Saturday, December 21, 2013

Florida is not alone, apparently Tennessee see my post on the bottom of this one.

Government Behaving Badly: Tennessee does it Again
janaburson at Janaburson's Blog - 6 days ago

I just read Tennessee’s new law regulating the treatment of opioid addiction with buprenorphine in office-based practices, due to take effect July 1, 2014. I repeatedly criticize Tennessee’s policies on addiction treatment, but they keep doing weird and counterproductive things, so I must blog about them. I don’t even blog about every little stupid thing […]

Saturday, December 14, 2013

Florida Medicaid not paying for Suboxone Bupernorphine?


Am being told by patients in Miami and South Florida that Medicaid is no longer paying for Suboxone  Treatment. I was told by Dr. Jeffery Kamlet told me that this was so, but I do not have the details if this for all patients or is this just an issue that one needs prior authority.

It it so that Florida Medicaid is refusing to pay for doctor and medication. Please leave me a post and/or write me to my email.

The only information I have found so far is this application for prior approval

I think there maybe a violation and perhaps the ACLU maybe interested in looking at it. or some
other attonies.

All I am getting from the internet is the usual list of doctors in Florida,

I have a strong impression of the healthcare management program that you most obtains approval for Suboxone and other similar medication maybe strong bias toward patients seeking maintains with Suboxone. People in Mental Health are not well known for reading research.

There is too much outright prejudice, and discrimination toward these types of patients.  Just because they are license does not mean they are protecting patients.

Please contact me at

Thursday, December 12, 2013

Methadone Patients get bad stigma again.

This comes from Substance Matter by Dr. Mark Willinbring. M

Sunday, December 8, 2013

MMT and 12-Step Groups: Stigma Persists

In his latest contribution to the academic literature, William L. White and colleagues turn their focus on 12-Step participation among patients in methadone maintenance treatment (MMT). Rates of self-reported Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) attendance were very high; however, participants frequently reported that their MMT status prevented them from taking part in many of the "key ingredients" of the groups that most members take for granted. When asked about the experience, nearly half of all respondents who had attended NA or AA reported that they had "received negative comments about methadone use" and nearly "a quarter (24.4%) reported having had a serious problem within NA or AA related to their status as a methadone patient."

The following table from the report details the "frequency with which respondents faced particular challenges":

Table 4: NA and AA Responses to MMT Patient Status                                NA            AA

Response to MM Patient Status:                                                                         (n=228)     (n=142)

Received negative comments about methadone use                                                43.0%     45.1%

Were pressured to reduce the dose of methadone                                                  21.9%     23.2%

Were pressured to stop taking methadone                                                             32.9%     34.5%

Were denied the right to speak at a meeting because of being
in methadone treatment                                                                                         14.5%      14.1%

Were denied the right to become a sponsor because of being                                  8.8%        9.9%
in methadone treatment

White and colleagues implemented this small study at not-for-profit opioid treatment program (OTP) in the Northeastern US. A total of 322 respondents answered a 53-question survey about their participation in recovery support groups. Of the 322, 259 (80.4%) reported a primary affiliation with a recovery support group. Of these, 88.8% reported it to be in some way a 12-Step group. Importantly, 66% of respondents reported past-year NA/AA participation, with 88-89% reporting the group was "helpful".

Despite these figures, the authors found MMT patients had low rates of participation in the "key ingredients" that seem to be critical influencers of long-term recovery outcomes: having a home group (50%), having a sponsor (26%), sponsoring others (13%), attending 12-Step social events (23%), and active step work (21%).

Anecdotally, we see a lot of patients at Alltyr who have a hard time finding a place in the local 12-Step scene. We even began compiling a list of medication-friendly meetings in the Twin Cities as we learned about them, but the stigma associated with maintenance is still prevalent. Could it be that we are on the verge of another breakthrough in medication acceptance? After all, there was a time when you weren't considered "sober" if you were on antidepressant or antipsychotic medications (but now, as Dr W likes to say, you're more likely to be referred to the psychiatrist by your sponsor than by anyone else). We would be interested to hear reader stories about this experience - or opinions on the topic. Are things changing - or not?

See the full paper by White, et al., here:

Her is a few things I have been copying from other sites but is worthwhile information. Gaia Vasiliver-Shamis, Ph.D If your phone's so smart, why isn't it doing science for you? Great tips for turning your toy into a tool! Gaia Vasiliver-Shamis, Ph.D Scientific Program Manager at NIH/ NIAMS 5 Killer Ways to Use Your Smartphone for Science - Scizzle Blog Go from procrastination to productivity with these great ways to use your smartphone for...

Gaia Vasiliver-Shamis, Ph.D
Go from procrastination to productivity with these great ways to use your smartphone for...

Saturday, November 16, 2013

Stuff we should have been told in treatment ''The Hidden and Forgotten Plague''

The Hidden and Forgotten Plague 

Thanks to my colleagues from 

National Alliance for Medication Assisted Recovery  

"Just that you people who are involved in advocacy, keep up the work. I have seen
changes come about because of people becoming involved. It is these who are the real heroes
in all this. Without advocacy, changes will not come about within the present system."
Dr. Vincent Dole 
''Listen to your patients'', Dr. Vincent Dole spoken at the  American Methadone Treatment Association in San Francisco in 2001. (The AMTA is now AATOD 
Don't miss the important documentary: 'The Hidden and Forgotten Plague - A film about hepatitis C'. with English subtitles Produced by The Swedish Drug Users Union. In Sweden approximately 50 000 persons are infected with…
Added on 9/29/13

Thursday, November 14, 2013

Am an enabler for health

Getting Off Right Safety Manual - Harm Reduction Coalition

Getting Off Right Safety Manual

Getting Off Right is a straightforward, easy-to-read how-to survival guide for injection drug users. It is a compilation of medical facts, injection techniques, junky wisdom and common sense strategies to keep users and their communities healthier and safer. The Safety Manual was written in collaboration by drug users and services providers.
Read below and download the PDF here.
Hard copies are also available for purchase in our store.
We would like to thank Kif Scheuer for contributing artwork on pages 16, 24, 35, 48, 57, 60, and 77.


