Common Ground Emerges in the Methadone vs. Drug-Free Recovery Debate.

Nicotine Skin Patch Helps More Quitters Resist Cigarettes When Worn Longer

Nicotine Skin Patch Helps More Quitters Resist Cigarettes When Worn Longer.

by on February 1, 2010

By Ellen Gibson Feb. 1 (Bloomberg) — Cigarette smokers trying to quit who wear a nicotine patch for six months, rather than the standard two, may stay away from smoking longer, U.S. scientists said. Researchers at the University of Pennsylvania School of Medicine found that 32 percent of smokers who wore the patch for 24 weeks were smoke-free, compared with 20 percent of those who used it for 8 weeks, according to a report in tomorrow’s Annals of Internal Medicine . Participants used GlaxoSmithKline Plc ’s Nicoderm CQ. Novartis AG makes a competing product. Smoking cigarettes increases the risk for lung cancer, heart attack, stroke and high blood pressure, according to the National Institutes of Health , and adults who smoke die 14 years earlier on average than nonsmokers. Those who puff may become addicted to nicotine, and quitters often undergo withdrawal and have cravings that persist long term. “Nicotine addiction is not an acute condition that can be treated in a couple of months,” said study author Robert Schnoll , an associate professor of psychology at Penn, in a Jan. 29 phone interview. “It’s a chronic condition that needs extended therapy and we hope this research will encourage doctors to keep their patients on the patch longer.” Glaxo’s NicoDerm CQ and Novartis’s Habitrol are patches that supply the body and brain with a steady stream of nicotine absorbed through the skin. Current guidelines recommend using the patches for 8 weeks, the study’s authors said. The nicotine helps to prevent withdrawal symptoms in people who stop smoking, according to the Bethesda, Maryland-based NIH. Study Design The study was conducted at Penn’s Transdisciplinary Tobacco Use Research Center in Philadelphia in people who smoked at least half a pack a day. About half of the 568 participants received active nicotine patches for 24 weeks. The rest had eight weeks of nicotine replacement followed by 16 weeks of placebo patches. All were given behavioral counseling. At the end of six months, 89 people in the treatment group were smoke-free for seven days, compared with 58 people in the placebo group, the researchers said. At the one-year mark there was no difference between the two groups, with both having a quit rate of about 14 percent. That statistic reinforces the idea that nicotine dependence should be treated more like opioid addiction, Schnoll said, where users are sometimes given methadone, a detoxification medication, for years. No Cold Turkey The American Lung Association in Washington doesn’t recommend that smokers quit “cold turkey,” without the aid of a prescription or over-the-counter treatment, said Norman Edelman , the organization’s chief medical officer, in a Jan. 29 phone interview. Nicotine supplements also come in the form of gum, lozenges, nasal sprays, and inhalers, according to the NIH. Other treatment options are Chantix, a drug from New York-based Pfizer Inc. that works on the brain’s nicotine receptors, and Glaxo’s Zyban, which is available in generic form under the name buproprion. The two main barriers to keeping patients on the nicotine patch longer are side effects and costs, Schnoll said. Common side effects of the patch include skin redness, headache, nausea, and sleep problems. The researchers found no significant difference in the intensity of side effects between the treatment and placebo groups after the eighth week, according to the report. Safer Than Smoking “We don’t know, longer term, what effect keeping people on the patch would have,” said Schnoll. “But nicotine replacement therapy is definitely safer than tobacco use.” The additional cost per quitter was about $2,482 for the 24-week treatment regimen, the research paper said. Only 8.6 percent of health insurers cover the full cost of the patches, and only 33 states subsidize them for Medicaid patients, the study’s authors said. “If you do the arithmetic,” said the lung association’s Edelman, “you’ll find that if you live in New York City and you smoke a pack a day, you’re already spending about $300 a month.” The study was funded by a grant from the National Cancer Institute and the National Institute on Drug Abuse. The study’s senior author, Caryn Lerman , has served as a consultant for GlaxoSmithKline. To contact the reporters on this story: Ellen Gibson in New York at egibson9@bloomberg.net ;

Dover-Foxcroft discusses methadone clinics

Dover-Foxcroft discusses methadone clinics – Bangor Daily News.

