http://www.roanoke.com/news/roanoke/wb/192305

Methadone clinic fails to trigger any disasters

Despite earlier fears, the clinic has brought neither increased crime nor depressed property values.

Four years ago today, a methadone clinic opened in Northwest Roanoke amid predictions that it would be a neighborhood nuisance, a drain on home values and a hub for criminals.

So far, it's been just a methadone clinic.

Nearly 1,000 people have been treated at the Roanoke Treatment Center at 3208 Hershberger Road. Every morning, often before sunrise, addicts arrive at the brick building to receive a dose of liquid methadone, a narcotic that curbs their cravings for prescription painkillers, heroin or whatever opium-based drug it was that drove them to the clinic for help.

When the clinic began dispensing methadone on Jan. 25, 2005, nearby residents feared the worst:

Homes would be burglarized by addicts. Drug dealers would find new customers in the parking lot, posing a threat to residents and children at nearby schools. Property values would plummet. Those fears turned out to be unfounded, according to police statistics, real estate records and interviews with neighbors.

Last year, police were called to the clinic 14 times, mostly for minor reasons such as a false burglar alarm or reports of suspicious activity that didn't turn out to be serious. In its first year of operation, the clinic had 34 police calls, most of which involved the trigger-happy burglar alarm.

That's not an unusually large number. A nearby business, which authorities declined to identify, had 42 calls for service last year, police spokeswoman Aisha Johnson said.

"I don't even know that place is up there," Joseph Waller said of the clinic, which sits near his home on Swarthmore Avenue. "There is no problem whatsoever on this street from it.

"If it had to be rated, it would be a plus for the neighborhood and not a hindrance. Because it helps somebody, doesn't it?"

Since the clinic opened, property assessments on the 16 houses that sit on Swarthmore -- the nearest residential street to the clinic -- have all gone up, according to real estate records.

The clinic currently treats 428 people, director Letitia Malone said. Nearly half of those receive take-home doses of methadone, so they don't visit the clinic every day. A total of 945 people have enrolled since 2005.

"I think things have gone very well," Malone said. "It's been a real uphill journey, but we've been able to help a lot of families, save a lot of lives, and do some good work and provide a needed service to the community."

Before the clinic opened, opioid addicts in Roanoke had to drive two hours to find the nearest methadone provider. Demand for the treatment has escalated as the region has seen an increase in abuse of prescription medications.

Nationwide, about 260,000 people are receiving methadone treatment from more than 1,200 clinics, according to Mark Parrino, president of the American Association for the Treatment of Opioid Dependence.

A frequent criticism of methadone treatment is that addicts are simply trading one drug for another -- which Parrino said misses an important point. "Absolutely, they are dependent" on methadone, he said. "It's the nature of the medication and the nature of their brain chemistry."

But dependence on a prescribed medication is much different than addiction to a street drug, which often causes behavioral problems and criminal activity, Parrino said. Studies have shown that people on methadone are far less likely to fall into those traps.

Over the past four years, state inspectors have cited the clinic twice for violations of standards. One citation was for incomplete paperwork for one patient; the other involved a computer error that led at least one patient to be given an extra 20 milligrams of methadone. Average doses range from 80 to 110 milligrams.

Two violations over four years "would be a very good record, compared to the others," said Leslie Anderson, director of licensing for the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services, which regulates methadone clinics.

Still, some people remain critical. Many residents of Northwest Roanoke remember that the clinic came to their part of town only after a proposal for one in Southwest Roanoke County was withdrawn in the face of fierce neighborhood opposition.

To them, a black neighborhood was targeted for what wouldn't be tolerated in a white neighborhood.

Jim Beatty, who lives within sight of the clinic, said that just because there have been no major problems doesn't mean that residents have forgotten the controversy of four years ago. "I think a lot of folks that I've talked with feel like it was dumped on us because we were the least able to fight it," he said.

A lawsuit by nearby residents that sought to declare the clinic a public nuisance was dismissed in 2006. But opponents vow to keep up their close watch for trouble.

"The clinic will say they are a good neighbor," said community activist Jeff Artis, who was involved in protests when the facility opened.

"All I have to say to that is when you know someone is watching, you will always be on your best behavior.

"And we'll be watching the Hershberger Road methadone clinic as long as Folgers makes coffee."

This Guy Is A Nut! Look at his webpage directed at shutting down the clinic which has been proven to be a good neighbor. He thinks it was placed in his neighborhood because he is black. Funny that he can't see the irony of him discriminating against addicts causing the same problems that in the 1960's whites said blacks would cause if they moved in their neighborhood. LOL

http://www.jeffartis.com/roanokesclchomepage/planshutitdown.html

I just wanted to say after reading this article there was a few of the usual "stigma" related ideas in it but I have to commend the coroner for pointing out he had never done an autopsy on anyone who had taken their methadone as directed and the mothers said there is a place for methaone and the diversion needs to be stopped. I can live with that. Heck, I agree with it! As long as diversion is killing people the closer I come to losing my rights. So there are some areas where I can agree to disagree with HARMD. I guess this is what is making the group MAMA furious. I can't understand Nancy G.'s drive to ban MMT and her unwillingness to work with anyone on Methadone to stop diversion.

Methadone is now the top cause of accidental overdoses in Wabash Valley

By Brian M. Boyce
The Tribune-Star
In our hearts: Cindy McClain keeps a memoir (above) of her son Dylan at the family table. Dylan, 20, died May 5, 2007 of a methadone overdose. At top, At top, McClain lights a candle each day in front of the photograph of Dylan

TERRE HAUTE — For different reasons, Chuck Fortner and Dylan McClain probably would not have read an article about the dangers of methadone.

Their mothers hope the families of people like them will.

All that's left: Cindy Pierce sits in her home with memories of her son Chuck Fortner. Fortner died from a methadone overdose.

“Use it,” Cindy Pierce said of her son Chuck’s story. “Anything that can help the reader. I want that very much.”

Fortner, 36, suffered from chronic back pain and died in an accidental overdose involving methadone last June 23.

“It’s just a very lethal drug,” Cindy McClain said.

McClain’s son, Dylan, 20, died May 5, 2007.

Dr. Roland Kohr, Vigo County coroner and pathologist at Terre Haute Regional Hospital, said methadone is now the top cause of accidental overdoses in the area, noting 21 of 290 autopsies he performed in 2008 involved the drug.

Kohr not only performs autopsies in Vigo, but also counties ranging from Edgar in Illinois to Sullivan and elsewhere throughout the Wabash Valley. That number represents 7 percent of the total autopsies he performed last year.

And with the shocking price difference between methadone and OxyContin, the former has quickly become a widely prescribed alternative to other forms of pain medication.

According to information provided by a Wabash Valley pharmacy Thursday, 100 10-milligram tablets of methadone retails for $21.13.

Meanwhile, 100 40-milligram tablets of OxyContin is $694.33.

As Fortner pointed out, methadone is “very cheap pain medication,” often going to the underinsured, the uninsured, those lacking education, those on disability and those with chronic pain.

And that demographic, as well as the kids to whom it trickles down to on the street, just aren’t likely to research what makes methadone so unforgivingly different from medication that was actually designed to alleviate pain instead of service heroin addicts.

“They don’t understand the difference,” she said.

And that’s what McClain and Pierce want to change.

Deceptive

and unforgiving

Methadone’s roots go back to World War II, as the German and American governments sought a cheap alternative to morphine.

During the late 1960s, methadone was introduced as a way to wean addicts off heroin.