Getting Off Right - Harm Reduction Coalition


Many locations, specially all over Europe have clinics for active users to "get off right", this service may also include nurses to assist. If it wasn't for our bigotry, we may learn there are many benefits to treating people with dignity.

 Clean, Well-Lit Place to Shoot Dope -- In Your City, Soon? [FEATURE]

The only existing supervised injection site for hard drug users in North America is Vancouver's Insite, but panelists at a session of the International Drug Reform Conference in Denver last month said activists in a number of US cities are working to be next. (Plans are also afoot in a couple of Canadian cities.)

client at Vancouver's Insite supervised injection site (
Supervised injection sites (SIS) are a proven public health and harm reduction intervention that can save lives by preventing overdoses, bring a measure of stability to the sometimes chaotic lives of addicts, reduce the spread of bloodborne infectious diseases such as HIV/AIDS and Hepatitis C, and reduce crime and disorder in the community.
SISs also exist in a number of European countries and Australia, but face both legal and political hurdles in the US. Still, advocates are ready to push the envelope here in a bid to bring the life-, health-, and money-saving innovation here.
Donald Macpherson, executive \director of the Canadian Drug Policy Coalition and former head of Vancouver's Four Pillars drug policy program explained the prehistory of Insite, offering hints of possible courses of action in the US.
"We had a public health disaster," he said, referring to the city's escalating heroin problem in the 1990s. "Drug users themselves opened an SIS in 1995, and the police watched it, but didn't shut it down. A second opened in 2002. A year later, another non-sanctioned injection site opened up. It was really messy and it took years."
But in the end, Vancouver ended up with Insite and has managed to keep it open despite the best efforts of the Conservative federal government in Ottawa.
"Insite survives because it has an exemption from Canadian drug laws," Macpherson explained. "We won in the British Columbia courts, we won in the Canadian Supreme Court, which instructed the health minister to issue a permit. But we still barely have Insite, and though other cities are working on it, there is a big chill in Canada right now and we're just trying to hang on to what we've got."
Plans for SISs in the US face similar obstacles, but that isn't stopping advocates in a number of cities -- notably Austin, New York City, San Francisco, and Seattle, as well as somewhere in New Mexico -- from pressing forward with plans to open them there.
"I don't know if we'll be first, but we'll be one of many," said Robert Cordero, president and chief program officer of Boom! Health in the Bronx.
Boom! Health, which resulted from the merger of Bronx AIDS Services and Citiwide Harm Reduction, is a multi-service organization with a three-story building that includes a pharmacy, pharmacists with a harm reduction orientation, and a seven-day-a-week drop in center.
"Safe injection would be embedded with all these other services," he said.
"I don't know if we want to be first, but we want to be one of many," said Olivia Sloan, outreach and education associate for the Drug Policy Alliance (DPA) in New Mexico, which has been working patiently to bring cutting edge programs like SISs to the state. "We passed harm reduction, including needle exchange, through the state legislature, but it's not working," Sloan said. "We have overdose deaths at four or five times the national average."
Advocates in New Mexico have been and continue to lay the groundwork for SISs, Sloan said.
"We took a political and academic approach, and our conversation about injection facilities started a few years ago," she explained. "We have mobile syringe exchanges. We drafted legislation last year and the Senate passed a memorial to require we study the feasibility of SISs in New Mexico. We have partnered with the University of New Mexico and are looking for a principal investigator."

In San Francisco, preliminary discussions with local officials about SISs have been going on for some time, but the San Francisco Drug Users Union may follow the path taken by organized Vancouver drug users, as well as many of the needle exchange pioneers in the US, and just do it.
"We have a committee very committed to an SIS that meets every Monday for two hours," said Holly Bradford, the union's coordinator. "We're really on the verge. We have a very active bathroom here; you just open the door," she smiled. We're bringing it to San Francisco," she said. "It might not be sanctioned or aboveground, but it's going to happen."
Whether underground or not, SISs face a hazard-strewn trek. State, local, or federal officials can throw up any number of obstacles, said Lindsay LaSalle, a Berkeley-based law fellow for DPA.
"Drug possession remains illegal and could impact any SIS user, although probably not the staff or operator because they're not handling the drugs," she explained.
"Then there are the crack house laws, which both the federal government and some states have. They make it illegal for anyone to maintain, own, lease, or rent a property where drugs are used, consumed, or manufactured. These laws could cover SISs, and this could impact both clients and staff and operators alike," she elaborated.
"Then there are civil forfeiture statutes. They've used them to go after medical marijuana dispensaries," she enumerated.
Winning local official support reduces some risks, but not all, LaSalle said.
"If SISs were sanctioned at the local level, many of the legal risks dissipate, but state actors could still choose to prosecute," she warned. "In most states, local officers are deputized to enforce state law, so they could still go after an SIS. If authorized at the state level, that would be an incredible victory, but we would still have to deal with the federal government."
While acknowledging that lawyers can be "a buzzkill," LaSalle also hastened to add that things can change faster than we think.
"These legal barriers are not so different from the challenges we've faced with other drug policy issues, like syringe exchanges," she noted. "They were seen as completely radical, but now we have an almost universally accepted public health intervention with the exchanges."
Part of the process of initiating a supervised injection site is selling it to other stakeholders. Panelists had a number of ideas about messages that worked.
"For business people, you tell them this is how we clean up the neighborhood," said a Seattle activist.
"It is a very incremental change from syringe exchange to supervised injection sites," said LaSalle. "Position it as a very small change in an organization that provides all these other services to drug users."
"There's always 'what we're doing is not working,'" said Sloan.
"We're not going to arrest our way out of this problem," suggested Cordero. "But don't go straight to the SIS conversation. Let people see what we're doing, and then they say 'you're doing God's work' and second, 'Holy shit! Where would all those people be if you weren't open?'"
The obstacles to implementing supervised injection sites in the US are formidable, but the need to do so is urgent and increasingly understood, as are the benefits. With activists and advocates in a number of American locales pursuing SISs through a variety of means, the question is not whether it will happen here, but when and where.

