Archive for the ‘Buy My Book!’ Category

Christmas Special

For anyone interested in a copy of my book, it’s now available in pdf form, on EBay, for $2.

If you are a patient at Stepping Stone, don’t get it on EBay. Stepping Stone patients can get it for free –  just give your email address to Amy, our receptionist, and I’ll email you the pdf.

 I’m also bringing a few paperback copies to Stepping Stone tomorrow, to give away.

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.

A Bit of History

             In the 1980’s, President Ronald Reagan helped guide the thinking of the nation, and emphasized law enforcement as the solution to the war on drugs. The War on Drugs was born. Spending increased for police and other enforcement agencies, but decreased for addiction research and addiction treatment. When crack cocaine captured the attention of America in the mid-1980’s, it re-ignited old fears.

            As in times past, what people thought of drug addicts depended in part on who was addicted. There was much rhetoric about the nature of crime committed by minorities, addicted to drugs, and of crack babies, based more on media exaggeration than on science. As a result, the drug laws were again re-written.

          During the Reagan years, laws were passed that were quite similar to the draconian Boggs Act of the 1950’s. The death penalty was even re-introduced for drug dealers, under certain circumstances. Laws mandating sentences for simple possession were resurrected, and in general, drug laws were set back to the way they were thirty years prior.

            Parents of the 1980s observed with alarm the rise in cocaine abuse, with its hazards and easy availability. They leapt into action, by forming the Parent’s Movement.  They were a powerful political voice that helped coerce lawmakers into passing tougher drug laws. The American public had once again demanded more punitive drug laws.

             Laws passed against the possession of crack were different from those for powder cocaine. The penalty for five grams of crack was the same as the penalty for five hundred grams of powder cocaine. African Americans, of lower socioeconomic status, tended to use crack because it was cheaper than powder cocaine. Therefore, African Americans were more likely than whites to receive a mandatory sentence for drug possession, because it took so little crack, a hundred-fold less, to carry the same sentence. (1)

             State and federal laws differed considerably, because federal convictions could not, by new law, be shortened by more than fifteen percent. This meant that being convicted in federal court lead to longer sentences than being convicted in state courts. District attorneys had the power to decide in which jurisdiction to try an offender, and this gave them considerable influence over the fates of arrestees. Predictably, prisons filled around the country, and prison censuses doubled, at both state and federal levels. (1)

             Shortly before the first of the George Bushes took office in 1989, the 1988 Anti-Drug Abuse Act was passed, which re-organized the bureaucracies assigned to overseeing the drug addiction problems of the nation. Under this Act, the Office of National Drug Control Policy (ONDCP) was formed, and William Bennett was designated drug czar. This agency was given the task of monitoring all of the anti-drug programs in government agencies. The forerunner to the Center for Substance Abuse Prevention (CSAP) was formed in the Substance Abuse and Mental Health Services Administration (SAMHSA). There was much fanfare about new policies, which would both emphasize a zero tolerance toward drug use and also give more attention to treating addiction. However, Bennett resigned abruptly and the fanfare fizzled.

              When Clinton took office in 1993, he cut funding for the ONDCP by eighty-three percent, and exhibited a general lack of interest in addiction and its treatment. His Surgeon General, Jocelyn Elders, angered many when she appeared to advocate legalization of drugs. (2) Probably in response to public pressures, and concerns about the rising rate of marijuana use among adolescents, Clinton publically announced a new attack on drugs, just before the next election year, and nominated Barry McCaffery to head the revived ONDCP.

              Throughout the 1990’s, heroin purity on the U.S. streets was gradually increasing. In 1991, heroin was about twenty-seven percent pure, while by 1994, it had risen to forty percent. That was a dramatic increase in purity, compared to 1970’s and 1980s, when an average purity of three to ten percent was found in U.S. cities. Many potential addicts, scared off cocaine by high profile deaths of people like Len Bias and John Belushi, turned to experimentation with heroin. (1). Columbian drug cartels, diversifying from dealing only with cocaine, began selling heroin to meet an increasing demand by the U.S. Because heroin was so pure, it could be snorted, rather than injected, and many people who balked at injecting a drug would snort it, and did. By 1997, heroin accounted for more treatment center admissions than did cocaine. (2). “Heroin chic”, a trend of thin and ill-looking models as the ideal of beauty, came into vogue in the mid-1990s.

             At that same time, in the mid-1990s, several more ingredients besides higher potency heroin were thrown into the simmering caldron of opioid addiction: the pain management movement and access to controlled substances over the internet. Then, with the release and deceptive marketing of OxyContin, the cauldron began to boil. 