By Diana Bowley
BDN Staff

DOVER-FOXCROFT, Maine — Having been directed to revisit a proposed land use ordinance that was defeated by residents in November, the land use ordinance committee held a lengthy discussion Wednesday about the possible need to include in the revision some regulations for methadone clinics.

That was scrapped, however, when a hospital health official told the committee it was “pretty unlikely” that someone would want to open a clinic in Dover-Foxcroft.

Rather than add more to the proposed ordinance, the committee decided to consider only the minor revisions suggested by residents at an earlier public hearing and at a meeting Wednesday and to forward the revised document to the planning board for its approval.

Some town officials believe the proposed ordinance was rejected earlier because of confusion over the ordinance and a couple of amendments.

By law, the town must have a land use ordinance that complies with the comprehensive plan adopted by residents in 2006. If the planning board approves the revised ordinance, it will be forwarded to selectmen for a public hearing, then placed on the town meeting ballot.

“As a committee, we were given this comprehensive plan that was approved that says you will have these kinds of zones and you will create them. We did that and it was defeated,” George Barton, chairman of the ordinance committee, said Wednesday. “We’re trying to hear what was wrong with it.” As of Wednesday, there were few suggestions for changes.

As in November, residents will be asked to approve an amendment to the comprehensive plan to change the buildable lot size in certain areas of the town from 10 to 2 acres. The comprehensive plan calls for a 10-acre lot size for building in some areas of the town, which the land use ordinance committee thought was too oner-ous, so the committee has recommended amending that to a 2-acre minimum.

Barton said the committee could find no other place in the state that required a 10-acre lot size in order to build. “We think that’s a real burden on a landowner. We want to say 2 acres, so that’s a change to the comp plan,” he said. Residents also will be asked to approve a subdivision amendment and an amendment to change the frontage in the comprehensive plan from 400 feet to 200 feet.

At Wednesday’s meeting, the committee heard from John Spieker, director of psychiatry and counseling services at Mayo Regional Hospital, who addressed the committee’s concerns about methadone clinics. The town has no ordinance that addresses either methadone or marijuana clinics.

Asked how realistic it would be to expect to see a retail methadone clinic in Dover-Foxcroft, Spieker said, “At this point in time, I would say it’s pretty unlikely.” Spieker said the town doesn’t have the population base of people on methadone who would change the care they are getting, probably in Bangor, to make such a busi-ness sustainable in Dover-Foxcroft.

Even if there were interest, Spieker said, zoning would not eliminate all the problems.

“I think zoning is a really, really important piece to struggle with and define,” he said. “But it won’t, in my opinion … guarantee that you will be mostly problem-free because a lot of it is going to be based upon what and how is the management and the structure of the entity providing that service.”

Substance abuse services are provided by a wide range of organizations, Spieker said, so a church-based organization, a hospital, a nonprofit organization or a for-profit business could open a clinic, and it could be very well run or very poorly run.

“We have no plan or goal to create a methadone clinic. That’s not part of our agenda for the purposes of substance abuse treatment,” he said of Mayo Regional Hospital.

“The biggest challenge that Maine has had — and it’s not just Maine, it’s really kind of northeast United States — is a preponderance of opiate-based prescriptions have really impacted our communities,” Spieker said.

He said there is a lot of prescription drug abuse and misuse, which is sometimes deliberate and sometimes not. Doctors prescribe a pain reliever for a long period and some people develop a physical and psychological dependency on that drug, he said.

“Nobody ever plans to become a drug addict or an alcoholic; it’s not something you aspire to when you’re five years old, but it does happen in a lot of people’s lives.”

Spieker said Maine has been doing surveys for a number of years on substance abuse and Piscataquis County “consistently ends up in one of the worst places,” the predominant component being alcohol followed by marijuana.

The challenge, Spieker said, is how to help these abusers make different choices and live a different lifestyle that doesn’t have those negative consequences.

Police report problem of drivers impaired by prescription drugs

Where are the statistics?  Why is it that the BDN jumps on every chance to put down MMT?  The police officers in this story only offer vague “recollections” of stories about “drugged” methadone patients…yet offer no concrete stats.  They offer less then 5 stories of methadone  “drugged” drivers….and there are over 2500 people on mmt in this state!  That is not even 5%!