Monday, October 28, 2013

Saving Lives with Narcan

Saving Lives with Narcan
By Tessie Castillo

No one wants to be in a situation where the life of a friend is at risk. Unfortunately, for many people who use opiates such as heroin or prescription painkillers, this scenario is not uncommon. Louise, a drug user in central North Carolina, has been called on to save lives over more than 100 times.

Drug overdose is the leading cause of accidental death nationwide, surpassing even auto fatalities. The majority of these deaths are caused by opiates, which slow a person’s respiratory system to the point where he or she stops breathing. As Louise can attest, seeing someone overdose on opiates can be scary – blue lips, shallow, gargled breathing, clammy skin – but many people simply look asleep. These are the most dangerous overdoses, because the warning signs may come too late.

Calling 911 is the best response to an overdose. Unfortunately, studies it’s not the most common. Studies report that due to fear of law enforcement, witnesses to an overdose call for help less than half the time. , and instead they try “home fixes,” such as rescue breathing, which helps, or putting ice or cold water on the person, which does not.

“We read in the news that most police officers are not making arrests at the scene of an overdose, but that is not our truth,” says Louise. “I have never once heard of an overdose [in my area] where police treated it as a medication situation instead of a criminal one. This is a major problem for drug users. Their lives are devastated by the legal system. With a criminal record they can’t get jobs, housing, scholarships; the justice system invades every aspect of life. So they won’t call for help. It’s not that we don’t care about our friends [who overdose]. But nobody wants to be the person who called 911 and sent everyone to jail.”

Due to fear of police, many drug users they may try “home fixes” in the event of an overdose, such as placing ice on the person’s groin, putting them in a cold shower, injecting them with milk or salt water, or a number of other remedies that don’t actually work. The best way to help someone experiencing an overdose is to do rescue breathing (not CPR) and to administer naloxone, an antidote that reverses the effects of opiate overdose.

In April 2013 North Carolina passed a new law, the 911 Good Samaritan/ Naloxone Access law, to help save lives from overdose. The first part of the law grants limited immunity for possession of small amounts of drugs to anyone who experiences a drug overdose or calls 911 for help. The second part of the law removes liability from doctors who prescribe naloxone to patients and bystanders who administer the antidote to someone experiencing an overdose. It also allows community organizations such as the North Carolina Harm Reduction Coalition to distribute naloxone to people at risk for opiate overdose and their loved ones under the standing orders of a medical provider.

Changing state law by granting limited immunity from drug or paraphernalia charges to witnesses who call for help can go long way towards encouraging people to do the right thing. In the past two years, 10 states have passed 911 Good Samaritan laws that do just that. This year, 12 more are moving similar bills, including North Carolina.

“We read in the news that most police officers are not making arrests at the scene of an overdose, but that is not our truth,” says Louise. “I have never once heard of an overdose [in my area] where police treated it as a medication situation instead of a criminal one. This is a major problem for drug users. Their lives are devastated by the legal system. With a criminal record they can’t get jobs, housing, scholarships; the justice system invades every aspect of life. So they won’t call for help. It’s not that we don’t care about our friends [who overdose]. But nobody wants to be the person who called 911 and sent everyone to jail.”

The 911 Good Samaritan laws encourage people to call for help, but there is another option to reduce premature deaths from overdose. Narcan, or naloxone, is an antidote that reverses the effects of opioid overdose. Similar to the EpiPen for allergies naloxone, Narcan is simple to use, effective, and safe enough to be administered by people with no medical trainingnonmedical personnel. Paramedics have used it for years, but particularly in rural areas where emergency response may come too late, Narcan is becoming available to drug users and their loved ones. Louise has personally reversed over 30 overdoses.

“The first reversal was the scariest,” she said. “I got a call in the middle of the night from someone in a panic. I told her to call 911, but she wouldn’t because of police. I explained over the phone how to do rescue breathing while I drove to the house with Narcan. When I got there I found the guy [who had overdosed] lying on the floor, bluish and naked. They had put him in a cold shower to try and wake him up. I didn’t even know what drugs he had taken, and no one could explain it to me because they were all freaking out. I gave him a dose of Narcan and he started breathing again, but raspy, so I gave him more. Then we called 911 and I left. I found out later that he had woken up soon after. He really appreciated what I’d done for him.”

Nationwide, over 10,000 lives have been saved through distributing Narcan directly to people most affected and training them on how to recognize and respond to an overdose. Yet the practice is not without dissent. Opponents argue that if drug users have the antidote to an overdose, they will use more drugs. Fortunately, scientific facts and eyewitness accounts prove these claims false. Narcan puts a drug user into acute withdrawal. The experience is so unpleasant that no user would deliberately increase use because Narcan was close at hand. Giving stomach pumps to alcoholics won’t cause them to drink more, because no one wants his or her stomach pumped. No one wants to self-administer Narcan either.

“People don’t set out to overdose,” says Louise. “Having narcan makes no difference in whether you overdose, but it makes a huge difference in whether you live.”
NCHRC   //  PO BOX 13761, Durham, NC, 27709  //  336-543-8050   //

Cotton Fever by Dr. Jana Burson

I can only copy what is best that I see, and Dr. Jana Burson do not stay behind.

