NAMA TALK

Together We Can Make A Difference Wednesday March 15, 2000

NAMA Talk—a weekly “zine for NAMA chapters and affiliates.”

Volume 2 March 15, 2000 Issue 3

TABLE OF CONTENTS:

• Feature Article -

NIDA SURVEY FINDS PRACTITIONERS WOULD TREAT ADDICTED PATIENTS WITH OFFICE BASED METHADONE NIDA PRESS RELEASE, Wednesday, March 1, 2000

• Organizational News by Joycelyn Woods

This will be a short column since there is a lot of reading in this issue of NAMA Talk and we are busy, busy, busy with the AMTA Conference.

• Articles

1. A PRESCRIPTION FOR BEATING HEROIN

Ed Housewright, Staff Writer of The Dallas Morning News The Dallas Morning News, February 27, 2000, Sunday

2. First Methadone Clinic Opens; Legislators Consider Changing Law By The Associated Press

Foster's Daily Democrat Monday, February 28, 2000 3. COMMENTS ON AN EVALUATION OF COMMUNITY METHADONE SERVICES IN

VICTORIA,AUSTRALIA: RESULTS OF A CLIENT SURVEY. (1) by Andrew Byrne, General Practitioner, Drug and Alcohol March 7, 2000

5. "Methadone deaths" (or are they?). Comments on

Methadone syrup-related deaths in New South Wales, Australia, 1990-95

by Dr Andrew Byrne, General Practitioner, Drug and Alcohol Specialist

March 10, 2000

6. Lindesmith Center Files Amicus Curiae Brief in Supreme Court Case Challenging Drug Testing of Pregnant Women News Release 3/10/00

7. Treatment for Opioid Dependence: Quality and Access (Editorial ) JAMA. March 8, 2000;283 (editorial.

8. Methadone Maintenance vs 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence : A Randomized Controlled Trial

9. Provision of Methadone Treatment in Primary Care Medical Practices: Review of the Scottish Experience and Implications for US Policy Policy Perspective

• Organizational Information, Funding and Fund Raising

1. The SearchZone - new from The Foundation Center http://fdncenter.org/searchzone/

2. The Philanthropy News Network (PNN) http://www.pnnonline.org

3. CharityVillage.Com Named As Best Site for Email Discussion Lists http://www.charityvillage.com/charityvillage/stand1.html

4. "SNAPSHOT": SAMHSA PROVIDES A FREEZE-FRAME OF UPCOMING EXTRAMURAL GRANT OPPORTUNITIES

5. CyberGrants

http://www.cybergrants.com/

6. Fundraising for Small NonProfits http://www.resolveinc.com/NEWS.htm

7. Techportal.org http://www.techportal.org

8. The People Tab InfoPieces, Requests... People! http://www.infostry.com

Announcements, Conferences & Meetings

Announcements, Conferences and Meetings

1. Sessions from Preventing Heroin Overdose: Pragmatic Approaches are Available on the Internet

2. Free Charles Garrett Campaign at Critical Juncture http://www.drcnet.org/wol/127.html#garrettcampaign

3. Is Our Drug Policy Effective? Are There Alternatives?," New York March 17-18, 2000

4. ORGANIZE! AN ACTIVIST-ACADEMIC CONFERENCE ON SOCIAL MOVEMENTS AND ORGANIZING

New York City, COLUMBIA UNIVERSITY APRIL 8-9th, 2000

5. Conference 2000 National Methadone Conference American Methadone Treatment Association April 9-12, 2000 San Francisco

6. 11th International Conference on the Reduction of Drug Related Harm April 9-13, 2000 Jersey Channel Islands, British Isles

7. Drug Use, HIV and Hepatitis: Bringing It All Together Baltimore May 7-10, 2000

8. 13th International Conference on Drug Policy Reform, Washington, DC May 17-20, 2000

9. 3rd National Harm Reduction Conference Miami October 21-25, 2000

Communities Respond to Drug Related Harm AIDS, Hepatitis, Prison, Overdose & Beyond

10. Lindesmith Seminars

March 14, 4:00-6:00pm "Let's Get Real: New Directions in Drug Education." Marsha Rosenbaum, PhD and Lynn Zimmer, PhD.

March 30, 4:00-6:00pm "MDMA ('Ecstasy') Research: When Science and Politics Collide." Julie Holland, MD, John P. Morgan, MD and Rick Doblin.