A synthetic opioid, the drug was administered orally at designated clinics. Doses were monitored and scheduled to wean addicts off gradually so they wouldn’t die from the effects of heroin withdrawal. Identification was required and distribution was supervised to ensure the appropriate dosage was used at the correct intervals.

But according to Kohr, over the past 10 years physicians have come to realize that when prescribed correctly, methadone can be an effective pain medication.

And with other name-brand pain medications coming under fire for a variety of problems, methadone has moved to the front, prescribed in what Kohr agreed are large quantities.

And while patients who follow their physician’s directions are in all likelihood safe, misuse can be fatal.

“It’s a far more dangerous drug than I think people have a concept of,” Kohr said.

Ignorance of the “wallop” packed by methadone can be lethal, he said.

McClain, spokeswoman for Indiana’s HARMD, which stands for Helping America Reduce Methadone Deaths, said methadone’s “half-life” is the problem.

Designed to combat the withdrawal symptoms of heroin addiction, methadone stays in a person’s system longer than other drugs.

So even after an individual has “come down” from the high, the chemicals are still working inside the body.

People used to the manner in which other pain medication gradually wears off are susceptible to shrugging at the doctor’s warnings and simply taking more of the highly addictive narcotic.

This makes the next dose potentially lethal, as the first isn’t fully out of the body yet.

“You just can’t take methadone like that,” McClain said, explaining the tolerance one builds up to other medications can lead one to believe they’re strong enough for larger doses of methadone.

Pierce said physicians need to monitor their patients’ usage and test their blood to make sure other medications aren’t mixed.

“Doctors are giving out 30 days worth of this drug,” she said, noting that for people with addiction problems and/or chronic pain, the temptation can be too great. That’s why the methadone clinics for heroin addicts make patients go on-site for the drug. “Just because you’re not feeling it doesn’t mean it’s not in your system,” she said.

And as pill-poppers look for the next high once methadone wears off, the result can be an immediate overdose, she said.

The Result

Fortner was a construction worker who first injured his back at age 20, Pierce said.

While roofing houses over the next 16 years, he had four back surgeries and suffered chronic pain.

Fortner had been taking OxyContin on prescription for two years before he moved to methadone.

“He thought it was a safer choice,” she said, noting he was unemployed at the time and cost could have been a factor.

Fortner was on methadone less than two weeks before he was dead.

The tolerance to OxyContin and other meds he’d built up over the years probably boosted his confidence, leading him to reach for a second dose when the effects of the first wore off, she now guesses.

“That tells me Chuck was in pain and he was trying to alleviate the pain. He didn’t realize the dangers,” she said, acknowledging she didn’t know much about the drug, either, until after her son died.

Kohr said he hasn’t performed a single autopsy involving a person who followed the prescription as written by a physician, but those who self-diagnose or mix methadone with other medications are at risk.

But as Pierce noted, the very demographic most likely to get the drug are the least likely to maintain discipline when a ready supply of relief is right in their hand, especially if they don’t understand the consequences.

“They’ll just go to sleep and not wake up,” she said.

Kohr first encountered the drug’s effects about four years ago while performing an autopsy on a 20-year old, otherwise healthy male, who had died without apparent cause.

Toxicology results showed methadone present, but at levels within the “therapeutic range,” he said.

It wasn’t until he probed further that he realized the “therapeutic range” of methadone is very wide as the drug is designed for heroin addicts with years of narcotic tolerance.

This could make the “therapeutic range” of methadone lethal to individuals who have never taken heroin.

Since then, he’s seen a spike in methadone-related deaths, usually where the drug is taken in combination with others, for pain or recreation.

Awareness

McClain said HARMD is her emotional outlet.

“I never feel like I do enough,” she said, recalling the 750 people who attended her son’s funeral last year, and the number of other kids’ friends affected by other kids’ deaths.

Through the association, McClain has met scores of families touched by methadone and other prescription drugs, ranging from patients with chronic pain to pill-popping teens.

Pills lack the stigma associated with needles and are easier to conceal than pipes and other drug paraphernalia, she said.

High-school students and even middle-schoolers engage in “trail mix parties” where bowls full of random pills are grabbed by the handful.

Kohr said the age and demographics of the autopsies involving methadone vary greatly, but combination with other medications seems to be a common denominator.

Whether it’s legitimate patients that unwittingly take other medications at the wrong time, or kids seeking a higher high, the result is the same.

Kohr said people with methadone prescriptions should “guard it” and make sure it doesn’t fall into the wrong hands.

  McClain referred to this as “diversion,” where someone takes a pill prescribed to someone else. She called it a major problem everywhere but particularly among kids.

The goal of HARMD is not the elimination or ban of methadone, McClain said, noting it, like all drugs, has a proper function.

But in all likelihood, everyone knows someone involved in pain medication, or knows kids who experiment with drugs.

Spreading awareness about methadone’s potential effects and lobbying for tougher penalties on those caught selling the drug to addicts are the main courses of action.

“And being there for other people who are going through the same thing,” McClain said of other families who have lost members to overdose.

Because the people most likely to misuse methadone are the least likely to read about its dangers, McClain and Pierce said they want the whole community to be aware.

Had they known then what they now know, their sons might still be alive.

“You always struggle with it. It never, never, ever goes away,” McClain said of her son’s death.

Brian Boyce can be reached at 812-231-4253 or brian.boyce@tribstar.com.

Doctor says methadone program needs funding, improvements to Ridgewood

SAINT JOHN - Dr. James West says the work being done at Ridgewood Addiction Services methadone maintenance program is good, but is hampered by a lack of funding and the facility.

West recently ended his time working at Ridgewood to concentrate on his private practice. Because of his departure, Marj Mullin, director of the methadone maintenance treatment program at Ridgewood, says arrangements have been made for his clients to see other physicians and Ridgewood continues to try and recruit other physicians.

"I think what they're doing at Ridgewood is good, but I don't think they have the facility to handle the volume," West said. "The whole medical system now is wait lists - waiting and not getting treated.

"(Ridgewood) can only deal with so many clients and there's such a long backup. It's frustrating to see so many people out there waiting to get in and can't."

There are more than 80 names on program's wait list.

While there is no easy fix, West said dispensing methadone at Ridgewood, rather than having clients fill their prescriptions at local pharmacies, could be a step in the right direction. He said this could lead to more spaces for clients, as well as improved supervision. He said things seem stalled with the current system. Pharmacies that agree to dispense methadone will only accept a certain number of clients.

"Instead of going to a pharmacy, they would be going to Ridgewood and seeing trained people who'll be watching them and more likely to pick up on when clients are having problems," West said.

Mullin said a program dispensing methadone at the facility began earlier this month.

"We have started what is a pilot project to administer methadone on-site to a limited number of people," Mullin said. "The purpose is to evaluate the effectiveness of that; the processes and procedures and looking towards the possibility of doing larger-scale administering."

The results of the project will be forwarded to senior leadership members of Regional Health Authority B and they will determine the next step.

In addition to improving the facility and dispensing methadone on-site, West said mixing up the service in terms of the counselling portion could also be beneficial. Those involved in the methadone maintenance program undergo counselling as part of the program, along with other social services.

"Not everybody needs extensive therapy," West said. "It's like people who come to my office, some only take five minutes while other take 20."

In this regard, West supports a scientific study proposed by Tim Christie, chairman of ethic services for the Atlantic Health Sciences Corporation. His proposal would provide methadone and nothing else - no counselling, for example - to 45 people on the wait list. Another 45 would simply remain on the wait list. The study would track and compare the two groups' results.