Cotton Fever

An addict still using heroin recently asked me what “cotton fever” was, and how he could tell if he was sick with it.
Cotton fever is caused by bacteria commonly found on cotton plants, initially named Enterobacter agglomerans, later changed to Pantoea agglomerans. Most intravenous drug addicts filter heroin through cotton filters, to remove particles that could clog both their injection needle and their veins. Sometimes fibers of cotton break off from the filter, carrying the bacteria with it. These bacteria in the bloodstream cause fever and chills, but in a healthy person, this usually resolves on its own. It’s rare to see it cause serious infection. However, doctors still recommend addicts with cotton fever seek medical care and receive appropriate antibiotics, due to possible impairment of their immune system brought about by intravenous drug use. (1)
At least one study isolated an endotoxin produced by this Enterobacter bacteria, so it’s possible that the fever is actually caused by this toxin released from the bacteria and not from an actual infection.
Enterobacter species, while found in feces of both animals and humans, are also found in the plant world. Usually, these bacteria aren’t a particularly vicious, which is why they rarely cause sepsis (overwhelming infection) unless the individual has an impaired ability to fight infection. In the 1970’s, some medical products (blood, IV fluids) were found to be infected with this species, and caused significant infections, but this was probably due to a large amount of the bacteria infused into patients.
Cotton filters become more fragile with use, so addicts using new filters probably have a lower risk of cotton fever. After cotton filters are used, they remain moist and can become colonized with all sorts of bacteria, especially if they are kept warm, as happens when they are stored in a pocket, close to the body. These bacteria can cause infection when injected. Cotton filters can transmit hepatitis C and possibly other infections, if they are shared with other drug users. (2)
Filters also retain some of the injected drug, making them of some value in the world of intravenous addicts. It’s considered a gesture of generosity to offer another addict your “cottons” because the addict will get some small amount of the drug. (3)
Even in view of all of the above, it’s still better to use a filter than to use unfiltered heroin. A new cotton cigarette filter has been shown to remove up to 80% of particulates in heroin, and reduces the risk of thrombosis of the vein from particles. Other makeshift filters are made from clothing, cotton balls, and even tissue paper.
Syringe filters are manufactured for medical and laboratory use. They can be designed to filter particles down to 5 micrometers. Besides being more expensive and difficult to obtain, studies show these filters retain more of the drug than other makeshift filters, making them less desirable to some addicts. (2)
Cotton fever itself usually isn’t fatal. The biggest challenge is knowing if the addict has cotton fever or something worse, like sepsis. Sepsis is an infection of the blood stream, and even heart valves can become infected, causing serious and life-threatening problems.
I asked a former IV drug addict about his experience with cotton fever.
Me: What does cotton fever feel like?
Former Addict: You get a fever that kind of feels like withdrawal. You know there’s something bad wrong, and you don’t know what to do about it. I’ve laid on the floor and thought I was going to die. A lot of times people get it when they’re rinsing, and that means they’re coming down anyway. When the dope got short and I was rinsing cottons, that’s when I got it.
Me: How long does it last?
FA: It seems like it lasts a long time, but the intensity is bad maybe an hour or two. You shake, you sweat; it feels just like the flu.
Me: Ever go to the hospital with cotton fever?
FA: No, no! (said emphatically) I was usually wanted by the police. Only time I went to the hospital is with severe trauma.
Me: I don’t understand what you mean by rinsing.
FA: Rinsing’s when you squeeze that last little bit of drug out of the cotton [filter]. You rinse the spoon and cotton with a little water. I would save all my cottons. That was my rathole for when the dope ran out. I would actually load the cottons into the barrel of a syringe then draw water in to the barrel of syringe, then squeeze until they were bone dry. I squirted that on to a spoon, and used a new cotton to draw that into a syringe.
Me: Why do you use cotton filters? Do you use it with every drug you injected?
FA: I used cotton to strain any dirt that may be in the product, that might get up in the syringe. I didn’t want no dirt. Didn’t have to be cotton. [If you don’t use a filter, you] shoot a bunch of trash up in yourself, and get trash fever.
I used an itty bitty cotton. Some people would use a quarter of cigarette butt. That was wasteful to me. It got too saturated, could hold too much residue, or dope.
I didn’t have to use cotton with quarter gram morphine or Dilaudid. Not enough trash to stop it up. If there’s trash in the syringe, I used a cotton.
Thankfully, this person has been in recovery from addiction for more than fourteen years.
Recovery is the best way to avoid cotton fever. You never have to go through that again.
1. Rollinton, F; Feeney, C; Chirurgi, V; Enterobacter agglomerans-Associated Cotton Fever, Annals of Internal Medicine 1993; 153(20): 2381-2382.
2. Pates, R; McBride, A; Arnold, K; Injecting Illicit Drugs, (Oxford, UK, Blackwell Publishing, 2005) pp. 41-43.
3. Bourgois, Phillippe; Schonberg, Jeff; Righteous Dopefiend,(Berkeley, California, University of California Press, 2009) pp8-9, 83-84.

34 YEARS the Feds. say nothing less than measurable proof of therapeutic success would be acceptable

From "Coping with Psychiatric and Psychological Testimony", by Dr. David Faust,  and Jay Ziskin

If this was quoted in 1979 to psychologist in the monthly magazine the monitor.  Why are all
the Federal Agencies continue to promote pseudoscientifically procedures?  Patients have the
right to know, and we should cause a big fuzz and write to the directors and chiefs of this
federal agencies.  Perhaps I will make a list of emails for you all to write to them.

This Evidence Based treatment have fallen in deaf ears. In fact the first record I find is
in the Chief of what is not SAMHSA back in the 1970, for those who are interested I find the
reference..... In fact I just found it. it was a Dr. Gerald Klerman, in 1979 wrote to the American
Psychiatric Association in APA's magazine The Monitor November 1979 page 9. quoted as
saying that nothing less than measurable proof of therapeutic success would be acceptable
to the government. "One can not demonstrate the efficacy of therapy in terms of the
"INTENTION OF ITS PROPONENT... never can a therapy can be consider routine and
acceptable on the basis of testimony of authorities... it goes on.