• INTERNET RESOURCES

1. KnowX http://www.knowx.com/

2. The Ultimate People Finder Search (from KnowX) http://kf.knowx.com/infoam.exe?form=pf/search.htm

3 REFDESK.COM http://www.refdesk.com

4. Website AcronymFinderCom

http://www.acronymfinder.com/

5. HANDSNET http://www.handsnet.org

6. Contacting Congress http://www.visi.com/juan/congress/

7. Physician Leadership on National Drug Policy http://www.caas.brown.edu/plndp/

8 List of Journals & Publications

This is a listing of some of the most important reading for methadone advocates on the web Back To Table Of Contents

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FEATURE ARTICLE Feature Article NIDA SURVEY FINDS PRACTITIONERS WOULD TREAT ADDICTED PATIENTS WITH OFFICE BASED METHADONE A NIDA-supported survey of primary care physicians, physician assistants, and nurse practitioners working in New York City found that two-thirds of the clinicians are willing to provide methadone maintenance treatment (MMT) in their offices to opiate addicted patients. Seventy-one clinicians at 11 sites in Manhattan and the Bronx took part in the survey, which was conducted by researchers at the Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, NY. The full report appears this month in the "Journal of Urban Health: Bulletin of the New York Academy of Medicine". "Office based methadone treatment would represent an enormous step forward in treating heroin addiction," said NIDA Director Alan I. Leshner, Ph.D. "This study shows that practitioners understand that their addicted patients are suffering from a treatable disease, and they are willing to provide that treatment." There are more than 600,000 diagnosed heroin addicts in the U.S. but fewer than 20 percent receive treatment, notes Ernest Drucker, Ph.D., of the Department of Epidemiology and Social Medicine at Montefiore Medical Center, principal author of the report. "In Europe, Australia, and Canada, more than half of all methadone is prescribed in general practitioner's offices, Dr. Drucker said. "This has dramatically expanded MMT availability and played a key role in containing the AIDS epidemic among injection drug users. In the U.S., however, this treatment is severely restricted by Federal and State laws restricting MMT to large specialized clinics. In 1996, the Institute of Medicine of the National Academy of Sciences recommended integrating methadone treatment into general medical practice. In 1997, a National Institutes of Health report recommended increased access to MMT, a loosening of Federal and State regulation, and insurance coverage for methadone treatment. -------------------------------------------------------

"Methadone is a synthetic opiate, similar to heroin, that blocks the effects of heroin and eliminates withdrawal symptoms. It has been used effectively and safely in addiction treatment for more than 30 years, and has been shown to increase the retention of patients who enter treatment, reduce rates of intravenous drug use and HIV infection, and reduce criminal activity by allowing patients to enhance their social productivity". -------------------------------------------------------- "The principal finding of our study is that these practitioners, who are already caring for the populations and communities most in need of more addiction treatment, are supportive of extending methadone treatment to mainstream medical practice," Dr. Drucker said. Dr. Drucker and his colleagues interviewed practitioners in community-based primary care and HIV/AIDS clinics serving inner city populations. Most had extensive experience in caring for patients who are on methadone maintenance treatment. Half of the practitioners expressed some concern that the multiple needs of methadone patients would be difficult to meet, but 66 percent said they would prescribe MMT for their patients, given proper training and support. "For these practitioners, methadone is not laden with stereotypic fears about bringing drug addicts into their practice," Dr. Drucker said. "They see methadone as another useful tool for managing the overall health of their patients." Source: NIDA PRESS RELEASE, Wednesday, March 1, 2000 Contacts: Beverly Jackson and Michelle Muth (301) 443-6245 The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on the health effects of drugs of abuse and other topics can be ordered free of charge in English and Spanish by calling NIDA Infofax at 1-888-NIH-NIDA (644-6432) or 1-888-TTY-NIDA (889-6432) for the deaf. These fact sheets and further information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov. Back To Table Of Contents

ORGANIZATIONAL NEWS by Joycelyn Woods Organizational News This will be a short column since there is a lot of reading in this issue of NAMA Talk and we are busy, busy, busy with the AMTA Conference. Maureen Neville reports that the Patient Board had a meeting last week and discused training for hearings. The clinic director is going to help the group get some training. This is real positive and a good idea for every one to sharpen their presentation skills because what advocates say can really have a significant impact. Deleware NAMA and Joe Neuberger are looking to change more policy. Actually this is new policy at the clinic that says or infers that methadone patients can not take valium because of interactions. Joe is looking for any ideas or information about this Jay Clarke of Norfolk NAMA reports that they are developing a website. By next issue I hope to be able to give you the address. Bill Nelles called me from the UK this week and they are having their methadone conference this month. It is a big success and next year NAMA hopes to attend. By the way Nelles as usual spole of NAMA with praise and said that they are going to follow in our foot steps in the way that NAMA has become involved with policy issues. Bill will also give us a report on the UK conference and a harm reduction conference happening in the Jersey Isles. And I am flattered as I have been invited to the European Methadone Conference in Alezzo Italy (May 3-5, 2000) by our Italian affiliate Gruppo SIMS. So I hope that some of our international groups will be able to attend so that we can meet. See -- I told you it would be short! Back To Table Of Contents