Police report problem of drivers impaired by prescription drugs – Bangor Daily News.

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1/28/10 | 52 comments

By Diana Bowley
BDN Staff

DOVER-FOXCROFT, Maine — Police can recite one incident after another where motorists were driving while impaired not only under the influence of alcohol and illegal drugs, but also under the influence of prescription and over-the-counter drugs.

Piscataquis County Sheriff’s Department Investigator Guy Dow recalls one instance of stopping a female driver who had her two grandchildren in her vehicle as passengers. The driver happened to be under the influence of OxyContin, a narcotic pain reliever.

“It’s something we encounter pretty regularly,” said Shawn Green, a patrol officer with the Bangor Police Department. “We’re basically an overdiagnosed and overmedicated society. Everybody has medication and people underestimate the effects that a medication can have on them, even if it’s legally prescribed, never mind those who are taking drugs illicitly on top of medication or in combination with alcohol.”

Piscataquis County law enforcement have encountered a big problem involving methadone, according to Dave Wilson, an investigator with the Piscataquis County Sheriff’s Department. Residents drive to the three clinics in Bangor to get their doses of methadone but by the time they drive back to Piscataquis County, the methadone has impaired their ability to operate a motor vehicle, he said. A number of them fall asleep on their way home, which has caused a number of accidents, he said Tuesday.

Green and Wilson, both trained drug recognition experts, spent two days Tuesday and Wednesday teaching law enforcement officers from Maine, New Hampshire and Massachusetts how better to identify drug impairment through an Advanced Roadside Impaired Driving Enforcement class held in Dover-Foxcroft.

Police from Kennebunkport, Cape Elizabeth, Brownville, and Dexter, and investigators from the Piscataquis and Sagadahoc county sheriff’s departments, the Boxborough, Mass., Police Department and the New Hampshire Harbor Patrol participated.

The class was designed as an advanced operating-under-the-influence-of-intoxicants class — an introduction to concepts of drug impairment, Green said. “It gives them insight into drug impairment, essentially, it teaches them some of the signs and symptoms of drug impairment specifically as it relates to eye indicators,” he said. The new education and the tools provided through the course will help them detect the drug-impaired driver, he said.

Green said similar classes have been held in several other locations in the state.

“It’s definitely made officers who participate in the class much more aware,” Green said. These officers are able to detect what drugs may be involved which would necessitate a trained drug recognition expert to respond on scene.

“In addition to your standard OUI and alcohol offense driver, we know that there’s a serious problem with people driving under the influence of drugs and or medication or a combination of those with alcohol,” Green said.

A drug is any substance that, when taken into the human body, can impair the ability of a person to operate a vehicle safely. These can include anxiety pills, over-the-counter cough medicines, sleeping pills, muscle relaxants and pain relievers, according to Green and Wilson. “People need to be aware of what their own prescriptions can do to them,” Wilson said.

“Obviously, we’re trying to make an effort to keep the roads that much safer and for those people who choose to use drugs and make the decision to drive, they need to know there are officers out there who are trained to detect them and who will take enforcement action,” Green said. “They need to understand the state law in Maine allows for us to make an arrest based on impairment regardless of what causes that impairment.”

FARMINGTON Program helps pregnant women with drug addiction.

IF ONLY THEY COULD WRITE THESE WONDERFUL ARTICLES ABOUT SUBOXONE, WITHOUT FEELING THE NEED TO BELITTLE METHADONE!