Here is the whole article. If you want a copy of the actual "The APA Monitor this article came out in November 1979 I will be glad to do so. Please email me at

Klerman Challenges Professions To Prove Therapy Works
Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) chief Gerald Klerman, addressing the annual meeting of the American Psychological Association in September, called on the mental health professions to take on the task of psychotherapy evaluation, noting that the promise of national health insurance and the consumer movement have led to a climate which demands more than custom as justification for reimbursement. Elaborating on an earlier speech in which he underscored the need,, to circumscribe legitimate mental health activity, Klerman told APA that nothing less-.than measurable proof of therapeutic success would be acceptable given the federal government's sizable and expanding role as a third-party payer. "We can attack the problem of defining boundaries in part by returning to the practical problem that many therapeutic methods are well intended; but poorly established in terms of safety, efficacy and economy. One cannot demonstrate the efficacy of a therapy in terms of the intentions of its proponents." "Neither can a therapy be considered routine and acceptable on the basis of the testimony of authorities--that is/ because outstanding •members of the profession are of the opinion that it is useful, safe and effective. I believe that only evidence as to outcomes will suffice in the rigorous climate of consumerism and health insuranc~ coverage."
Klerman pointed to the recently established National Center for Health Care Technology as a sign of the times. The center is currently evaluating 40 treatment methods for efficacy, including aversive drug treat- ment of alcoholism. "I view this as a possible prototype," Klerman said--"a 'shadow of the future.' Next year, evaluation of the efficacy of group treatment of family distress might be requested. Or of chlorpromazine for treatment of schizophrenia. Or Librium for sleep and anxiety." "The establishment of this center within a short time of the formation of the Health Care Financing Administration to tighten the federal reimbursement purse strings, in my view, makes it especially noteworthy," Klerman added. "As the federal third-party payer, HCFA dispenses dollars in the 'megabillion' range. It thus inevitably sets a tone which other reimbursers may follow." The public no longer accepts credentialing and licensure as sufficient guarantees of effective and safe service, Klerman said. "The new consumerism demands •a  new 10ok at these protections. It demands not just good training, but good services. It demands an evaluation not just of the state of the artist, but the state of the art .... If we don't respond, i~ will be brought upon us." W.H.

Please note that this article was written in 1979, that is over 34 years ago, and clinician continue to do their own thing and call it treatment.

Advice to Mental Health Clinicians (take it will you. Your patients lives depends on them

Advice for Mental Health Clinicians

Mark Willenbring, MD at Substance Matters: Science and Addiction - 2 weeks ago
A clinician recently sent me this email: *Dr. Willenbring,* * * *I read an article in the New York Times from early this year discussing Effective Addiction Treatment that in part highlighted your comments and Alltyr's mission to be a 21st century model for addictions treatment.* * * *As a therapist in an outpatient practice not specializing in addictions treatment--but who nevertheless encounters co-morbidity with substance abuse on a pretty regular basis--it can be confusing to know how to approach the psychosocial aspects of treatment. I believe in a multimodal approach for chron... more »

I also suggest that people read Drs. Scott O. Lilienfeld William T. O'Donohue  book
"GREAT IDEAS of Clinical Science: 17 Principles that Every Mental Health Professional Should Understand"

This two guys and others have been trying (I think some times in vain  but they are making some headway, to me just do not seem to be fast enough) to convince clinicians to become scientist first and then practitioners. Suggest you follow them and if you get existed start reading the references study in the back of the books.

I got mind use and very good condition from ABebooks (I don't get a toaster for announcing them, I do not care where you get the books  from)

Another one read by Scott is 

Brainwashed: The Seductive Appeal of Mindless Neuroscience [Hardcover]


too much rubbish being written about Neuroscience and this book ought to help you to be more critical about what is being said by Professionals who are extrapolating way beyond the data available.  I don't always agree with what they have to say but scoot specially is Definitely a clear thinker.

Thursday, July 18, 2013

Your feedback and Statements are always. Welcome.

My statistics on this blog, shows that there is a fairly high rate of visits to this site. Since I opened it a years or so ago. I has had over 1,500 visits or so a year.  My stats do not state whether your are visiting by mistakes, or you are actually reading the articles. But I would surely welcome what
you have to say. Whether you agree with me or not. I try not to take my "believes" very seriously
although I take it with commitment to the improvement of.

I am in the process of reading a book that has been confirming quite a  bit of what I think about
our current Rehabilitation of Substance Use Treatment.  The book is "Inside Rehab.: The Surprising Truth About Addiction Treatment-and How to Get Help That Works" by Anne Flesher not written by
a professional but by an investigative reporter.  She is quite nice about some of the error that these
rehabilitation facilities are doing. I would be a lot more confrontative given the fact of the devastation that they can cause in patients lives. Too frequently some (not all of these) facilities make rules, regulations, and policies that are based for the facilities conveniences not for the best interest of the patients.  And they can do quite a bit of damage in individuals if they have not done it in large groups of people

So do me a favor, and react to some of these articles that I place in this blog. AS YOU MAY NOTE, not of all of the articles are written by me. I give credit and they are written by other sources.

How to switch from methadone to buprenorphine from Jonaburson's blog

How to Switch from Methadone to Buprenorphine (Suboxone)
janaburson at Janaburson's Blog - 4 days ago

I’ve helped about thirty or forty people switch from methadone to buprenorphine. Some were patients at my office, where I do office-based treatment with buprenorphine (formerly known as Suboxone or Subutex), and some have been patients at one of the two opioid treatment programs where I work. Most of the time, the transition goes smoothly; […]

Thursday, July 11, 2013

Methadone Dosing: Use the Evidence

From: Janaburson's Blog

While Methadone and other medical replacement therapy has been badmouth by most if not
all member of organization like X Anonymous.  Methadone and Bupernorphine, for opiates
as well as Naltrexone for Alcoholics.
  Scientific evidence discoveries have shown that medication replacement therapy are substantially more effective (and safer) than Alcoholic Anonymous or Narcotics Anonymous. The animosity by members of these organizations is reprehensible given that they do not have any evidence except their own bias and poorly conceived opinions.