ARTICLES 2. A PRESCRIPTION FOR BEATING HEROIN Ed Housewright, Staff Writer of The Dallas Morning News The Dallas Morning News, February 27, 2000, Sunday THIRD EDITION, SECTION: SUNDAY_READER; Pg. 1J DRUGS (1937 words)

Methadone gains credibility as way to end addiction to street drug or pain-killers

Before dawn each day, they start lining up outside Dr. J. Thomas Payte's clinic on the edge of downtown Dallas. When the doors open at 5:30 a.m., the doctor's patients file in for their fix of a narcotic they say they can't live without. Most of these men and women, of all ages, classes and colors, used to be addicted to heroin. Some abused prescription painkillers. They've traded those drugs for a daily dose of methadone, a legal but highly regulated substance that advocates say turns junkies into productive citizens. "For me, it's the answer," said Klyndia Smith, 45, as she waited for the clinic to open. "It enables me to maintain some semblance of a normal life." Methadone, which blocks the addict's craving for heroin and kills pain without producing a high, isn't new. It has been around for more than 35 years and has been criticized by some in the medical mainstream because it's not a true cure. It, too, is addictive, and many patients stay on methadone for years. Some are hooked for life, as hooked as they would be on any street drug, without all the negative side effects. But methadone, long dispensed from nondescript clinics that keep a low profile, is gaining credibility. Prominent government officials and scientific organizations have recently touted it as a safe, effective weapon the fight against heroin use, which is on the rise nationally. Federal drug czar Barry McCaffrey surprised - and angered - some drug opponents by calling for wider use of methadone. The National Institutes of Health concur, saying methadone "significantly lowers illicit opiate drug use, reduces death and crime and enhances social productivity." In Texas, the number of methadone clinics has increased from 55 to 70 in the past three years, according to the state Health Department, which licenses clinics.

"The literature is very, very comprehensive that methadone is an effective treatment," said Dr. Jane Carlisle Maxwell, chief researcher for the Texas Commission on Alcohol and Drug Abuse. "There are an awful lot of people who are using methadone, doing well and maintaining normal, crime-free lives. "We want people to be abstinent, but one of the things we're learning is that. . . for some long-term drug users, their brain chemistry has changed. They may never be able to be abstinent because their brain is telling them, 'You've got to provide this chemical to me.' " The increase in methadone use coincides with a spike in heroin- related deaths. In 1998, the most recent year for which figures are available, a record 374 people in Texas died from heroin overdoses, according to the commission on alcohol and drug abuse. In Plano alone, 13 teens have been killed by heroin since 1994.

McCaffrey endorses More addicts should be persuaded to shift to methadone, according to the Office of National Drug Control Policy, which Mr. McCaffrey, a former Army general, heads. Currently, at least 810,000 people nationwide chronically use heroin, and 170,000 receive methadone, the office says. "Only a fraction of those addicts who can benefit from methadone treatment do so," said a written statement from the drug office. "There is a substantial body of knowledge and a rare scientific consensus on both the utility of methadone treatment and its appropriateness for many addicts. . . . Methadone treatment must be more widely available to those who need it." To methadone user Tommy Romine, there's no debate on the drug's merits. "It's been fantastic," said Mr. Romine, 37. "It got me off dope. It's really changed my life for the better." He and many other addicts tell painfully similar stories. They turned to crime to support their habit. They lost jobs and families. Their health deteriorated. On methadone, users say, their lives stabilized. A quick swig of the cherry-flavored liquid in the morning is all it takes. No cravings. No withdrawal pains. No shooting up.

The nine Dallas-area methadone clinics open early so people can get their fix before work. Their clientele defies stereotypes. "We've got people who live under the bridge, and we've got people who own the bridge," said Rick Bingham, a counselor at D. Gonzalez and Associates, a Garland methadone clinic. On a recent morning at Dr. Payte's modest, white-brick office at Market Center and Turtle Creek boulevards, a plethora of occupations were represented: Realtor. Cook. Architect. Painter. Waitress. Mechanic. Telecommunications manager. An attorney who is a patient wasn't there. Dr. Payte, who opened a methadone clinic in San Antonio 33 years ago, has 275 patients in Dallas. Many say they have tried repeatedly without success to kick heroin on their own. One of the doctor's youngest patients is 19-year-old Veronica Miles of Waxahachie. (To get methadone, a person must be at least 18 and have been addicted to heroin for a year or more.) She visits the clinic with her father, Rodney Miles, also a recovering heroin addict. "I can't function without methadone," said Mr. Miles, 45. "It changed my lifestyle totally. I'm productive now. It turned me into a normal person. The oldest methadone user in Dallas County may be Lee Jackson, 77, who has taken it for 36 years. His health prevents him from visiting a methadone clinic, so a caseworker delivers it to his North Oak Cliff nursing home. "I can't say enough about methadone," he said. "Without it, I'd be dead or in jail somewhere." USE CARRIES STIGMA Most methadone users want to remain anonymous. They say reliance on the drug, even though it's legal, carries an enormous stigma. A 40-year-old architect, the mother of two young children, hasn't told anyone but her husband. "I'm fearful of what people might think," she said. "If I told my friends,I'm afraid they wouldn't let me around their children." Another methadone patient is a physician who wouldn't give his name or age. He said he became addicted to prescription painkillers four years ago, trying them out of curiosity.