"This is based on scientific literature that says if you take two people that are both opiate addicts and you give one methadone and the other nothing, the person you give methadone will do vastly better on almost every conceivable outcome," Christie said in a previous interview.

West believes merging Christie's idea with the current program is more effective than addicts sitting on a wait list and continuing their habits.

"I think when you talk to people abusing drugs and ask how they get their money, the answer is stealing, robbing and others prostituting themselves," West said. "It's all illegal activities, so the less people who have to get that money to provide drugs, it reduces the illegal activities."

What it all comes down to for West is the work and desire to help more people is there, and the funding and resources have to catch up.

Methadone clinic bails on Monterey

http://www.livingstondaily.com/article/20090130/NEWS01/901300303/-1/NEWSFRONT2

Man to stand trial in methadone death

A Novi man was ordered to stand trial on charges his delivering methadone to a Brighton woman caused her death in August.

Norman Kenneth Schoder's former live-in girlfriend testified at a preliminary hearing Thursday that the 24-year-old man sold Frances Buresh his prescription methadone pills, which a medical examiner said contributed to the death of the victim.What else contributed to the death?

Cassandra Redmond of Flint testified that Schroder told her, "I hope (Buresh) didn't die because of the methadone pills," after learning Buresh had been found in her home in the Hidden Arbor condominium development Aug. 9.

The hearing ended with Livingston County District Judge Carol Sue Reader ordering Schroder tried on a charge of delivering a controlled substance causing death. The crime is punishable by imprisonment up to life.Life, mind you.... A LIFE sentence for selling Methadone to someone. How many laws change based on the outcome? If you sell Methadone and nobody dies then it is traficking but if someone drinks a fifth, pops a few Xanax (never mind how they obtained them because they are socially acceptable) and dies it turns into murder.

Redmond said she met and became friends with Buresh, whom she knew as Tina, at Narcotics Anonymous.LOL But they say Hogwash when we tell people you can get more drugs at an NA meeting than a crack house! People never complain about the location of an NA meeting but let a Methadone Clinic move in next to them & whoa is me! She said that on Aug. 5, Schroder and Buresh discussed on the phone the potential sale of Schroder's methadone.

She told police she believed Schroder sold the 40-year-old Buresh 15 pills.

On that day, Buresh spent the evening with the couple at their tNovi apartment. Redmond's testimony was conflicting on whether Buresh drank alcohol or consumed methadone pills that day.

Redmond testified that the next day she and Schroder took Buresh home, stopping at a bank so Buresh could withdraw $90 to give to Schroder to pay for the methadone. Bank records show the woman made the withdrawal at 5:54 p.m.

Brighton Police Detective Bradley Patton testified that officers went to Buresh's home Aug. 9 for a welfare check, after friends reported not seeing Buresh in several days.

Officers found Buresh dead on her couch and eight white pills, later identified as methadone, in a small container.

An autopsy later showed that Buresh died of "methadone intoxication," and that she also had alcohol in her system.

Howell defense attorney Mark Gatesman questioned Buresh's drug use, and Patton said his investigation showed that Buresh was a "known drug user" and that her drug of choice was heroin.Too bad he didn't sell her Heroin. if she had overdosed on that the fault would have been her own.

However, Assistant Prosecutor Shawn Ryan noted that the medical examiner did not find heroin in Buresh's system.

Schroder remains lodged in the Livingston County Jail. He is expected back in court next month.

.

CAMDEN - January 29, 2009 (WPVI) -- A methadone clinic in Camden is on the move and concerns about the changes of location are coming from two fronts.

For decades a methadone clinic has operated in the 400 block of Broadway in Camden.

Now, the board of directors of the South Jersey Port Corporation has agreed to lease one of its buildings at the Broadway terminal to the clinic's owner, Parkside Recovery, for $26,000 a year.

The state, which owns the port, will also spend nearly $2-million dollars to rehab the building

It's about half a mile from the nearest homes; still, some think it's a bad idea for the Waterfront South neighborhood

Monsignor Michael Doyle is the pastor of Sacred Heart Parish. He says most of the methadone clinic patients are from outside the city of Camden and that his neighborhood has been dumped on enough.

The current Parkside Property will be demolished to clear the way for an expansion by UMDNJ's medical campus. Some of the patients we spoke with think the move 18 blocks south will make it tougher for some to get help.

Helene Pierson is executive director of Heart of Camden a nonprofit that rehabs homes in Waterfront South and says the port is not the place for the clinic.

"They're a New Jersey state agency that has certain bylaws for maritime use, so a methadone clinic is not proper use of that," Pierson said.

The clinic is hoping to relocate in the fall, however, the heart of Camden nonprofit is planning a lawsuit to try and block the move.

..

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http://www.thecnj.co.uk/camden/2009/012909/news012909_02.html

Sarah Lucas: ‘Everyone has got their own way of making money... It’s like a big family but you don’t trust people’ ‘From first thing to last, your whole day is the drug’

With drug deaths in Camden now running at almost one a week, Simon Wroe talks to a woman winning her battle with addiction and witnesses a police raid on a crackhouse