Methadone Dosing: Use the Evidence

The most successful opioid treatment programs and the most successful patients in those programs use evidence-based dosing of methadone. Many studies over the last 40 years show patients do better on adequate doses of methadone. They have better outcomes when they’re on enough methadone to block physical withdrawal signs and symptoms than when they’re on insufficient doses.
In the past, methadone clinics often had dose caps. Some clinics told their patients they didn’t need any more than 60 or 70mg of methadone per day. But over the last 40 years, we have multiple studies showing poorer outcomes at clinics with these low dose caps, as opposed to individualized dose determination. Numerous studies show higher drop-out rates in patients on doses less than 60mg, as well as more illicit opioid use and higher rates of HIV infection, as compared to patients on 100mg or more. For most patients, the blocking effect is seen in the neighborhood of 80 to 120mg of methadone per day. (In Tennessee, there are still dose caps. In that state, doctors have to get approval from a non-physician at the state’s Department of Mental Health to take a patient’s dose above 120mg.)
Patients vary widely the way they metabolize methadone. A patient with slow methadone metabolism may do best on 30mg of methadone per day, and a fast metabolize may need much more than 120mg per day. This rate of methadone metabolism is probably determined by our genetics. When patients ask me how much methadone they should be taking, my answer is, “Enough.” I’m not advocating taking doses higher than they need to be, but if the patient looks like they’re in withdrawal, and they feel like they’re in withdrawal, it’s best to take the dose up. We want to use the lowest effective dose.
There are still misguided opioid treatment programs that try to keep methadone doses low. Sometimes clinic staff can send shaming verbal or nonverbal messages, and imply patients who ask for an increase in their dose are somehow trying to get one over on the clinic. Staff shouldn’t shame patients who ask for a dose increase; staff should defer decisions about methadone dosing to their medical personnel.
Sometimes patients don’t want to increase their dose of methadone because they have mixed feelings about their treatment. If they feel guilty about being in a methadone program, they may want to keep their dose low. Sometimes family members, with the best of intentions, will demand the patient stay on a low dose, not understanding that their loved one is less likely to do well on an inadequate dose.
Frequently I see patients who are feeling bad, not sleeping, and achy all over in the mornings, and dosing at 40mg. I ask them if we can increase their dose, and they say something like, “No, I promised myself I wouldn’t go higher than 40mg.” Too often, patients don’t increase their dose for fear that coming off methadone will be harder to do at higher doses. This may be partly true. It may not be harder to come off of, but it take longer to taper off a higher dose. But the patient won’t do as well while they’re in treatment, so what’s the point?
Some patients prefer low doses because they want to have just enough methadone per day to keep them out of terrible opioid withdrawal, but not so much to block the euphoria they get from using an illicit opioid later in the day.
I tell patients that methadone is a little like chemotherapy. For chemo to work, you have to take a big enough dose to do the job. It’s the same way with methadone. It’s not a perfect analogy but patients get what I’m saying.
Let’s turn to the other side of dosing. I’ve seen some clinics with many patients on what I would consider very high methadone dosing. It’s hard to criticize, because I do think there are some patients who need doses higher than 250mg, particularly if they’re on certain medications, or are pregnant. But that’s rare, and at some clinics, many patients seem to be on these big doses. Since these patients have their dose increased slowly, they build a tolerance to the methadone, so such patients aren’t sedated. There’s no long-term damage to the body with very high dose methadone, but higher doses can cause some problems.
It may be hard for a patient on a very high dose to transfer to another clinic. Some methadone clinic medical directors are hesitant to accept a patient in transfer if they’re on 200-plus milligrams of methadone, unless there’s evidence that this dose is required. For example, I was looking over the records of a patient on 290mg, in preparation for transfer. This man was on no other medications and otherwise healthy. When I saw the peak and trough data, I was puzzled, because they were both high, and this was done at 200mg of methadone. So why was the patient taken to 290 milligrams? I know peak and trough levels aren’t the only factor to be considered when determining the right methadone dose, but there was scant information about why the doctor decided to raise the dose, or even if the patient had even seen the doctor recently. I wasn’t particularly concerned the patient would be sedated, because the dose had been raised slowly, over months. But I was concerned that the patient was on more methadone than he needed, especially since many of the patients at this clinic were on doses of more than 200mg per day.
Some studies have shown higher doses of methadone affect the way electrical impulses are transmitted through the heart. In some studies, higher methadone doses are more likely to produce prolongation of the QT interval than lower doses. (2) This QT prolongation does put patients at risk for a potentially fatal heart rhythm problem. The medical literature at present suggests that periodic EKG screening of patients on doses above 100mg is probably a good idea, but there’s still disagreement on this issue.
There is another factor to be considered. This may offend some readers, but we need to acknowledge the nature of addiction. It’s a disease who tells its sufferers, “More is better!” I think it’s important to acknowledge this point, and discuss it openly, but not in a shaming way. This psychological part of addiction doesn’t always go away within the first few weeks.
My approach to a patient on a relatively high dose, who desires an increase in methadone, is to meet with the patient, preferable prior to dosing. Sometimes I like to meet the patient two hours post-dose if I’m worried about sedation. I ask about withdrawal symptoms and check for pupil size and reaction, and other signs. I check the last drug screen. If the patient doesn’t describe withdrawal symptoms, and I don’t see objective signs of withdrawal, I’ll ask the patient how they expect to feel on an ideal dose of methadone, and if it’s possible their addiction is driving the desire to increase. I’m surprised that most patients aren’t offended, but welcome the opportunity to talk openly. Some patients say they honestly can’t tell if they are in withdrawal, or if their addiction tells them they are in withdrawal. My job is to help decide which it is.
Some patients feel “high” for the first few days after a dose increase, but tolerance builds quickly to this feeling. Some patients mistakenly believe they should always get that high after dosing. If the addiction is driving the patient’s way of thinking, the dose may never be “enough.” When I explain this to patients, most understand.
2. Krantz, Lewkowlez, Hays,, “Torsade de Pointes Associated with Very-High Dose Methadone, Annals of Internal Medicine, Sept. 17, 2002, Vol 137(6) pp 501-505.

