are based on clinical indications rather than impersonal regulations."

This is a great outcome when we stop to think about it. Out of 100 heroin addicts who were out on the street costing themselves and society untold grief, 85 were salvaged and contribute to themselves, their families and society because of methadone and medical maintenance. Granted, most of them would probably have remained in the clinics if they had not been accepted for medical maintenance, but after five years of repressive clinic rules, they had earned by their exemplary behavior the chance to be free of some of the restrictions .

We need more doctors who are knowledgeable about substance abuse who would be willing to integrate methadone patients into their practices. Of course, there is the problem of regulation , the DEA and other government agencies; and believe me, as methadone patients we know about regulations and sympathize with those doctors who would be willing to do this. We would, however, also be eternally grateful.

Even though I have once-a-week take homes, I have a 45-minute drive each way to the clinic in good weather and drive a car with over 100,000 miles on it. After eight years, I am more than ready to find a local physician who would be able to prescribe for me on a monthly basis. Some of us just do not need weekly or twice monthly counseling sessions, nor can we afford them.

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Depressive Episodes in Methadone Detoxes

There may be a good reason why many have a difficult time detoxing off methadone. According to Philip Kanof et al, in the American Journal of Psychiatry (1993 March), "development of an organic mood syndrome is a common occurrence in patients undergoing slow detoxification from methadone maintenance treatment and is associated with a poor outcome.

Even with these 24 highly-motivated patients, the failure rate was substantial. The patients were selected for detox because they were not using any illicit drugs, were not involved in "drug-culture-related activities", were employed and had stable family relationships. Thirteen (over half) of the patients involved in the study did not complete the detoxification..

All of the patients were stabilized and maintained at a starting dose for 2-5 weeks before start of detox, and all data obtained at this time was referred to as the baseline. The study was double blind which means that neither patient nor investigators knew the patient's dose. All of the patients' daily doses were decreased by 5mg weekly until their dose reached 15mg. At that time, the daily dose was decreased by 3mg weekly.

Using 3 different rating scales, 2 of which were subjective and one objective scale, these patients were self- and staff-rated for signs of opiate withdrawal on a weekly basis. "Patients who failed to complete detoxification manifested significantly greater increases from baseline in symptoms of dysphoria as measured by" subjective and objective signs of opoid withdrawal. "The results indicate an association between the emergence of clinically significant symptoms of dysphoria and lack of success in therapeutic detoxification from methadone maintenance." Symptoms including fatigue, insomnia, loss of appetite, etc. suggest "criteria for a major depressive episode as defined in DSM-III-R. However, the prompt reduction in symptoms of dysphoria following restabilization on methadone. . .clearly demonstrates the organic etiology of the prominent mood disturbance."

Does this mean that all is lost and that we will be dependent forever on methadone? These researchers feel that there may be good evidence that anti-depressants should be started before detox in order to prevent or treat depressive symptoms. Also, all of these subjects were detoxed at the same rate, but we are all individuals and need to detox at our own rate. Some of us may need to stop the detox several times to become restabilized before continuing.

The point needs to be made, however, that methadone maintenance is a legitimate treatment for opioid dependence, and it is not the be all and end all of every methadone-maintained person to detox. The world will not come to an end if we have tried to detox and have been unable. The subjects selected seemed to be doing just fine before they started to detox. Remember the criterion for being selected--the subjects were not using any illicit drugs, they were employed or going to school, were not involved in drug-related activities, and they had improved and stabilized family relationships. What do we define as success? Let's not put people in impossible situations. If a person wants to detox, that's fine--more power to them if they can do it. If they can't, but have made all those other improvements in their lives, why can't we leave them alone?

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Drug Policy Foundation Grant

With the next issue of Methadone Today will come funding from the Drug Policy Foundation (DPF). Many of you know how we have struggled to keep the newsletter in print and mailed over the past year, and this grant comes just in time to save it. We appreciate the opportunity that the DPF grant has given us to keep the lines of communication open and encourage even more patient and clinic participation. Thank you, DPF!!!