Every morning, pockets of Camden wake up with the hangover of a drugs problem.
Road sweepers remove discarded syringes from parks and alleys; rough sleepers are roused from doorways.
At St Pancras Coroner’s Court in King’s Cross, inquests are opened into the deaths from the day before, often with nobody but a coroner’s officer present.
Earlier this week, the coroner ruled Vivian Stansbury, a 41-year-old addict from St Pancras Way, Camden Town, had died of a massive heroin overdose. No family or loved ones were there to hear the verdict in the echoing courtroom.
There are about 50 similar inquests each year in Camden, completed with only a handful of people being aware – the names change but the story remains the same. The borough has the highest drug mortality rate in London.
Down the road at Highbury Corner Magistrates’ Court the day begins with the overnight cases: a bedraggled procession of addicts, charged with minor possession or breaching bail conditions, are thrust into the dock and fined money they invariably do not have. In Euston, users waiting for their morning methadone queue on the pavement outside the Margarette Centre, a drug treatment facility.
Within an hour the dealers are stirring. Life begins again. For those who witness this process each day it can seem tragic, contemptible or just exhausting. But whether they look on or look away, an estimated 3 per cent of Camden’s population is living this desperate cycle of dependency, crime and self-destruction.
Sarah Lucas knows the routine well. Aged 30, she has spent the past 16 years fighting and feeding her heroin and crack cocaine addiction. Eight of those years were spent on and off the streets of Holborn, Soho and Camden Town. In that time she has seen the insides of dozens of courtrooms, prisons, hospitals and rehab centres, and begged or stolen thousands of pounds to fund her habit.
“Your whole day is the drug,” she said. “The drug runs you. It’s the first thing you think about and the last thing you think about.
“Everyone has got their own way of making money. Everyone’s morals are different. It’s like a big family, but you don’t trust people. I don’t really like what the working girls do but I would steal anything. The madames in the brothels like steak and fish and raw chickens. The prostitutes give you their bra sizes to go and nick sexy underwear for them. The dealers take PlayStation games and cannabis, and they love jewellery.”
Sarah is a small, pale woman, five foot four and just under seven stone. The viral infection hepatitis C, which she contracted by sharing drug equipment, makes her constantly fatigued and unable to gain weight. Her features are those of a young girl, yet her eyes are much older. She wears her hair pulled back severely in a tight bun. Over an hour she lights the stub of a rollie several times but does not smoke it.
“I know it’s our own fault,” she said. “But people think we take it to get high and we don’t. We take it to feel normal.”
Sarah has been dead on arrival at A&E twice after overdosing on speedballs – a common combination of heroin and crack injected together – and nearly died a third time from septicemia. Her body bears the scars of years of misuse: she has holes in both sides of her groin from injecting, a leg that will never recover from deep vein thrombosis, and crack-induced asthma.
Yet Sarah is one of the lucky ones. After numerous attempts to clean up, she is finally winning the battle and becoming a mother to her 10-year-old son again.
Her methadone intake is down to 35ml a day and she has not touched street drugs in a year-and-a-half, although she still sees the dealers who used to serve her every time she goes through Camden.
For the past three years she has lived with her partner, whom she met on the streets, in sheltered housing in St John’s Grove, Archway, run by the homeless charity St Mungo’s.
Drugs outreach ser­vices currently have nearly 2,000 people on their books in Camden, although only half this number will seek treatment and most of those will not stay the course.
“The stats don’t lie,” admitted David Devoy, St Mungo’s regional director. “There’s more going on in terms of drugs in Camden but there’s also more going on in terms of responses. Ten years ago, society just looked away from these people and it paid the cost.”
Rehabilitation, he said, has “got to come from the users to some extent. And it’s not linear; it’s more of a zigzag.”
Bona fide successes in the field are so rare, in fact, that the borough’s other main drugs service, Camden Primary Care Trust, recently rebranded as NHS Camden, declined to be interviewed.
“I detoxed seven times, I went to rehab four times,” said Sarah. “But my mind frame was just ‘the day I get out I can’t wait to put a needle in my arm’. I was trying to kill myself, more or less. There’s no point pushing somebody into rehab if they don’t want to go.”
Her voice is hoarse. She has been shouting at QPR, her football team. She used to play for their ladies under-18s, before she was kicked out for drugs. At her lowest ebb, Sarah had a £200-a-day habit and weighed just five-and-a-half stone. She looked so bad her mother would not let her see her son and she had a needle fixation; if she had no drugs she would inject herself with water “just to have the feeling of the thing, the relief”. When she was too weak to shoplift she would beg outside the HSBC cashpoint in Charing Cross.
“You wake up sick and think about where you’re going to get your next bag. I was injecting 10 hits a day,” she said.
“The lowest I would make begging would be £80 a day, and more on the weekends. With the shoplifting I’d make a lot more, but I was getting arrested once or twice a week. Prison was no different. I just used in there as well. It was like going on holiday. It felt like more punishment being out on the road. Some people would deliberately do stuff at Christmas to get in there.”
Sarah was expelled from school at 13 for aggression and was sent to a school for the excluded. She started using crack by accident in illegal ragga clubs in Tottenham Court Road.
“People were smoking it in spliffs in the clubs. I just thought it was weed. Then I liked it and started buying it.” At 15, she was taking heroin to come down; by 17 she was injecting.
She added: “Crack ruins your veins. Well, it all does. I had blood poisoning and pneumonia.”
When she got out of a spell in hospital in 2001, Sarah resolved to get clean. Doctors put her on oral methadone but she kept scoring on top so they put her on injectable methadone. She moved into the Endell Street hostel in Covent Garden.
“Eleven people died while I was there. No one turns up to the funerals. You see these paupers’ graves and feel so bad for them. People were always trying to shut Endell Street down but it was helping people. Without it there would have been more people in their doorways cooking up.”
Nearly half the tenants at Endell Street, as at St Mungo’s Bloomsbury hostel in Endsleigh Gardens, have dependency problems.
Drug use on the premises is not condoned, said Mr Devoy, but impossible to stop.
“We would certainly evict someone if all the help was thrown back in our faces. We’re in the business of giving people chances but not blind chances,” he said.
The hostels encourage addicts towards independence through a programme of activities, detox and resettlement.
A new “floating support service”, unique to Camden, now keeps key workers linked with particular clients after they leave hostel to stop them “lapsing”.
Sarah began seeking further help through the Milton Services drug support programme in 2004.
She stopped injecting crack, then smoking it altogether and is gradually weaning herself off methadone.
To deal with her crack cravings, however, there is nothing.
“That’s the worst one,” she said. “You’ve got to fight the cravings. Even some days today, if I see a little brandy bottle on the streets it’ll set off my cravings.”
Sarah has been on the road to recovery for seven years but it is slow and painful work. She undergoes therapy and weekly treatment for Hep C.
Security guards still follow her in shops and some of her family refuse to speak to her.
“It makes me angry – I’ve done all this hard work to get where I am and people still say I look like a crackhead. Am I ever going to look normal?” she wondered.
Once she is better, she wants to work as an outreach worker to the homeless. “I still see my old lot when I go shopping with my mum. I feel sorry for them – I don’t want to leave them. I feel bad that I’m in somewhere now and they’re not.
“I was out there for years and I hated it but when I stopped doing it I missed it. My life just went quiet. It was so loud out there. When I go to the West End and see someone sitting on my old pitch I think: ‘What you doing sitting there?’ Then I realise: ‘It’s not your pitch anymore’.”

Corinna Reid, 33, is wanted by the Spanish authorities to face charges over the death of her 16-month-old son Aiden Cormack-Reid in Tenerife two years ago.

Her case is now in the hands of Scottish ministers after a sheriff recommended she be extradited. Aiden's father Robert Cormack, 38, was transported to Spain today after agreeing to his extradition last week.

The offence is alleged to have taken place at the Hotel Paraiso Floral de Adeje in Tenerife on January 12, 2007.

Spanish authorities initially told the couple Aiden died due to respiratory failure brought on by bronchitis and allowed them to return home to Edinburgh.

But further toxicology reports carried out last year found the toddler had prescribed methadone and diazepam in his system.

The couple were told of the results and questioned last April and a European arrest warrant was issued for them.

If found guilty of murder, they could face a maximum 20-year jail sentence, or 15 years for manslaughter.

Miss Reid's lawyer, Ewen Roy, argued that extraditing her would breach her human rights because she is nursing the couple's six-month-old daughter.

At Edinburgh Sheriff Court today, Sheriff Frank Crowe ruled there were not "exceptional circumstances" to prevent her being handed over to Spain.

Mr Roy said his client intended to appeal the decision at the High Court next month.

Miss Reid declined to comment as she left court with family members.
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It doesn't say HOW the toddler obtained the drugs. Accidently finding them usually would involve taking one or the other & for some reason it doesn't sound right that a parent would force feed 2 different drugs to
a toddler but the article says she was breastfeeding so I wonder....However, it is suppose to be safe to breastfeed on methadone so this really puzzles me. I believe the couples lawyer has told them to be quiet but I often believe attorneys advice to "say nothing" leads to innocent people looking more guilty. Ya know? Like, the Casey Anthoney case...George and Cindi Anthony have been accused of having knowledge or partaking in the death MORE since they have had an attorney who no doubt is telling them to be quiet.

http://www.freep.com/apps/pbcs.dll/article?AID=200990129095

Detroit closes its methadone clinic

The City of Detroit has closed its methadone treatment center, which assisted about 500 heroin addicts in battling their problem, because of budget constraints.

Although the discontinuation of the program on Jan. 23 was not part of the plan to eliminate a $300 million deficit that Mayor Ken Cockrel Jr. will present Friday to the City Council, it is an example of the kinds of services that will end as the city grapples with its budget crisis.

The city could no longer afford the $1.7 million program, which it has run for more than 30 years, said Coraleen Rawls, general manager of the city’s Department of Human Services. The city referred each of the 500 clients to other providers, officials said.