"I made a horrible, horrible, horrible decision in my life, and I paid a lot for it," he said. "It's horribly embarrassing to talk about. It's so hard for me to put into words what the term 'powerless' is until you get addicted to a substance. You will do absolutely anything to get it." A man who gets methadone at West Texas Counseling & Rehabilitation in Irving recently built a $ 250,000 house in a Dallas suburb. He hasn't told his two young sons about his past heroin use or his 18 years on methadone. "Some day they'll find out, but I want them to find out when they're a lot older and they can deal with it," said the 47-year-old. "They see me as a regular dad, seemingly successful."

SOME DISAPPOINTMENTS But methadone is no panacea, and it doesn't work for everyone. Brandi Gray is an addict who has been on and off heroin many times. In her third week of methadone treatment not long ago, she said she was determined to succeed. "This time I really am sick of heroin," said Ms. Gray, 21. "Every other time I said I was sick of it, but I really wasn't." However, she acknowledged later that she continued to use heroin sporadically and dropped out of the methadone program. She then checked into a mental hospital to become free of all drugs and has recently started methadone at another clinic. Again, she said she's optimistic she can stay off heroin. Estranged from her parents because of her long history of drug abuse, she'd been living with her grandparents. But they, too, kicked her out after a recent relapse. After that, she was staying in her car. "I screwed up everything - my whole life, my relationship with my family. There's no going back," she said. "I can mend it a little bit, but not all the way." A walking anti-drug ad, she urged others not to get hooked. "The high you get is not worth what you lose," she said. "Heroin is terrible. I wouldn't wish it on my worst enemy."

Not only does methadone block heroin cravings, it also prevents the excruciating withdrawal symptoms - intense cramps, sweating, nausea and diarrhea. Methadone was developed in Germany during World War II as an alternative painkiller to morphine. It belongs to a class of drugs, called opiods, that includes morphine and heroin. In the early 1960s, two New York researchers discovered that methadone could be used to treat heroin addiction. Some people wean themselves from methadone, but many say they're afraid to even try. They worry that they'll immediately revert to heroin, and their lives will again careen out of control. Advocates maintain that giving methadone to heroin addicts is no different from giving insulin to diabetics. The drug's only known side effect is minor constipation for some people. "I don't want to even talk about" getting off methadone, said another 47-year-old man who asked not to be identified. "I don't think it'll ever happen for me. I will go to my grave being a methadone addict. I've come to realize that I have an addictive personality." That many users can't give up methadone provides ammunition for critics. Even though it's safe and tightly controlled, they say, methadone is still a drug. And users are still addicts. "I think if it's used as a conduit from heroin with the eventual goal of getting off methadone, that's fine," said Ed Cinisomo, vice president of Daytop Inc., a national, abstinence-based drug treatment chain that has a facility in Dallas. "Some people certainly need that. But I know people who are on methadone for a very long time. It becomes a lifestyle. People deserve better than that. You're conditioning them that this is the only way they can survive. "These poor folks are like lemmings showing up at the clinic every day. It's a whole subculture."

HOW IT WORKS At most clinics, people receive drug counseling along with methadone. They're encouraged to participate in support groups such as Narcotics Anonymous. Patients usually start on a low dose, 30 milligrams. That's about a quarter-inch in a small disposable cup. After three months of regular visits to a clinic, most patients are allowed to take home four doses a week so that they don't have to come in every day. After three years of good attendance, some users are allowed six take-home doses and visit the clinic only once a week. Patients are given random urine tests. If they continue to fail, they can be kicked out of the program. Methadone isn't cheap. Most clinics charge $ 50 to $ 60 a week. Of course, that's a bargain compared with the $ 300 to $ 400 a day that some junkies spend on heroin. Heroin users typically need four to six fixes a day. By comparison, one dose of methadone stabilizes a person all day long. Private insurance sometimes covers methadone treatment, but many people don't file claims because they're afraid their employer will find out about their addiction and fire them. Low-income patients receiving public health-care benefits may be able to receive methadone for a nominal charge. One Dallas executive said methadone helped lift him, literally, out of the gutter. Hooked on heroin, he was once homeless and "damned near selling my soul." Now, he owns a company in the medical field. "I have lived a very normal lifestyle for many years," said the 50-year-old man, who wouldn't give his name. "This is something that should be well-accepted. It's got a very big stigma and it's wrong. Methadone is not the root of all evil. "If anything, it has been many people's saving grace. It has for me and my family and numerous associates and friends."