Saturday, June 22, 2013

FREEEEEEE Suboxone Treatment in South Florida

If you live in South Florida or can get there for the number of times that are required by the researchers. There is a Suboxone Treatment starting now in June 2013. You receive the treatment by participating in the studies (and you get paid $500 instead of you paying for the treatment).The study is sponsor by a different pharmaceutical company, not Reckitt Benckiser Pharmaceuticals.

The researcher Segal Institute conduct approximately 300 multi-centered, so there maybe one research center near you that maybe doing the study. The pharmaceutical sponsor for this study is using a different variation of the initial formula. This formula ought to make the Buprenorphine Naloxone more effective and to last longer in the nervous system. To make an appointment in South Florida please call Segal Institute at 1 877 734 2588. When they answer the telephone and you tell them that you want to participate in the new Buprenorphine study, please also tell them that Franco referred you to the study and provided with this initial information. At the end of the number of weeks the studies, (I believe it is 40 but I will double check this number) having participated in the study will approve you for a longer participation. I believe that the sponsor is willing to provide participants with one year of Buprenorphine treatment.

Soon they are also preparing to do a study on medications for cocaine dependence. Perhaps this is the first medication for this ailment.

There are a number of other paid studies now available most of them in Mental Health and Substance Use treatment. When the list becomes available, the list will be made available here. And always tell the researcher that Franco referred you to the study. Let Franco know that you contacted the Segal Institute for Medical Trials. there are also studies for Bipolar Disorder; Constipations due to use of Opiate Medication (such as methadone); If you are accepted into one of their studies, I will give you a tip if you informed them of my referring you to them. Please email contact Franco so that arrangements can be made.

(to be continuo)

Monday, June 3, 2013

New post on Janaburson's Blog / Case Report of Death from Ibogaine Ingestion

Case Report of Death from Ibogaine Ingestion

In the latest issue of the American Journal on Addictions (Volume 22 (3) May/June 2013, p. 302) was a one-page case report of a death due to ibogaine, ingested for the purpose of curing heroin addiction.
Ibogaine is a hallucinogenic psychoactive substance found in some species of plants that grow in Africa. It’s been used in religious ceremonies, chewed to give a mild stimulant effect. With increased doses, this substance has hallucinogenic effects. Ibogaine is a sloppy drug, affecting at least three types of brain receptors. Ibogaine’s metabolite, noribogaine, has serotonin reuptake inhibition properties, like found in many antidepressants. It also has a weak opioid effect on the mu opioid receptors and a stronger effect at the kappa opioid receptors, causing less dopamine to be released. It also has effects on at least two other receptor types.
Limited studies show that since the drug does block the release of dopamine, it may have some benefit in the treatment of addiction to these drugs. Both animal studies and case reports suggest ibogaine may reduce withdrawal symptoms of opioid addiction and craving for cocaine. But so far there have been no good scientific trials of the drug. This drug has been outlawed in the U.S. and in most European countries due to concerns about the drug’s side effects and case reports of death. Ibogaine’s supporters claim this drug can cure addiction to alcohol, cocaine, opioids, and nicotine.
In this case report, the decedent was a 25-year old male with heroin addiction and a history of supraventricular tachycardia, meaning he had an underlying heart problem that caused episodes of rapid heart rate. This man took ibogaine 2.5 grams over 3 hours, and then had hallucinations, difficulty with balance, fever, and muscle spasms. He improved over the first day, but by the next day he developed problems breathing and had a respiratory arrest. Despite cardiopulmonary resuscitation, he remained in a deep coma and died after two days of multi-organ failure.
This death was of course a tragedy, but I’m not sure this case and other similar cases mean ibogaine won’t ever have a place in the treatment of opioid addiction. It surely gives us information that patients with underlying heart disorders are at increased risk of death from ibogaine.
I still think there’s a need for further (careful) research on ibogaine. This can’t be done at present in the U.S. or Europe, but perhaps other counties can do necessary trials.
Yes, this is a medication that can kill, but then, addiction kills, too. And many medications routinely used in the medical treatment of various illnesses can be deadly at the wrong doses or in the wrong patients. For all medical treatments, the risks have to be weighed against the benefits. Right now, we don’t have a full idea of the benefits or the risks of ibogaine.
Like many treatments for addiction, there are also people who make unsubstantiated claims in favor of ibogaine, and sell it via the internet or in countries where it isn’t outlawed, as a miracle cure for opioid addiction. The evidence for this claim is lacking, to put it mildly. This case report reminds us that ibogaine can be deadly. Until/unless we have more knowledge about the risks/benefits of ibogaine, evidence-based treatment of opioid addiction with methadone and buprenorphine are much better options and should be recommended.
For further information of the state of ibogaine research, here’s a great reference:

Thursday, May 23, 2013

Organization of American States OES Report on history of Drug Policy

This article comes from Stop the


OAS Releases Historic Report on Drug Policy Alternatives [FEATURE]


Posted in:
The Organization of American States (OAS) Friday released a ground-breaking report on hemispheric drug control that includes not only an assessment of the current state of affairs, but also looks at a number of alternate scenarios for future directions in drug policy, including explicit analysis of possible regulation and legalization regimes.