“The money just isn’t there,” Rawls said. “We have had this program for a long time, and it’s with much sadness that we do have to close.”

Clinics offer methadone to heroin addicts because it satisfies their craving for the drug without the damaging effects.

The department informed employees of the closure in November, and they received layoff notices on Jan. 23. The final number of layoffs has yet to be determined, but Rawls estimated the figure at 20.

The closure was an internal department decision that predated Cockrel’s arrival in office, Rawls said.

Gina Thompson Mitchell, president of the AFSCME local that represents the affected employees, said workers are upset about the closure.

Not only will the layoffs only add to the city’s already large number of jobless, but Mitchell said some clients would not be accepted by other providers. How scary for them. This could happen to any of us. I wonder if they couldn't charge the clients? Then maybe the ones that could not pay could be covered by the cost offset? Anything would be better than the cost that the city will face after the clinic closes and people relapse.

“They’re going to go to the street drug if they can’t get the methadone.”

Look at some of the comments ....

larryeight1 wrote:

BOO-HOO, Hippies can't get their free dope anymore, that just breaks my heart.They seem to kick their habits just fine when they go to jail for commiting crimes against innocent taxpayers to support their self created problem. So they feel a little uncomfortable-puke,shake,runs-for a few days and then their clean.But nooo, methadone users just want to get some form of dope in their bodies every day, thats pathetic.
Maybe Fentanol will make a comeback and take care of some of the problem. The City(County, State and Feds) never should have started this free alternative dope b.s. You cure their heroin cravings so they now smoke crack and/or drink excessively to get high,brillant. The bottom line is the majority are losers and cowards who can't handle life sober.
In these economic times (or anytime for that matter) this is the last thing our tax dollars need to be supporting. I am sorry for any of the workers who can't be placed elsewhere.Some are former addicts, good luck.

HighlandParkBorn wrote:Have you known heroin addicts? I have, I'm sorry to say. Not one of the lazy, lying, selfish thieves did anything for others before first shooting up and have been nothing but a burden afterwards. Every one of them should be sterilized so as to not cause even more damage to children or to taxpayers.

Expensive prisons are not the answer for druggies.
Using chain gang techinques that force criminals to work to support themselves is the answer.Sorry, liberals. There's no sympathy here for those choosing to use illegal drugs.
Let the dopers quit cold turkey, then maybe they might become productive citizens. If not, well, then they shouldn't have shot up in the first place..

DetroitStreetApe wrote:
It is not in the best interests of humanity to coddle drug addicts, especially in taxpayer funded programs. The only cure for substance abuse is to stop using the substance. I'm all for a real war on drugs. But on the other hand, it's easier to control the dreck with bridge cards and heroin. Go figure.

henryu wrote:I'll take away their drug habit!

LolaJ wrote:

OH SHOOT......... WE HAVE ELDERLY PEOPLE FREEZING TO DEATH AND GETTING THEIR HEAT TURNED OFF IN DEAD OF WINTER, WE HAVE PEOPLE KILLING THEIR ENTIRE FAMILIES BECAUSE THEY LOSE THEIR JOBS, AND YET BUREACRAPS CAN DOLE OUT $1,700,000.000 TO KEEP THE JUNKIES FROM (RUINING THEIR HEALTH). DO WE HAVE ANYBODY SANE THATS IN CHARGE OF HANDING OUT TAXPAYERS MONEY? OR WILL IT ALWAYS BE CROOKS, WHORES AND THIEVES?
THERE IS SUPPOSED TO BE BILLIONS FROM THE MICH LOTTERY DONATED TO SCHOOLS. WHY ARE THE SCHOOLS CLOSING, NO TOILET PAPER, NO SUPPLIES, NO BOOKS FOR THE KIDS! WHOS POCKETS ARE THOSE FUNDS GOING INTO?

hard4unto2 wrote:Thank God we're not in Western Michigan where the Meth dope fiends run rampant, huh? ( I was living in this aapartment and I use to say, "I wish thhis chick across the hall would empty herkitty litter box!". Turns out she was cooking meth. WOW... She could have blew me up! Thank God we in Detroit, huh?

And they wonder why we relapse...LOL With all this support?

http://www.kenoshanews.com/news/judge_will_wait_to_decide_whether_homicide_charges_took_too_long_4264658.html

Judge will wait to decide whether homicide charges took too long

BY JOE POTENTE
jpotente@kenoshanews.com

A judge will wait until at least March to decide whether prosecutors waited too long to file charges against two Kenosha County men accused in a 2006 methadone death.

Kyle T. Young, 19, of Twin Lakes, and Joshua D. Jones, 22, of Trevor, will return to court March 10 for a possible ruling on their attorneys’ motions to dismiss their cases, based on undue prosecutorial delay.

The charges were filed Nov. 25, 2008, 28 months after Jesse James McFarlin died.

Young and Jones are charged with first-degree reckless homicide for delivering methadone to McFarlin, who was pronounced dead July 28, 2006, the apparent result of a mixture of methadone and alcohol.

Kenosha County Circuit Judge Mary Wagner adjourned a motion hearing Tuesday, to give the defendants’ attorneys an opportunity to review Assistant District Attorney Richard Ginkowski’s response to their motions.

Ginkowski cited past case law in defending his delayed prosecution, which he said he put on hold until other cases were settled involving the state’s toxicology expert in the case, Christopher Long.

Young’s attorney, Don Bielski, said the delay compromised his ability to have the case waived into juvenile court. Young was 16 at the time of McFarlin’s death.

Bielski warned Tuesday that he plans to subpoena Ginkowski to testify as the case’s lead investigator. Bielski said that would likely create conflicts of interest, making Ginkowski and his colleagues in the Kenosha County district attorney’s office unable to continue prosecuting the case.

In that event, a prosecutor from the state attorney general’s office or another county would likely have to sub into the case, Bielski said.

http://www.courierpostonline.com/apps/pbcs.dll/article?AID=/20090128/NEWS01/901280356&s=d&page=1

Methadone clinic gets home at port

CAMDEN — A methadone clinic that has been a trouble spot in downtown Camden for decades will get a new home inside the Broadway Terminal of the South Jersey Port Corp.

Directors of the South Jersey Port Corp. voted 6-0 Tuesday to lease space within its secure marine terminal to Parkside Recovery Inc., a division of NHS, a private, nonprofit corporation. Based in Layfayette Hills, Pa., NHS operates 580 facilities in nine states.

The move has fostered a six-year bitter war between two neighborhoods in the city. Those living near the current clinic, which dispenses methadone to 700 addicts a day, are glad to see it go. Those living near the new site in Waterfront South picketed the port and lobbied hard to bar the move.

The Broadway marine terminal is a gated compound near the Gloucester City border in a highly industrial area that buzzes round-the-clock with longshoremen, truckers, government inspectors and port employees.

It is 18 blocks south of the clinic's current location at 400 Broadway. The clinic has operated in the shadow of Cooper Hospital for about 30 years. Now that the area is slated for housing, an elementary school and a massive infusion of capital from the health and science sectors, officials determined the clinic sitting on a state-owned property must go.

Recently, the state sold the site to the Camden Redevelopment Authority for $775,000 with funds from the University of Medicine and Dentistry of New Jersey. The university plans to build classrooms there for third- and fourth-year medical students who do their clinical training at Cooper. The long-range goal is to expand that program into a four-year medical school.