BY BETTY JESPERSEN Staff Writer 01/17/2010 enlarge Staff photo by David Leaming CARE FOR TWO: Nurse-midwife Daisy Goodman sits in an examination room at Franklin Women’s Care, a program of the Franklin Community Health Network in Farmington. Goodman earned a doctorate of nursing practice degree with a thesis on treatment of pregnant women in rural areas who have chemical addiction issues. FARMINGTON — Nurse-midwife Daisy Goodman remembers caring for a pregnant woman looking for help in kicking an addiction to prescription painkillers.She was among a rising number of women, including pregnant ones, who were seeking treatment for drug addiction, according to a study of a 10-year period by the state. “She wanted to stop because she knew it was bad for the baby,” said Goodman, who now works at Franklin Women’s Care, a program of the Franklin Community Health Network in Farmington. “She described herself as a good mother but had a pill habit she couldn’t stop,” she said. The woman, who had children at home, wanted to try methadone, a narcotic used in the treatment of addiction. It meant she had to travel hours every day to get her dose at the nearest clinic. She knew that otherwise, she would go through painful withdrawal at home, Goodman said. “I had deep respect for her commitment,” she said. “She did very well during her pregnancy, went to the clinic consistently, delivered a healthy baby at term and breastfed successfully. But her baby did experience withdrawal.” Out of that experience and others, Goodman developed a plan to help pregnant women in rural areas who are addicted to drugs. The plan was the doctoral project for her Doctor of Nursing Practice Degree she received from Massachusetts General Hospital’s Institute for Health Professions last month. The guidelines encourage doctors in rural communities to build collaborations with addiction specialists and physicians who can prescribe buprenorphine — a drug with fewer side effects than methadone. Preliminary study findings indicate that buprenorphine is at least as safe as methadone treatment during pregnancy, according to National Institute of Drug Abuse, which is evaluating the drug as a treatment for pregnant women dependent on narcotic pain relievers. Goodman said when prescribed by a physician in a medical office, addiction treatment with buprenorphine can become part of the patient’s general medical care. Then, if specialized care, such as substance abuse or psychological counseling, is needed, those referrals can be made directly, and privately, by the physician. The study reports that the use of methadone during pregnancy is controversial and that it does not protect newborns from going through withdrawal, a condition that requires medical intervention and extended hospitalization. In Maine, there has been a significant increase in the number of women entering treatment for drug addiction, according to a study by the Maine Office of Substance Abuse. Between 1997 and 2007, the number of Maine women in treatment for drug abuse increased by 72 percent, from 3,828 to 6,589. The statistics ranged from a decrease of 18 percent in Lincoln County to an increase of 287 percent in Franklin County. Hancock, Washington and Oxford counties had increases of more than 200 percent. Kennebec County increased by 63 percent and Somerset by 85 percent. The report also found the number of pregnant women seeking addiction treatment increased by 79 percent. Goodman said the high numbers are just the tip of the iceberg. “The larger, submerged part of the iceberg is all the women who have opiate dependency but are not yet in treatment. Also, physicians who prescribe buprenorphine are not required to report those cases to the Office of Substance Abuse,” she said. “I would like to see obstetrical providers become more involved in recognizing and treating opiate addiction,” she said. Research shows the health of mothers and infants improves when addiction treatment programs and prenatal programs are brought together, Goodman said. “The goal is to deliver care within the community as much as possible, not just during the pregnancy but post-partum and through the stress of motherhood when there is an increased chance of a relapse,” she said. Kelley Bouchard, a certified registered nurse and perinatal outreach educator at Maine Medical Center in Portland, has developed a program on the care of babies whose mothers are in treatment for addiction. “We are seeing more and more pregnant women with addictions around the state. The real challenge for health care providers is to get comprehensive care for these women,” Bouchard said. “Buprenorphine is a way for a woman to get treatment closer to her community but the issue is that the support system is not in place,” she said. “Daisy’s guidelines for treatment are the first that I am aware of in the country and they offer a consistent approach to the care of these women,” she said. The public is quick to stigmatize women who become pregnant while addicted, both Goodman and Bouchard say. “Some of their stories are horrific,” Bouchard said. “They are dealing with trauma from domestic violence and 90 percent of that is sexual abuse.” “The public doesn’t think about that,” she said. Nurse practitioner Noreen Comeau and Dr. Steve Bien, who work at Wilson Stream Family Practice in Farmington, offer addiction treatment and see pregnant women in collaboration with Franklin Health Women’s Care. Bien is one of three physicians in Franklin County who can prescribe buprenorphine. Comeau said as part of the treatment, patients attend counseling and support groups to deal with the issues that led them to addiction in the first place. “I would like to see more primary care offices offering their own patients addiction treatment. It is a medical problem just as high cholesterol or diabetes or heart disease is,” she said. “Stop ostracizing people because they have an addiction problem. It is a disease, so let’s help these people fix their problem instead of blaming them,” she said. Betty Jespersen — 778-6991 bjespersen@centralmaine.com // <![CDATA[ if(ua.indexOf('Firefox/2') == -1) { document.write(""); } ]]>