Copyright 2000 The Dallas Morning News Back To Table of Contents

3. First Methadone Clinic Opens; Legislators Consider Changing Law By The Associated Press Foster's Daily Democrat Monday, February 28, 2000 . HUDSON, N.H. (AP) — The state's first short-term methadone clinic opened quietly last October, and the facility's director says most of his patients are people who live within a 15 to 20 minute drive. Robert Potter says his clinic's list of clients proves that heroin addiction is a serious problem in New Hampshire. "People will say, 'We don't have a problem here, not in our town,"' Potter said. "I beg to differ, and I have the zip codes to prove it." Right now, about 400 New Hampshire addicts travel every day to clinics in Maine or Massachusetts to get methadone, a drug that helps them kick the heroin habit and start leading productive lives again. Some must travel 200 miles or more each day, a trip that makes it hard for them to work. That's because New Hampshire law only allows short-term methadone treatment — up to six months, although there is an exception for pregnant women. Potter says it takes most addicts 18 months to two years to complete methadone treatment successfully. Now legislators are considering two bills that would allow long-term treatment in New Hampshire, one of only eight states that ban it. The bills are sponsored by Sen. Katie Wheeler, D-Durham, who believes it is time for New Hampshire to take a public health approach to heroin addiction instead of continuing to deny a problem exists. "There's a perception that we'll be soft on crime if we do this, that these will be places for addicts to hang out and sell the drug on the street," Wheeler said. "We don't have a very grown-up, nonpolitical view of the situation." One bill, approved unanimously at a Senate hearing last week, would allow Potter's clinic, Merrimack River Medical Services, to offer long-term methadone treatment until the state approves a more permanent program. The other bill, also approved, would set guidelines for similar clinics to open on a two-year, pilot-project basis.The bills are supported by the state Department of Health and Human Services, the New Hampshire Medical Society and various drug treatment specialists.

They argue that methadone treatment works. Although methadone is itself an addictive narcotic, it allows users to withdraw from heroin and start functioning again. Most people who use it go back to work, stop stealing money to support their heroin habits, get counseling and get treatment for other health problems, advocates say. "They don't get high, they don't get stimulated — they get normal," said Dr. John Dalco, who works part time at Potter's clinic. The widespread availability of methadone treatment in most states also has led to a big drop in heroin-related deaths, authorities say. The bill's supporters also say heroin use is on the rise in New Hampshire, as elsewhere, because it has become cheaper, purer and more available. The state's Drug Abuse Warning Network found that mentions of heroin use by patients in hospital emergency rooms doubled each year from 1996 to 1998. State statistics also indicate that it has replaced cocaine as the third most popular drug in New Hampshire, after alcohol and marijuana. Dr. Gerard Hevern, an Allenstown doctor who specializes in drug treatment, said heroin use is growing rapidly among high school students. "Heroin is very common from about 10th grade on," Havern said. "It is as readily accessible as beer in any of the high schools locally and throughout New Hampshire." State health officials would like to see the Legislature skip the pilot project phase of the bill and just pass legislation that would allow for long-term treatment, so addicts can start getting help. "It's not the people in treatment you're worried about," said Rosemary Shannon, chief of treatment services for the state's division of drug abuse prevention. "It's the people who aren't in treatment." © 2000 Geo. J. Foster Co. Back To Table of Contents **********************************************************************

4. Comments on An evaluation of community methadone services in Victoria, Australia: results of a client survey. (1) by Andrew Byrne, General Practitioner, Drug and Alcohol, New South Wales, Australia March 7, 2000 This study reveals some interesting and important findings regarding the treatment of heroin dependency patients in Victoria, Australia where most patients attend pharmacies for their dosing with accredited GPs prescribing. It is a credit to the authorities that there has been such an expansion of treatment services to meet the increasing numbers of dependent citizens. It is especially important to document the functioning of methadone dispensing in community pharmacies since this is where most of the expansion of such treatment is occurring around the globe. However, while changes will have occurred since 1995/6, the authors' positive conclusions still need to be tempered with some reservations about the limitations of current treatment delivery. As in other states, there is a perception by Victorian dependency patients that pharmacy dosing sometimes lacks confidentiality (46% said it was 'too public') and that there is some discrimination in others being served first (42%). Dosing hours and location (only 66% satisfied) were also problems, especially when looking for work (53% said it 'interfered'). The authors state: "Results of the study were generally encouraging. The majority of clients surveyed stated they were satisfied with their relationship with their prescriber and their pharmacist, and with the methadone programme overall. Overall, our survey indicates that the Victorian community-based methadone service is in general an acceptable model of methadone service delivery for clients in the metropolitan area." The survey of 195 patients would seem to indicate otherwise, revealing worrying deficiencies with treatment delivery as well as responses to that treatment. Only 72% were satisfied with their treatment and over a third stated that they would not have commenced treatment if they had know more about it, quoting 'hassles' amongst other problems. Although the average duration of treatment was over 2 years, 40% of patients had received no take-away or dispensed doses at the time of the interview. Only 10% received 2 such doses weekly, and they were more likely to be female. The reason for this uniquely rigid regimen is not given.