The DPF puts out a pamphlet which states that it was established in 1986 and is the "leading independent forum for alternatives to the failed drug war, including legalization, medicalization and harm reduction. The basic premise of the Foundation's work is that a war is not a domestic policy. . . .The Foundation counters drug-war spawned misinformation and hysteria through accurate research and a widespread educational campaign. Because of [their] work, the media and the public increasingly recognize the destruction and futility of the drug war."

Now that the funding problem is not at crisis level (we can still use a dollar or two from our readers to defray costs), and we will be putting out an issue every month, we are hoping that many more of you will submit articles for publication. If you submitted an article that did not get published, it may not have reached me. However, mail comes directly to me now, and I will do my best to include every person's efforts. Don't worry about spelling--that is the function of the spell checker and the word processor. We want your ideas, stories and concerns. This is your newsletter. Has something happened to you at a clinic that you feel is unfair? Have you ever been in jail and been denied methadone treatment? How about the hospital? Do you have a counselor or other staff member who has gone to bat for you when no one else would? What were you like before methadone, and what are you like now? We know you have an amazing story, and we want it. If you prefer, we don't have to publish your name.

The DPF has notified us that the only condition of funding for the newsletter is that we do not publish any articles that could be construed as lobbying. Although we have published some in the past, they have been assured that we will not do so during the next year using any of their funding, equipment or supplies. According to Webster's Dictionary, ‘lobbying' is defined as "a group of people trying to bring pressure to bear on legislators to pursue policies favorable to their interests. Please keep this in mind when submitting articles.

This is an appropriate place to offer thanks to NPL and especially Arlene Heiser for their generous support in making sure we have had access to equipment and supplies for printing Methadone Today. Thanks to Sterling for allowing me to interrupt his work space (doing so with good grace) while making copies of the newsletter, to the counselors for not saying much when getting in their way, to Kemmer for allowing me to disrupt Wednesday mornings, and to Dr. Burk just for being himself.
Thanks to Penny for writing the rough draft of the body of the grant. To Joycelyn Woods, Executive Vice-President of NAMA, many thanks for her help and support every day through
e-mail communication and especially for helping us through the grant process when all the while she was busy writing her own.. Who says methadone patients don't have their "stuff" together?

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The Use of Insulin in the Treatment of Diabetes:
An Analogy to Methadone Maintenance

by J. Thomas Payte, M.D.

A five-year study was conducted on 300 insulin-dependent diabetics. The purpose of the study was to determine if the use of insulin resulted in any long-term benefit to diabetics. The concept was based on two widely accepted hypotheses: (1) that a formerly insulin-dependent diabetic could learn to live a comfortable and responsible life without insulin, provided that he or she wanted to badly enough; and (2) that the use of any exogenous substance to replace or simply substitute for a deficient endogenous substance is conceptually unacceptable to modern scientific thinking and may be inherently evil.

It is obvious that exogenous insulin, being highly suspect at the outset, should be used in the lowest possible doses and for the shortest time possible. In this study, treatment with insulin was limited to two years and the daily dose was limited to a maximum of 40 units. The posttreatment follow-up period varied from three days to three years, depending on the duration of survival. During the treatment phase (insulin maintenance), random urine samples were collected under direct supervision and tested for glucose at least weekly. A positive urine glucose resulted in a warning to the patient. After three positive urine tests, the dose of insulin was reduced by five units daily for each positive urine test. This policy was intended to increase motivation on the part of the patient to provide urine specimens negative for glucose. If positives continued, the insulin was eventually discontinued and the patients were placed in the follow-up group. The authors of the study felt that patients would have a better chance of reentry into insulin maintenance at a later date if (a) the patients survived and (b) patients accepted full responsibility for their insulin dependence and were willing to go to any lengths to recover.