"I'm pleased the decision has finally been made. It's been a long time coming. At least, the new site is further away from residents and the port is better able to secure these services. A medical school helps Cooper remain an academic center, and it will give us a facility that will make medical education much better in South Jersey," said John P. Sheridan, president and CEO of Cooper Health System.

Monsignor Michael Doyle, pastor of Sacred Heart Church at Broadway and Ferry and a South Camden activist for decades, called the move "barbaric injustice" to a neighborhood already burdened with the Camden County Sewage Treatment plant and a trash-to-steam operation.

"It would be hard to find another area in North America that has been trampled as much by powerful people, mostly men in white shirts, who care little about the poor. A methadone clinic here will have a neon sign for the mind that says "drugs sold here.' " Sad to hear this from a priest.

Patrick Mulligan, assistant director of the Heart of Camden, a grass-roots neighborhood group, called the forces behind the move "the height of hypocrisy."

"You're not doing the city any good to have one neighborhood claim its success depends on the death of another," he said.The presence of a clinic should not be viewed as the death of a community.

Under the agreement, Parkside Recovery will lease 7,500 square feet on the first floor of building P1 and P2 within Broadway Terminal for 10 years for $3.50 a square foot, or $26,256 a year. The port also will provide 40 parking spaces on the opposite side of Broadway and space within the port for a mobile van.

The new site will be 1,300 square feet larger than the current site. The extra room should eliminate some of the concerns expressed by residents that addicts would be spilling out onto the streets. Ah yes, nothing worse than cleaning up spilled addicts. LOL

The new site will have a large waiting room, space for child care for those parents who come for counseling, and better security, said Parkside's Executive Director Charles Greene.

"I just can't wait to get my staff into a decent building," Greene said.

The state Division of Addiction Services is prepared to spend $1.9 million on renovations to the port building.

The port will bid the work out in March and hope to begin construction in April or May. By October, the port expects the old clinic to close and the new one to open, said Marlin Peterson, the newly named assistant executive director of the South Jersey Port Corp., a quasi-state agency.

Also on Tuesday, Kevin Castagnola was named acting executive director Tuesday. Castagnola will fill in temporarily for Joseph Balzano, who is recovering from an illness.

http://www.post-trib.com/news/1400162,vmethadone.article

Porter-Starke spreads word about its methadone clinic

A new billboard on Interstate 94 announces the clinic, which has been open for almost a year, and is the first foray into openly advertising the clinic that the group has taken.

Carmen Arlt, director of addiction services, said Porter-Starke had decided to go ahead finally with advertising, aftering relying mostly on word-of-mouth, because the clinic was running smoothly and everyone was comfortable with the processes.

"We are ready to rock and roll," she said.

The group chose to do a billboard on the interstate because of its high traffic, Bob Franko, vice president of marketing and development for Porter-Starke, said. Although Porter-Starke has stayed away from advertising the clinic so far, he said, officials knew from the beginning they would have to eventually start building community awareness about it.

The billboard, which can be seen about a mile before the Lake Station exit when headed east on the interstate, has a red and white background with a headline that says "Addicted to opiates?" Underneath, it lists Porter-Starke Services Methadone Treatment Center and contact information.

"We were very, very conservative about how we were getting the information out," Franko said. "We didn't want to raise a big stink about it."

The billboard, which was put up Jan. 19, is already showing results. Arlt said six or seven people have come to the clinic, saying they didn't know about it until they saw the billboard. The clinic has 67 methadone patients but can handle up to about 300.

For now, this is the only formal advertising Porter-Starke is doing for the clinic and the billboard is contracted to last for three months, with each month costing about $1,000, Franko said. It's likely, though, that Porter-Starke will try to do another billboard in a second location later on this year, he said.

The clinic also is doing some word-of-mouth advertising, going to local doctors, emergency rooms and even street hangouts to start letting people know about the clinic, Arlt said.

"Wherever we know there's a lot of drug traffic, we'll go down physically and hand out pamphlets," she said.

Although the advertising could also attract drug dealers who see the clinic as a concentrated base of clients, Arlt said she wasn't too worried because of the clinic's numerous indoor and outdoor cameras.

Arizona Capitol Times

January 16, 2009

Bill would add methadone to Arizona's DUI law

BYLINE: Anjanette Riley

Arizona's DUI laws are some of the most severe in the country, and Sen. Jim
Waring wants to make the laws even more restrictive with the introduction of a
bill that would ban motorists from driving under the influence of prescription
methadone.

Methadone - a synthetic opioid developed in World War II Germany - is a
common treatment for drug dependence. An oral dosing of methadone stops feelings
of withdrawal in addicts and blocks the euphoric effects of heroin and morphine.

Statutory law bans individuals from operating a vehicle while under the
influence of drugs, but exempts individuals taking a drug prescribed by a doctor
from DUI penalties.

Waring's bill would remove methadone from the list of exempted prescription
drugs, giving drivers taking the medication the same punishment as a person
driving while under the influence of alcohol or an illegal drug.

"People came to me because I did a DUI bill that had a lot of success,"
Waring said. "This is not as huge an area. It will not create as many fatalities
as drunk driving does, but we do not want to overlook something that might be
easily rectified. "

The bill, S1003, was introduced in response to a series of accidents in 2008
caused by the delayed response times of drivers using methadone. Several of the
accidents, such as the one that killed five cheerleaders in Prescott, were
caused by drivers taking methadone in conjunction with other prescription drugs.

Waring said he would consider adjusting the measure to distinguish between
penalties for drivers using only methadone and for those taking the drug as part
of a prescription cocktail.

"I understand there is a middle ground," he said. "I would be amenable to
change. "

Sen. Linda Gray, chairman of the Senate Public Safety and Human Services
Committee, has indicated an interest in the bill, Waring said.


Linda Gray
Republican District 10
Senate
1700 W. Washington
Room 309
Phoenix, AZ 85007
Phone Number: (602) 926-3376
Fax Number: (602) 417-3253



Email Address: lgray@azleg.gov


Jim Waring
Republican District 7
Senate
1700 W. Washington
Room 302
Phoenix, AZ 85007
Phone Number: (602) 926-4916
Fax Number: (602) 417-3250



Email Address: jwaring@azleg.gov

Please write Mr. Waring, I did.

A lesser evil for drug addicts

By MINDELLE JACOBS

Last Updated: 27th January 2009, 1:20am

There may be public health benefits for addicts of injection drugs shifting from street drugs to the misuse of prescription medication, according to a controversial paper.

Addicts who forge prescriptions or engage in so-called double-doctoring to get prescription opioids such as dilaudid and Oxycontin are significantly less likely to inject, which reduces the risk of blood-borne diseases such as hepatitis C or HIV.

They're also less likely to overdose or become ill because the potency of prescription drugs is known, unlike that of illicit drugs, according to the advance electronic article in the medical journal Public Health.

"One crucial risk factor for harm related to injection drug use has traditionally been the unknown, and often widely varying, potency ... of street drugs," says the article.

The purity of heroin ranges from 10% to 70%, it notes, leading to overdose risk.

While the non-medical use of prescription opioids, especially when capsules are crushed and injected, bears health risks, there's still less danger of overdosing, the authors write.

In addition, the misuse of prescription drugs cuts crime because addicts aren't robbing people to get the funds to buy heroin, they suggest.

Forging prescriptions or double-doctoring "are clearly not desirable or ideal ways to care for addicted populations" but potential reductions in mortality, illness or crime can be seen as "superior objectives to justify such behaviours," they write.

UNORTHODOX

"An unorthodox way of thinking about the increasing prevalence of (prescription opioid) use among street drug users might be as an unsanctioned or indirect form of medical opioid substitution," they explain.

