Harmed by HARM’D

HARM’D (Helping America Reduce Methadone Deaths) is an organization that lobbies against methadone, or at least against methadone- related deaths. Though they fall short of advocating abolishment of methadone completely, they do advocate for stronger federal regulations of methadone clinics.

 As part of the research I did for the book I wrote last year, (“Pain Pill Addiction: Prescription for Hope”) I looked carefully at the HARM’D website, http://harmd.org. Recently, I was surprised to see the website appears to be abandoned. In the past, one could find extreme and inflammatory statements on the website’s discussion boards. The statements on HARM’Ds website were fueled by grief from the deaths of loved ones, who died from methadone overdoses. They used to have a video on the website, describing loved ones who died with methadone in their system. Most were young people, and many were not addicts, but made a bad choice and died as a result of it. Watching the video was very sad.

Listening to the videos on HARM’Ds website, and reading comments posted by HARM’D’s members gave me the impression the organization was completely opposed to methadone. However, last year I emailed the organization with some questions, and the president of HARM’D’s board responded quickly.

HARM’D advocates special training and licensure for physicians who work at methadone maintenance clinics, and mandatory drug testing for patients (though these are already mandated, by federal regulations for patients in opioid treatment centers). They want naloxone (brand name Narcan, a drug that reverses the sedation of an opioid overdose) to be dispensed so if a patient overdoses at home, their family can learn to inject them with Narcan and thus revive them.

HARM’D advocates the use of methadone only as a last resort, after safer drugs fail. (I presume they are speaking about pain patients, since opioid treatment centers only have two medications they can legally prescribe to treat addiction). HARM’D wants to make sure patients in pain clinics and methadone clinics are adequately informed about the dangers of methadone. They say doctors treating chronic pain patients have other drugs from which to choose. They want to eliminate take homes for patients who are still using drugs, and want clinics to be open every day of the year, for new or unstable patients. They recommend that methadone clinics have a “no benzo” policy. They would like to see a reduction in the number of take home doses allowed for stable patients, so patients on methadone would have to come to the methadone clinic more often. They promote quick detoxification from a methadone clinic, if urine drug screens are positive.

I wish the members of HARM’D could meet and talk with stable and successful patients on methadone. Many, if not the majority, of patients who start in methadone programs do extremely well and have no further drug use while on a program. They return to their work and to their families, and become functional citizens. These patients are anonymous. They keep quiet about taking methadone, because they don’t want to face the stigma attached to being a methadone patient. They know that some people in their lives would criticize them harshly for choosing this treatment option. HARM’D doesn’t see these patients. Nobody sees these patients, except the staffs at their methadone clinics.

Some of HARM’D ideas are good; additional training for physicians working in methadone clinics is a great idea. Perhaps doctors who work in opioid treatment clinics should be required to have American Society of Addiction Medicine (ASAM) certification or the equivalent in the field of psychiatry. If a physician who wants to work in an opioid treatment center has no previous experience with addiction and its treatment, required attendance at a comprehensive, one day training course would assure that this physician understands the pharmacology of methadone. This would increase the quality of care at opioid treatment clinics, and doesn’t seem overly burdensome for physicians who desire to work in clinics. In fact, my state has held several such training courses for new and established doctors who work at opioid treatment centers.

To further complicate the issues, many personal injury lawyers are becoming involved in filing lawsuits on behalf of patients who have died from methadone overdose deaths, and their families. A search of the internet reveals many similar advertisements. One law firm advertised themselves as “Dangerous Drug Lawyers.” This probably wasn’t the best wording they could have chosen. (What’s dangerous, the drug or the lawyer?)

Thankfully, there is also an advocacy group for patients on methadone: NAMA, for National Alliance for Medication-Assisted Therapy. They have wisely asked members to take an advocacy training course, before speaking out about methadone. This is smart, because it gives NAMA more credibility. It’s easy to state your position and support it with facts when you know the facts. Many members of HARM’D seem to be talking from a place of emotion, while members of NAMA focus on the facts, as revealed in forty years’ worth of scientific studies and forty years’ worth of outcome studies for addicts.

Opioid treatment centers already have many regulations they must follow. Even following all of these regulations, a small amount of methadone will inevitably spill into the black market, but this amount is small, in comparison to the amount of methadone diverted to the black market from pain patients. In the last several years, I’m happy to see that pain medicine specialists are prescribing less methadone.

 I don’t know if HARM’D is still a functioning organization. Perhaps they will open another website, perhaps not. Either way, I hope their members have found peace. Even though I don’t agree with them on most things, I feel compassion for anyone who has lost a loved one to addiction, because I have, too.

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