Colombian President Santos (l) receives the report from OAS head Insulza in Bogota Friday (
The report comes even as the US military is expanding its drug war in Latin America.The military is deploying assets to Central and South America, and US military assistance in Latin America has quadrupled in the last decade -- even as the region faces no external and diminishing internal threats.
The report, The Drug Problem in the Americas, was commissioned at last year's Cartagena Summit of the Americas, where a number of Latin American leaders led by Colombian President Juan Manuel Santos criticized existing drug policies and called for a discussion of alternatives. On Friday, OAS head Jose Miguel Insulza hand-delivered the report to Santos in Bogota.
Prepared by researcher and analysts at the Inter-American Drug Abuse Control Commission (CICAD) under the supervision of the OAS, the report is divided into two discrete sections, an analytical report and a scenarios report. It is the scenarios report that addresses possible directions in drug policy, including the formal consideration of legalization and regulation regimes.
The scenarios report envisions four possible (and not necessarily mutually exclusive) policy directions and how each scenario "understands" the drug problem, what the attempted response would be under that scenario, and the opportunities and challenges involved in acting on those scenarios.
Two scenarios, "Together" and "Resilience," represent largely traditional responses to drug use and the drug trade, with calls for the strengthening of weak states and their judicial institutions or addressing underlying social problems and strengthening communities to fight violence and addiction, respectively.
It is the other two scenarios, "Pathways" and "Disruption," that represent innovations in thinking at the policy-making level. In the "Disruption" scenario, the violence and instability created by the drug trade under prohibition is so severe that authorities "cut a deal" with traffickers in a bid to achieve social peace. This might, more or less fairly, be called "the Mexican scenario," given that previous Mexican PRI governments are almost universally assumed to have made such bargains with trafficking organizations, and given widespread speculation these days that the current PRI government may be considering something similar.

drug seizure, Mexico (
In the "Pathways" scenario, CICAD "understands" the problem as "the current regime for controlling drugs through criminal sanctions (especially arrests and incarceration of users and low-level dealers) is causing too much harm." The response is "trying out and learning from alternative legal and regulatory regimes, starting with cannabis."
The opportunities presented under the "Pathways" scenario include "development of better drug policies through experimentation, reallocation of resources from controlling drugs and drug users to preventing and treating problematic use, and shrinkage of some criminal markets and profits through regulation," while potential problems include "managing the risks of experimentation, especially with transitioning from criminal to regulated markets (including possible increases in problematic use), dealing with contraband, and new inter-governmental tensions that result from differences in regimes between jurisdictions."
The report is being welcomed as marking a true advance in the drug policy dialog at the hemispheric and international levels.
"The review explores what can be done in a post-drug war world," said Kasia Malinowska-Sempruch, director of the Open Society Global Drug Policy Program. "This report envisions a number of possibilities that will broaden the current debate on drug policy reform."
"As part of the scenarios team, we worked to make it clear that another reality is indeed possible, that our countries can move orderly toward regulated drugs markets, and that there are possibilities to achieve better results," said Lisa Sanchez, coordinator of drug policies at the Transform Drug Policy Foundation and Mexico Unido Contra la Delinquencia, who worked on the report. "It is clear that the state should no longer ignore its responsibility to guarantee the health and security of all its citizens, and to do this, it needs to regain control over the drug markets which are currently illegal."
"While leaders have talked about moving from 'criminalization' to 'public health' in drug policy, punitive, abstinence-only approaches have still predominated, even in the health sphere," said Daniel Wolfe, director of the Open Society International Harm Reduction Program. "These scenarios offer a chance for leaders to replace indiscriminate detention and rights abuses with approaches that distinguish between users and traffickers and offer the community-based health services that work best for those in need."

methamphetamine user under arrest, US (
"This is the beginning of an international conversation on a new approach to drugs," said David Holiday, senior regional advocacy officer for the Open Society Latin America Program. "We can hope this will move policies from those currently based in repression to strategies rooted in public health and human rights."
That international conversation on drug policy will get going next week, when the OAS report will be presented and discussed at the bi-annual CICAD meeting in Washington, DC. Two weeks after that, the report and discussions over drug policy in the Americas will be the main agenda item -- "Toward a comprehensive anti-drug policy in the Americas" -- at the annual session of the OAS General Assembly, which is attended by foreign ministers in the region. Advocates are hoping that these regional discussions will also be taken up at the 2016 United Nations General Assembly Special Session on Drugs.
"Never before has a multilateral organization engaged in such an inclusive and intellectually legitimate analysis of drug policy options," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "Indeed, it would have been inconceivable just two years ago that the OAS -- or any multilateral organization -- would publish a document that considers legalization, decriminalization and other alternatives to prohibitionist policies on an equal footing with status quo policies. Political pressures by the US and other governments would have made that impossible."
But much has changed in just the past few years, Nadelmann noted. In 2009, former presidents Fernando Henrique Cardoso (Brazil), César Gaviria (Colombia) and Ernesto Zedillo (Mexico) joined with other members of the Latin American Commission on Drugs and Democracy in saying the time had come to "break the taboo" on exploring alternatives to the failed war on drugs.
In 2011, those presidents joined with former UN Secretary General Kofi Annan, former U.S. Secretary of State George Shultz, former Federal Reserve Board chairman Paul Volcker, former Swiss President Ruth Dreifuss and other members of the Global Commission on Drug Policy in calling for fundamental reforms to national and global drug policies. Former presidents Jimmy Carter, Ricardo Lagos (Chile), Vicente Fox (Mexico) and Aleksander Kwasniewski (Poland) were among those who seconded their recommendations.
Late that year, sitting presidents began to join the calls of their predecessors. These included President Santos in Colombia, Otto Perez Molina in Guatemala, José Mujica in Uruguay and then-President Felipe Calderonof Mexico. Simultaneously, the victorious marijuana legalization ballot initiatives in Washington State and Colorado transformed a previously hypothetical debate into real political reform. Other states will almost certainly follow their lead in coming years.
"The OAS scenarios report thus represents the important next step in elevating and legitimizing a discussion that until a few years ago was effectively banned from official government circles," Nadelmann said. "It is sure to have legs in a way that few reports by multilateral institutions ever do."