The mean dose was 41mg (mode 30mg) with only 15% receiving 60mg or more. Almost half of the patients (44%) were still using heroin regularly by self-report. These outcomes are consistent with the literature which yields a consensus that maintenance doses of methadone should normally be in the range 60mg to 120mg daily with only a small proportion of cases needing less or more than these levels. Hence up to 85% of Victorian patients may have been receiving inadequate doses in 1995/6. Dr Vincent P. Dole wrote "With adequate dosage of methadone, taken daily, heroin use should be completely eliminated in 95% of all patients." He also recommended a minimum blood methadone level of 0.2mg/l to prevent cravings in such patients. The lack of dispensed doses in this study is unparalleled in the world to my knowledge and is not based on sound scientific grounds. Like inadequate dosing, it is known to be associated with a significantly lower retention rates (Rhoades 1998). Dispensed doses for the Sabbath are given in many areas and reports have shown no differences from strict 7-day pick-ups (Gelkopf 1999). References 1. An evaluation of community methadone services in Victoria, Australia: results of a client survey. Ezard N, Lintzeris N, Odgers P, Koutroulis G, Muhleisen P, Stowe A, Lanagan A. Drug and Alcohol

Back To Table of Contents *********************************************************************** 5. "Methadone deaths" (or are they?). Comments on Methadone syrup-related deaths in New South Wales, Australia, 1990-95 (1) by Dr Andrew Byrne, General Practitioner Drug and Alcohol Specialist New South Wales, Australia March 10, 2000 This study identified all NSW coronial files over 5½ years in which methadone was involved, whether or not it was causally implicated by the findings. Of approximately 1300 opioid overdose deaths, 242 involved methadone, 134 being from the syrup which is used in methadone maintenance treatment (MMT).

Methadone tablets,which are used for pain management, were implicated in 52 cases and the methadone was of uncertain or mixed origin in 67 cases. These authors carefully analysed the 134 'certain' methadone syrup related deaths (MSRD) in relation to treatment status at the time of death. Those on registered treatment at the time of death (54%) were compared with those who were not in treatment. [if we add in the 'uncertain' 67 cases, this makes 202 total and *if* the same proportion were in treatment - 54% - then this would leave 109 deaths of MMT patients in which methadone syrup was a possible factor. This is very close to Zador and Sunjic's figure of 105 overdoses reported in January 'Addiction' journal report covering the same period.] In both 'treatment' and 'non-treatment' groups, about 75% were male, 40% were single, mean age about 30 (range 14 - 54) and around 80% were unemployed. A very worrying proportion (13% and 9%) of cases had been released from prison in the month prior to death, demonstrating what a high- risk period this is [see Seaman 1998]. It would be instructive to know how many had already been on MMT on release. It appeared that one third of the non-treatment group had previously been registered for MMT but two thirds had never had MMT in the state. There were 3 HIV positive cases among the 134. The researchers confirmed the almost self evident finding that most of the methadone in the treatment cases was from their own prescribed doses (96%) while most of that taken by the non-MMT cases was diverted from others and obtained on the black market (68% with 31% 'uncertain'). A much higher proportion of those out of treatment had injected the methadone syrup. Around 80% died in the home environment. In around 85% of cases in each group, two drugs in addition to methadone were detected at autopsy. Tranquillizers, morphine and alcohol accounted for most while only about 10% were apparently due to methadone alone. Like Barrett [1996] in Texas, these authors found that methadone blood levels are of limited benefit in diagnosis. 86% of post-mortem specimens were within the "therapeutic range" of 0.3 - 1.0mg/l.

After close examination of clinical records, only six cases of the 72 MMT cases were thought to be due to inappropriate clinical practices. This included dosing errors, excessive take-away doses or faulty assessment. Most of these received treatment which was outside official treatment guidelines. The authors' final conclusion states: "Almost half of [the syrup deaths] occurred in drug users not in MMT .. [who were single, unemployed male known drug users] .. similar to cases in MMT. If we include the 25% of cases where [the] form of methadone involved was unknown ... the total proportion of diversion-related deaths may be as high as 63%. In some of these cases, methadone may have been merely another drug of abuse for a group of injecting drug users who represent a high risk group and for whom safe use messages need to be appropriately and sensitively targeted. However, for other cases, illicit methadone may have been used to medicate symptoms of withdrawal, which may indicate a high unmet demand for MMT." Of these two possibilities, the former is probably exceptional as methadone is rarely used as a recreational drug. This latter is supported by the documented and continuing shortage of treatment places in Sydney and elsewhere. Numerous patients entering treatment state that they had purchased 'street' methadone in favour of using heroin. Both of these groups should receive targetted preventive education as recommended by the authors. References 1. Sunjic S, Zador D. Methadone syrup-related deaths in New South Wales, Australia, 1990-95. Drug and Alcohol Rev (1999) 18:409-415