All patients were required to endure one hour of individual or group counseling each week, which addressed such subjects as meal planning, hygiene for the feet, pancreatic imagery, and dietary assertiveness. Counseling patients fell into one of three categories: those who had no need or desire for counseling; those who might need counseling but were entirely unwilling to participate; and those who both wanted and needed extensive counseling, but the counselors were so busy spending an hour a week with the others that they were unable to meet the increased demands and needs of this group. Avoiding this bothersome, time-consuming, and costly process of individualized treatment also served to reduce the risk of enabling the patients' maladaptive behaviors by what could seem to be a reward system. The resulting uniformity of service assured that the needs of no one were met. It was hoped that by making the treatment unpleasant that motivation for recovery would be enhanced.

Half the participants failed to complete the two-year treatment with insulin maintenance. Some patients simply dropped out of treatment, but most were terminated for continued glucose-positive urines. This was despite repeated warnings and in absolute defiance of the reductions in insulin dosage with each glucose-positive urine. It was concluded that this population is poorly motivated, difficult to work with, and is lacking the resources needed to effect the major life changes required for recovery. Many of this group died during follow-up. Some survived with amputations, blindness, neuropathies, and other conditions associated with the unhealthy life-styles of the diabetic.

The remaining half did manage to complete the two-year treatment and even appeared to experience relatively good health and seemingly normal functioning. Of course, this illusion of apparent good health was at the expense of continuing to maintain the insulin-dependent status with daily insulin. Some investigators speculated that insulin might be continued over a longer period of time and at higher doses. This notion was quickly rejected as being absurd because good health should not be obtained at just any cost. As the patients approached the two-year period, the insulin doses were tapered over the final two months. All subjects began having positive urine tests and again were showing active insulin-dependent diabetes. The obvious conclusion is that insulin does not help the insulin-dependent diabetic and is not effective in treatment. The high mortality rate of posttreatment patients suggests that insulin may have had some delayed, deadly toxic effects. This concept should be the subject of future research.

This "insulin spoof" was originally written with the idea to share it among friends and colleagues. Somewhat surprisingly, the spoof was well received by many who urged that it be shared with a wider audience. Initially, the intention was to transpose rather typical and illogical clinical thought processes about methadone maintenance to another more familiar chronic and incurable disease.

The transposition to a disease that is much more widely understood made the line of reasoning clearly absurd in the new context. Yet when this pseudologic is applied to chronic opiod dependence and methadone maintenance, few people find anything wrong or out of place. One might conclude that the vision of some is clouded by the philosophical and ideological considerations that erect barriers to understanding, accepting, and implementing this lifesaving treatment modality for those chronic intractable heroin addicts who need it.

Any humor in this parody is quickly lost when one estimates the loss of life and other costs associated with untreated heroin addiction that can be attributed to a persistent shortage of methadone treatment slots. This shortage is due, in part, to persistent negative attitudes toward the methadone treatment modality.

1Chairperson, Committee on Methadone Treatment, American Society of Addiction Medicine; Founder and Medical Director, Drug Dependence Associates, 3701 West Commerce Street, San Antonio, Texas 78207

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Hair Testing for Drugs--A Case for Discrimination

Our laws against certain drugs began as a result of discrimination against minorities. The first two laws against opiates were passed in response to discrimination of the Chinese; they were thought of as an inferior race. In 1910, legislation was requested regarding cocaine since its use was touted to be the direct incentive to the crime of rape by Negroes. Thus, the stage was set for greater and greater social control and loss of liberty.

When urine testing began in the workplace, it was for those who had jobs such as air controller, pilot, etc.--those who had to be aware of public safety concerns. Now, any employer can test anyone for drugs--from the person who routes airplanes to the one who sweeps the floor. It is bad enough that a person has to submit to tests that allow an employer to have access to what was done over the weekend, even when proficiency testing is available and could properly show fitness for work. Proficiency testing tells the employer if you are able to do the job--without invading your privacy.

Now, however, the big push is for hair analysis, which tells your employer what you did all last year. Despite the problems associated with urine testing (threat to personal liberties, lab error, false positives, etc.), the time it takes the body to break down a drug is relatively the same in all races; not so with hair testing. This method allows whites, who used drugs at the same time as their African-American counterparts, to escape detection while African-Americans are either denied jobs or fired.