The authors see such behaviour as filling an unmet need because methadone and other heroin substitution treatment is limited in Canada and the U.S.

In B.C., which has one of the higher per-capita methadone treatment rates, there's only enough methadone for 50% of the people who are regularly injecting opioids, says Dr. Perry Kendall, B.C.'s provincial health officer and a co-author of the article.Oh, Lord...so the other 50% should just pop pills and lay down the needle. Wonder how long before they realize you can inject Oxycontin?

Some medical issues are more likely to attract funding than others and mental health and addiction are still so stigmatized that it's hard to compete for health dollars, he says.

"At some point, (addicts) are going to want to quit and ... access to treatment is not that available in a timely fashion."

In the paper, Kendall and his co-authors recommend that more research be conducted comparing the mortality, illness and crime burden of heroin users and prescription opioid users.

"If you're going to abuse opioids, it might be better from a public safety ... perspective to be abusing diverted prescription ones than the stuff that's manufactured in Mexico or Burma," Kendall said yesterday.

Co-author and Simon Fraser University public health specialist Benedikt Fischer said the point of the paper was to open up the debate.

SHIFT AWAY

"There's a shift away from heroin and increasing use of prescription opioids and everyone seems to be panicking about it," he says.

"We're just trying to do a bit of constructive thought-provoking in the interests of public health," he explained.

"We don't want anyone to be using drugs illicitly. It's not good for public health. We're just saying, relative to the previous predominant reality, (pharmaceutical substances) may not be all bad."I know they mean well but sometimes I wish people on our side would be quiet. LOL

Adds Kendall: "We could look to (Barack) Obama who said now science has a place in policy. I would hope that might sneak north of the border."

People 'scared away' by methadone clinics

Posted By BRENDAN WEDLEY , EXAMINER MUNICIPAL WRITER

Posted 10 hours ago

Methadone clinic operators need to work with the community to better integrate the clinics into the city, the planning committee decided last night.

City council, sitting as planning committee, received an information report on the zoning bylaw that permits certain properties to be used for methadone clinics. The planning department informed council that any property zoned for a clinic could be used for a methadone clinic.

The city needs to provide some planning guidance, Coun. Bob Hall said.

"Basically every commercial site across the city can have a methadone clinic," he said. The Horror!

Hall told council that some people who have businesses next to methadone clinics are devastated by the operation of the clinics.

"People are being scared away from their businesses," he said.

Council asked staff to provide another report with suggestions on how to integrate methadone clinics into the community.

Some people think of a person who receives methadone treatments "as someone who makes absolutely no contribution to society and that is absolutely wrong, wrong, wrong," Coun. Patti Peeters said.

There were 819 people registered with the College of Physicians and Surgeons of Ontario as receiving methadone treatment in Peterborough. What? Doctors on Methadone? Surely you jest....Why are there not a string of dead bodies in their wake? A cover up must be afoot...LOL

NOTES:Council started the planning committee meeting at 7:20 p. m. It was scheduled to start at 6:30 p. m. but a closed-door session of committee of the whole on a proposed sale or purchase of land ran late.... Coun.Ann Farquharson wished MayorPaul Ayotte,who was absent, a happy birthday.

I am concerned about this because we may have people taken off their Methadone which have been on it for years. Many Meds cause this phenomenon and it is not proven that the study released was certain that Methadone was the cause. See Dr.Andrew Byrne's comments which are thought provoking at least. He raises some very important flaws in Dr. Krantz theory and he asks this (which is a perfect example why I love Dr. Byrnes) "Do I belabour the point? If this is a serial killing, Miss Marple, where are the bodies? " LOL Gotta Love Him!

http://www.redfernclinic.com/c/

Safety Guidelines Issued for Prescribing Methadone

http://www.medscape.com/viewarticle/587321

January 26, 2009 — The Center for Substance Abuse Treatment (CSAT) convened a Cardiac Expert Panel that issued safety recommendations regarding arrhythmia risk and rate-corrected QT interval (QTc) interval monitoring for clinicians prescribing methadone. The new clinical practice guidelines were published in the December 2 Early Release issue of the Annals of Internal Medicine, but the Annals subsequently withdrew the article and have now republished it in their January 20 online issue. To determine the changes in the republished article and the need for these changes, Medscape Internal Medicine interviewed lead author Mori J. Krantz, MD, FACC, FACP, associate professor, University of Colorado & Denver Health Cardiology, and director of the Prevention Department, Colorado Prevention Center. Compared with the originally published version, “there were no scientific or content changes” in the revised article, according to Dr. Krantz, but changes were made “to ensure adequate separation between this publication and the division of the US government (CSAT) that convened the expert panel.” The reason for earlier withdrawal of the original article was “the need to reformat the disclosure to make clear this guidance was not a formal position paper from CSAT, which has its own internal process for creating governmental documents that often entail extensive, external field review,” Dr. Krantz said. “This scientific publication was expedited to the medical community because the cardiac expert panel felt it was a pressing public health concern.” Background information in the article notes that methadone, which is the most widely used agent for opioid maintenance, may prolong the QTc and result in torsade de pointes. The US Food and Drug Administration (FDA) issued a clinician safety alert regarding increasing fatalities and cardiac arrhythmias, and subsequently a manufacturer's black box warning. Multiple factors may contribute to drug-induced arrhythmia, including hypokalemia, structural heart disease, hepatic cytochrome P450 inhibitors, and genetic predisposition, as evidenced by a prolonged QTc interval at baseline. In May 2003, the CSAT convened a meeting to review preliminary evidence regarding the proarrhythmic properties of methadone. This meeting was reconvened on July 20, 2007, leading to a recommendation that a multidisciplinary expert panel be formed on the cardiac effects of methadone. This panel included electrophysiologists, pain-management specialists, and epidemiologists, as well as representatives from the FDA, the National Institute on Drug Abuse, the American Association for the Treatment of Opioid Dependence, and the American Society of Addiction Medicine. “This guideline is unique given the diversity of input and its cross-cutting nature in terms of clinical relevance,” Dr. Krantz said. “It is also fairly declarative regarding practical action steps for providers with regard to optimizing cardiac safety in methadone treatment.” Members of the expert panel reviewed pertinent English-language literature identified from searches of MEDLINE and EMBASE (1966 to June 2008), US national substance abuse guidelines and those of other countries, information from regulatory authorities, and information concerning clinician awareness of adverse cardiac effects. This review of the evidence suggested that methadone, both oral and intravenous, is associated with QTc interval prolongation and with torsade de pointes. The panel issued the following specific recommendations in 5 key clinical areas: Recommendation 1 (Disclosure): When clinicians prescribe methadone, they should inform patients about arrhythmia risk. Recommendation 2 (Clinical History): Clinicians should ask patients about any history of structural heart disease, arrhythmia, or syncope. Recommendation 3 (Screening): All patients should have a pretreatment electrocardiogram (ECG) to measure QTc interval and a follow-up ECG within 30 days and each year. If the methadone dosage is greater than 100 mg/day, or if patients have unexplained syncope or seizures, additional ECG is recommended. Screening with ECG may also be done as indicated for patients receiving methadone who have multiple risk factors for QTc interval prolongation, such as a family history of long QT syndrome or early sudden cardiac death or electrolyte depletion. Screening is also recommended when a cytochrome P450 inhibitor or other QTc interval–prolonging drug, including cocaine, is started. Recommendation 4 (Risk Stratification): For patients in whom the QTc interval is between 450 and 500 milliseconds, the potential risks and benefits should be discussed, and they should be monitored more frequently. If the QTc interval is greater than 500 milliseconds, discontinuing or decreasing the methadone dose should be considered, as well as eliminating other contributing factors such as drugs that cause hypokalemia. Use of an alternative therapy may be indicated. Recommendation 5 (Drug Interactions): Clinicians should be knowledgeable concerning interactions between methadone and other drugs that tend to prolong the QT interval or to slow the elimination of methadone. "Opioid treatment programs in the United States are accordingly challenged with integrating cardiac arrhythmia risk assessment into [the] routine care process without reducing access to vital addiction treatment services," the authors write. "We believe that increased clinical vigilance will reduce sudden cardiac death among the approximately 250,000 patients receiving methadone in opioid treatment programs as well as the nearly 720,000 patients receiving methadone for chronic pain through U.S. retail pharmacies.” For patients in whom marked QTc interval prolongation or torsade de pointes develops while receiving methadone therapy, buprenorphine is the only alternative therapy approved by the FDA. The authors note that pending larger prospective studies, (R) methadone could prove to be a safe therapeutic alternative vs the standard racemic mixture (R,S) methadone. However, (R) methadone is currently unavailable in the United States. "With regard to cardiac arrhythmia risk, standard methadone can be safely administered as long as the potential for QTc interval prolongation is recognized through ECG screening and appropriate clinical actions are taken in the presence of QTc interval prolongation," the authors conclude. Dr. Krantz told Medscape Internal Medicine that these guidelines are geared toward the entire medical profession, particularly those who often prescribe the drug, such as pain management specialists. “This life-threatening rhythm disturbance is a consequence of the ‘medication’ and crosses specialty lines, so to speak,” Dr. Krantz said. “As such, [the guideline] is also geared to cardiologists and critical care doctors who see these patients in the [intensive care unit and who] to date have been unfamiliar with the association between methadone and torsade de pointes. Finally, this paper is relevant to pharmacoepidemiologists and regulatory stakeholders involved in surveillance of drug related serious adverse events.” The CSAT of the Substance Abuse and Mental Health Services Administration sponsored the 2 expert panel meetings but had no role in the design, data collection, analysis, or manuscript preparation. The views presented in the Annals article are those of the authors and other referenced sources and do not necessarily reflect the views or policies of the Department of Defense, the CSAT, the Substance Abuse and Mental Health Services Administration, or any other part of the U.S. Department of Health and Human Services. The authors of the guideline note that clinical practice guidelines are intended to improve patient care but not to replace clinical judgment, in that the guideline may not apply to all patients or clinical scenarios. The authors have disclosed no relevant financial relationships. Ann Intern Med. Published online January 20, 2009.