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*********************************************************************** 6. Lindesmith Center Files Amicus Curiae Brief in Supreme Court Case Challenging Drug Testing of Pregnant Women News Release 3/10/00 The Lindesmith Center's Office of Legal Affairs, in conjunction with nearly two dozen medical and public health organizations submitted an amicus ("Friend of the Court") brief to the US Supreme Court in support of plaintiffs in Ferguson v. The City of Charleston.

Ferguson v. The City of Charleston challenges a policy designed and implemented by Charleston, South Carolina law enforcement officials whereby pregnant women who sought obstetrical care at the Medical University of South Carolina ("MUSC") were subjected to unwarranted, non-consensual drug testing designed and used to facilitate the arrest and prosecution of mothers who tested positive for cocaine. (MUSC is a state-funded hospital and the only medical facility in the Charleston area to treat indigent and Medicaid patients, a majority of whom are African-American.) When the policy was implemented, no drug treatment was available for pregnant or parenting women; mothers who tested positive at MUSC were simply jailed, often moments after giving birth. Ten women who were arrested for testing positive, including nine women of color, challenged the policy on various constitutional and statutory grounds and are now asking the United States Supreme Court to overturn the Fourth Circuit's decision to uphold the policy. Plaintiffs believe the Fourth Circuit committed a significant Fourth Amendment interpretation error in adjudicating in favor of Defendants. Furthermore, this ruling, if allowed to stand, will severely corrode the trust that is the basis of the physician-patient relationship. Pregnant women will be deterred from seeing doctors, from talking candidly with them, and from consenting to medically advisable medical tests. Unfortunately, the women who are most likely to be deterred from obtaining medical treatment -- those most likely to test positive -- are also the women who would most benefit from attentive prenatal care. Such a policy departs from established and carefully considered medical standards for substance abuse treatment and prenatal care and is highly inimical to The Public Health. The full text of the Lindesmith Center's brief is online at <http://www.lindesmith.org/about_tlc/ferguson_fact.html>. Back To Table of Contents *********************************************************************** 7. Treatment for Opioid Dependence: Quality and Access (Editorial ) Bruce J. Rounsaville, MD; Thomas R. Kosten, MD JAMA. March 8, 2000;283 (editorial). A major priority in US medicine is the need to improve quality and access while containing costs. Two articles in this issue of THE JOURNAL address 2 important quality and access issues in opioid stabilization treatment: primary care methadone treatment,1 which can improve access by broadening the prescriber base, and the abbreviation of methadone therapy,2 which might improve access by allowing more patients per year in the available treatment slots. These articles address 2 strategies to enhance quality: directly observed methadone administration in primary care and intensified counseling in brief methadone treatment.

Office-based care can clearly increase access as current methadone maintenance delivery in specially licensed, centralized programs reaches only an estimated 14% of patients with opioid dependence because of limited treatment slots and geographical constraints.3, 4 Greater access is needed to cope with the recent upsurge in heroin use5 and the increasing proportion of human immunodeficiency virus (HIV) transmission accounted for by injecting-drug use.6 However, increase immediate medical costs if many more heroin users are brought into treatment. Ensuring quality while broadening access requires compromises between simple office-based prescribing with controls that characterize current methadone maintenance programs. In their comparison of office-based prescribing programs in 2 Scottish cities, Weinrich and Stuart1 report a 3- to 5-fold increase in the proportion of heroin injectors receiving methadone with comparable treatment retention. Furthermore, by requiring supervised consumption of methadone, the Glasgow program minimized methadone diversion and reduced opioid-related deaths-admirable achievements in quality assurance. The risks of diversion and overdose can be reduced even further by using a recently available medication-buprenorphine plus naloxone-that will precipitate opioid withdrawal if diverted and taken intravenously.7 Based on safety and equivalent efficacy to methadone,8-10 buprenorphine is currently being evaluated for congressional approval for office-based practice. However, quality of care entails more than simple recruitment and retention in treatment or even reduction in opioid-related deaths. Quality care should lead to psychosocial rehabilitation, which medications alone cannot provide. Provision of methadone without psychosocial supports has been shown to yield a poorer outcome than methadone plus weekly counseling.11 However, intensive day program treatment within a methadone program leads to no better outcomes than once weekly counseling, supporting the greater cost efficacy of weekly counseling.12 Weekly counseling can complement buprenorphine stabilization in a primary care office setting and have outcomes superior to buprenorphine provided in a methadone clinic setting.13 In this buprenorphine study, the primary care intervention was evaluated for only 3 months.13 However, much briefer detoxification of 30 days or less is the most common treatment for opioid dependence. A critical issue for office-based treatment of opioid dependence is the value of brief or extended detoxification vs stabilization for a year or longer. The study by Sees et al2 in this issue of THE JOURNAL was conducted at a methadone clinic rather than primary care sites and demonstrates the superiority of methadone stabilization vs extended discontinuation over 6 months. Detoxification has repeatedly shown substantially poorer outcomes than methadone maintenance.14 In a recent review of ultrarapid detoxification for opioids,15 the limited efficacy of this approach even at 3-month follow-up was found to contrast strongly with the long-term efficacy of methadone