According to a study done by Gary Henderson, Ph.D., at the University of California at Davis, at the same dose, non-Caucasians had up to 12 times as much cocaine in their hair as Caucasians. Also, the drug stays in the hair for longer periods of time--greater than 10 months for one non-Caucasian.

The reason for this may be that cocaine binds to melanin, as reported by Robert Joseph et al at the American Academy of Forensic Sciences in Nashville, February 19-24, 1996. Some of the findings were:

Male, African, black hair--10 times more binding for cocaine than male Caucasian brown/black hair.

Untreated, male African black hair bound cocaine almost 500 times more than blond Caucasian hair.

Bleached male African hair--four times that of blond male Caucasian hair.

Green et al, Journal of Analytical Toxicology (March/April 1996), in an animal study, reports that the ratio of methadone in black to white hair is 21 to 1--this despite the fact that the melanin content in the black hair used in this study was only 3.5 times greater than that of the white hair.
These are not the only problems with hair testing. There is no uniformity in the testing cutoff point (point at which it is agreed that a test is negative), and there are no set testing techniques. In other words, four different labs may use four different ways to produce results. There is also the problem of environmental contamination, among others.

The best that can be said for hair testing is that it indicates whether a person has used drugs or not. However, the problems far outweigh the benefits (if any) of such a test. Why in the world does an employer need to know whether a person took drugs 6 months ago? In fact, why do they need to know if a person took drugs last night? If a person can pass a proficiency test (computer testing for awareness, alertness, and ability to do the job competently) that is all the employer needs to know.

According to H. Westley Clark, M.D., J.D.,, M.P.H., University of California, "African Americans, Hispanics, and East Indians are at greater risk. . ." for detection of drug use. They also test for a longer period of time than Caucasians. "Hair analysis is a very good technique to foster discrimination. [It] has the aura of science, [and] it is pushed by scientist [sic] who can use fancy terms and fancy language to reassure employers, politicians and courts that only drug users are being identified by the techniques involved."

Dr. Clark suggests that African Americans could bleach their hair to "level the playing field." Or, we could all go one step further and shave our heads.

1Clark, H. W., M.D., J.D., M.P.H., carter@itsa.ucsf.edu (1996 July 26). "High Tech Discrimination in the Workplace: Hair Testing Favors Whites Over Non-Caucasians. harmred@drcnet.org, Subject: Hair Analysis, the End of Racism and the Bell Curve.

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Buprenorphine vs Methadone

Buprenorphine is an analgesic for use in the treatment of opiate addiction. It produces less euphoria than morphine and heroin, and "some studies also suggest that withdrawal effects are less severe with Buprenorphine than with methadone." As with LAAM, it is released slowly so that dosing may be every other day instead of every day as is done with methadone.

A study done by Dr. Eric Strain et al at Johns Hopkins University found that patients who were treated with Buprenorphine stayed in treatment as long as those who received methadone. In another study by Dr. Rolley E. Johnson et al, done with about the same number of patients (162), the retention rate was somewhat less (42% as compared to Dr. Strain's 56% retention rate).

Buprenorphine "is administered under the tongue via a small syringe. Patients do not swallow the medication but allow it to be absorbed through the mucous membranes that line the inside of the mouth." Another difference is in the dose--8 mg of Buprenorphine seems to be equal to 50-60 mg of methadone. In Dr. Strain's study, if a patient's urine tests showed opiates, the dose "could be increased to a maximum of 90 mg of methadone or 16 mg of Buprenorphine."

The National Institute on Drug Abuse (NIDA) "officials are quick to caution that approval of Buprenorphine would not diminish the importance of methadone in the treatment of heroin addiction. ‘It's certainly not our intent to supplant methadone,' Segal says. ‘Rather, NIDA wants to expand the drug treatment armamentarium and the overall number of patients in treatment."1

1Bowersox, J. A. (1995 Jan./Feb.) Buprenorphine May Soon Be Heroin Treatment Option. NIDA Notes. http://www.nida.nih.gov/NIDA_Notes/NNVol1ON1/Bupren.html

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