1. David Musto, The American Disease: Origins of Narcotic Control, 3rd ed., (New York: Oxford University Press, 1999) p 274.

2. David T. Courtwright, Dark Paradise: A History of Opiate Addiction in American, (Cambridge, Massachusetts, Harvard University Press, 2001) pp180-181.

excerpt from “Pain Pill Addiction: Prescription for Hope”

Great News! My Book Wins Awards!

I got some great news this week. My book, Pain Pill Addiction: Prescription for Hope, was a finalist in two categories of the Indie Book Awards: Current Events/Social Change, and Health/Wellness.

For a list of winners and finalists, go to:  http://www.indiebookawards.com/2011_winners_and_finalists.php

 I’m thrilled. My patients and their families have told me how much they like the book, but I wondered if it had appeal beyond those directly affected by pain pill addiction. It’s nice to get some indication that it does.

Great Book About Opioid Addiction!!!

I orginally started this blog to promote the book I wrote about pain pill addiction. As it’s turned out, the blog has been much more popular than the book (it isn’t exactly flying off the shelves), so I’d like to remind blog readers – again – that if you like the blog, you’ll love my book.

You can order it from Barnes & Noble, or Amazon. But I’m selling it for a much-discounted rate of $13.95 on EBay. That’s with shipping included.

http://shop.ebay.com/i.html_from=R40&_trksid=p5197.m570.l1313&_nkw=pain+pill+addiction&_sacat=See-All-Categories

Great New Book to Recommend!

by Rebecca Janes, LMHC, LADC

So there I was, cruising Amazon.com, looking for new books about opioid addiction and treatment, when I saw an intriguing title: Methadone: The Bad Boy of Drug Treatment.

I ordered it, and just finished it.

I fully recommend this book for anyone interested in learning more about methadone treatment. It’s written by Rebecca Janes, LMHC, LADC. The book’s cover says she has around fifteen years’ experience working in methadone treatment centers. She’s obviously knowledgeable about the studies supporting treatment of opioid addiction, and she’s able to summarize this knowledge succinctly. She explains complicated ideas in simple ways that make sense.

 It’s a small book, at 120 pages, and doesn’t have many references, but it covers most essential areas. The price is $12.95, and it’s published by Outskirts Press. As I said, you can buy it on Amazon, where it’s also available as a Kindle edition for only $2.99.

 The first chapter is dedicated to correcting mistaken impressions the general public has about methadone treatment, and Chapter Two corrects myths addicts often tell each other. Chapter Three describes what does not work in treatment, and Chapter Four tells what does work. Chapter Five tackles more controversial aspects, such as appropriate treatment of pain and anxiety for patients maintained on methadone.

 Patients on methadone will find this an ideal book to give to important people in their lives who nag them about getting off methadone. It’s great for parents and other relatives. It would be ideal to give to doctors with negative or judgmental attitudes, since it’s a quick read, and doctors aren’t likely to want to spend much time reading about a treatment they don’t believe in. It would be a great book to recommend to probation officers and social workers who don’t have much knowledge about methadone and its use. 

The only criticisms I have of the book are its few references, and it doesn’t cover buprenorphine at all. But then, if you want more in-depth information about opioid addiction, methadone, and buprenorphine, complete with references, you should buy my book: Pain Pill Addiction: Prescription for Hope. You can get it for $13.95 on EBay, shipping included. Or have I mentioned this before?

Top Ten Books for Methadone Counselors

I have a fair number of methadone counselors who read my blog. I’m often asked by these counselors what books I recommend, which is like asking me what kind of dessert is good. The list is so long. But here are the ones all methadone counselors should read:

  1.  Medication-assisted Treatment for Opioid Addiction in Opioid Treatment Programs, by the Substance Abuse and Mental Health Services Administration. This is better known as “TIP 43,” because it’s the 43rd book in the series of treatment improvement protocols published by SAMHSA. You can get any book in the series for FREE! Yes, this book and several others are free resources. The website is: http://store.samhsa.gov. While you’re there, order TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, and TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment. Then browse around, and see what else interests you. This is a great website, and all addictions counselors should be very familiar with it. There’s great material for counselors and their clients.
  2.   Pain Pill Addiction: Prescription for Hope, by….me. Hey, it’s my blog, so of course I’m gonna list my book. At least I didn’t put it at number one. But seriously, I do think my book describes what opioid addiction is, why this country is having such problems with opioid addiction now, and the available treatments for this addiction. I focus on medication-assisted treatments, which means treatments with methadone or buprenorphine, better known as Suboxone. After reading my book, any substance abuse counselor should be able to talk intelligently with patients and their families about the pros and cons of medication-assisted treatment. I tried hard to base this book on available research and not my own opinions, though I do state some of my opinions in the book. My book also has summaries of the major studies done using medication-assisted treatments, so that if you need resources to prove why methadone works, you’ll have them. OK. I’m done blathering. Order it on EBay and you’ll save some money.
  3.      Motivational Interviewing by William Miller and Stephen Rollnick. This is a book all addiction counselors should have… and read. I’ve learned so much about how to interact with people as they consider if, how, and when to make changes in their lives by reading this book. The authors demonstrate how the Stages of Change model easily fits with this style of counseling. There are some solid examples of how to incorporate MI techniques.
  4.      Cognitive Therapy of Substance Abuse, by Aaron Beck et. al. This is a venerable text describing cognitive therapy as it applies to substance abuse. The book is relatively concise, but it’s still dense reading. Get out your underliner because you’ll want to find some parts to read again. The dialogues in the book that serve as examples are instructive. This book has been around for some time, as texts go, since it was published in 2001.
  5.     Narcotics Anonymous Basic Text, by Narcotics Anonymous World Service. Now in its sixth edition, this is one of the books that serve as a foundation for 12-step recovery in Narcotics Anonymous. If you are a counselor who’s in recovery, you’ve probably already read it. If you’re not, you need to get it, read it, and be able to talk intelligently about the 12-step recovery program of this 12-step group. The AA “Big Book,” which is AA’s version of a basic text, has much of the original old-time words and phrases, and speaks mostly of alcohol. For these reasons, some addicts won’t like the Big Book as well as the NA Basic Text. However, the Big Book does have a certain poetry that will appeal to others. (….trudge the road of happy destiny…) You can order it at http://na.org or go to that site and download it as a pdf.
  6.  The Treatment of Opioid Dependence, by Eric Strain and Maxine Stitzer. Written in 2005, this is an update to a similar title written in the 1990’s. This book reviews the core studies underpinning our current treatment recommendations for patients in medication-assisted treatment of opioid addiction. I don’t know why more people haven’t read this book, because it’s relatively easy to understand. Don’t make the mistake of assuming it will be too advanced for you. Get it and read it.
  7. Addiction and Change: How Addictions Develop and Addicted People Recover, by Carlo DiClemente. This book describes the paths people follow as they become addicted and as they recover. It’s focused on the transtheoretical model of the stages of change, so named because it can be used with many counseling theories. I think this is a practical book, and easier to understand than some texts.
  8.  Diagnosis Made Easier: Principles and Techniques for Mental Health Technicians, by James Morrison M.D. This is an improvement of his earlier book, DMS IV Made Easy, written in 1992. At any work site, addictions counselors will have to be familiar with the criteria used to diagnose mental illnesses. Since around 30 – 50% of addicts have another co-occurring mental illness, you need to be familiar with the criteria used to diagnose not just addiction, but these other illnesses as well. And this book makes learning relatively painless. It’s practical and easy to read, and based on common sense. It contains many case examples, which keep it interesting.
  9. The American Disease: Origins of Narcotic Control, by David Musto. This book has been updated and is on its third edition, but so much has happened since this last edition in 1999 that the author needs to write an update. This is an interesting book, and it moves fairly quickly. This information puts our present opioid problem into the context of the last century or so. As an alternative, you can read Dark Paradise: A History of Opiate Addiction in America, by David Courtwright in 2001. I included this book, but be warned it’s heavier reading. This author is an historian, so maybe his writing style didn’t resonate with me as much. Still, he has much good information. You can’t go wrong with either book. You could also read The Fix by Michael Massing, which is another book about the history of addiction and its treatment in the U.S… This last book doesn’t focus on just opioid addiction, but still gives all the pertinent history. This book is written by a journalist and will keep your interest. It was written in 2000.
  10.  Hooked: Five Addicts Challenge Our Misguided Drug Rehab System, by Lonnie Shavelson. This book, written by a journalist, follows five addicts through the labyrinth of addiction treatment. You’ll see the idiotic obstructions addicts seeking help are asked to negotiate in our present healthcare system. I was angry as I read the book, seeing obvious simple solutions that couldn’t be enacted for one administrative reason or another. Let this book make you angry enough to demand change from our system. Be an advocate for addicts seeking treatment.

 Have I left out any? Let me know which book have helped you be a better counselor or therapist.

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