West Palm Beach woman charged with DUI in September crash

Stanley, of West Palm Beach, was arrested Sunday and booked into the Palm Beach County Jail on charges of DUI with serious bodily injury to another, DUI with property damage and operating a motor vehicle without a license.

A judge this morning ordered Stanley held in lieu of $4,000 bail.

http://www.tcpalm.com/news/2009/jan/22/methadone-key-alleged-drug-dealers-murder-charge/?feedback=1#comments

Methadone key to alleged drug dealer's murder charge

An alleged drug dealer won’t be going free despite a state appeal court ruling that he can’t be held accountable for first-degree murder of a local college student who died of a methadone overdose in 2005, prosecutors say.

William McCartney III, 34, of Vero Beach, still faces a lesser murder charge, third-degree murder, as well as drug sale charges, said Assistant State Attorney Ryan Butler.

College student Nolan Adams, 19, died at his home Jan. 25, 2005 after ingesting methadone, allegedly bought from McCartney, according to court files.

On Wednesday, the Florida 4th District Court of Appeal in West Palm Beach upheld Circuit Judge Dan Vaughn’s 2008 ruling that McCartney couldn’t be charged with first-degree murder under state drug statutes because methadone isn’t in the statute’s list of drugs for that crime.

Methadone is a synthetic drug developed as an alternative to heroin, which is derived from opium. Opium is in the state murder statutes. However two drug experts testified that methadone is not an opiate.

“The state argues that methadone is a synthetic opium,” according to the appeals court ruling. “We cannot agree.”

McCartney remains jailed without bail pending trial.

“For my wife (Phyllis) and I, it is incredible that the judicial system has taken almost four years,” said Adams’ father, Ray Adams, of Vero Beach. “We are still awaiting trial.

“We laid my son to rest,” he said. “Each time this comes back up (the case) we have to relive the horror” of what happened.

The appeals court ruling now means Butler may move ahead with prosecuting McCartney. The lesser murder charge McCartney faces isn’t affected by the appeal court ruling, Butler said.

McCartney also faces two counts of sales of a controlled substance, as well as sale of methadone and xanax drugs. If convicted, he could face serving more than 15 years in jail.

McCartney’s case is scheduled to come up for court review April 22 in Indian River Circuit Court. At that time, it could be set for trial, court records show.

I can't believe after 4 years and an appeal overturned that this man is still being charged with murder.

http://www.citizen-times.com/apps/pbcs.dll/article?AID=/20090123/NEWS01/901230331&s=d&page=1

Murder charge filed in methadone death

MILLS RIVER – An Asheville man faces a murder charge after authorities said he supplied the methadone that killed a Mills River man last August.

Henderson County sheriff's deputies Thursday arrested Nikolas Ramiro Flores, 19, of Cessna Way, after the grand jury indicted him Tuesday on a charge of second-degree murder. The charge stemmed from an investigation into the death of 19-year-old Christopher Thomas Waters. Family members found Waters dead Aug. 11 at his Amywood Lane home.

Investigators determined Waters died from acute drug toxicity, or overdose from methadone, according to a news release from the Sheriff's Office. Authorities determined Flores gave Waters the prescription drug, which is commonly used to treat opioid addiction.

It's unknown where Flores got the methadone, Henderson County Sheriff's Capt. Charlie McDonald said.

“I do know that it wasn't anything he was authorized to have,” McDonald said. “He acquired it by illegal means.”

Thursday's arrest is the second prescription drug-related death charge filed in Henderson County since September. Investigators charged James Michael Arnold, 23, of Willis Way, with second-degree murder in the death of Justin Kane Anderson, who overdosed on the painkiller fentanyl and died in July.

Arnold also is charged with possession with intent to sell or deliver fentanyl and sale or delivery of fentanyl. Arnold has a March court date on the drug charges, online records show.

“I think we've got prosecutors that are willing to prosecute if we can show clear evidence that links the person the victim,” McDonald said. “When you've got kids selling drugs to kids and kids dying as a result, it's pretty bad.”

Flores' bond was set at $50,000. McDonald said he may face additional drug charges. There are no other suspects at this time. No other suspects? What about the dealer where the methadone came from?

Nikolas Ramiro Flores

This has gone completely out of hand. This boy looks like a baby. His mother wrote a comment on the article as follows...

This is Nikolas's mother. This family has been devastated! Nik is NOT a murderer! We need a rally in front of the court house on March 16 with posters that state to free him, and about the unfair accussations! I feel for the Waters family, but this is not the answer to their emptiness! Chris Waters took that drug on his own decision. They were best friends. We need to find the real killer behind all this, and Nik can help. Please help the innocent be free. We all can do it if we stick together. Be there!

This is so sad. Personal accountability has got to come into play somewhere. If I lived near NC I would be there to march with this mother because I have a 19 year old boy and if this was him I would be outraged.