stabilization treatment. In the study by Sees et al, patients who were stable while receiving methadone maintenance had precipitous declines in heroin use, needle-related HIV risk behaviors, and drug-related crime. However, methadone stabilization is not a cure-all. Cocaine use, sex-related HIV risk behaviors, employment problems, and family problems persisted, and more than 50% of patients in both groups used heroin at least once during any given month of treatment. The study by Sees et al2 also suggests limited impact of intensifying delivery of traditional ancillary counseling. During the first 60 to 90 days, 3 times more psychosocial treatment was offered to (and required of) patients in the detoxification group. However, during that time, heroin use was nearly identical in the 2 groups. Moreover, requiring more psychosocial treatment may have been aversive, since attrition was higher in the detoxification group even during the first 90 days of treatment, when methadone dosing was comparable. It is particularly noteworthy that patients using cocaine were more likely to drop out of the detoxification program, which included an additional session of group therapy about cocaine for patients presenting with cocaine-positive urine specimens. Hence, more hours of traditional drug counseling did not appear to enhance efficacy. Thus, for cost-effective office-based practice, counseling should be provided, but the costs associated with high-intensity psychological interventions are not justified. This finding is consistent with previous work examining buprenorphine detoxification16 and low- vs high-cost day program interventions12 with this population. Other work has suggested that patients who continue to use heroin and cocaine may respond to psychological interventions that are more focused and manual-guided.17-19 The findings of Weinrich and Stuart and of Sees et al provide timely input for the public policy debate over cost, quality, and access for treating patients with opioid dependence.14, 20-22 Quick fixes for the problem have included false starts such as detoxification followed by "drug-free" outpatient care. This option has been examined carefully for more than 25 years to resounding disappointment in its failure either to prevent heroin relapse or accomplish public health aims such as preventing the spread of HIV infection.23, 24 Moving opioid stabilization into the mainstream of office-based medical care has national and congressional support25 facilitated by the recent development of buprenorphine plus naloxone treatment. If the Scottish example1 can be followed, this new approach can provide a 3- to 5-fold increase in access. It can also reduce cost per patient, although added access will clearly increase short-term substance abuse treatment costs while reducing long-term costs associated with overdose emergencies, HIV infection, and crime. The Glasgow study also suggests that the best investment in quality should focus on monitoring delivery of the pharmacotherapy such as supervised consumption during the first year of treatment. Sees et al2 suggest that quality of care does not increase with expenditures on

high-intensity psychosocial treatments exceeding routine care. Much remains to be learned about implementing and optimizing effectiveness of primary care treatment for heroin dependence and other substance use disorders.1 Guidance of the development of US primary care opioid stabilization programs requires empirically based evidence about optimal inclusion criteria for program participation, induction procedures for methadone and other opioid agonists, ancillary psychosocial treatments, duration of treatment, and dispensing strategies. However, implementation of primary care opioid treatment should not be delayed until definitive answers are available. While the case for primary care opioid stabilization treatment is the most compelling, the potential value for other substance use disorders is suggested by low treatment utilization rates for patients with alcohol and other substance use disorders26 and the recent or impending availability of new pharmacological treatments including naltrexone27 and acamprosate28, 29 for alcohol dependence. Implementation of primary care treatment for substance use disorders offers the possibility of increased access to care for these common and undertreated disorders. Careful study will be required to maintain and improve the quality of that treatment.7 Source: http://jama.ama-assn.org/issues/v283n10/toc.html

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*********************************************************************** 8. Methadone Maintenance vs 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence : A Randomized Controlled Trial Karen L. Sees, DO; Kevin L. Delucchi, PhD; Carmen Masson, PhD; Amy Rosen, PsyD; H. Westley Clark, MD; Helen Robillard, RN, MSN, MA; Peter Banys, MD; Sharon M. Hall, PhD JAMA. March 8, 2000;283:1303-1310 Context Despite evidence that methadone maintenance treatment (MMT) is effective for opioid dependence, it remains a controversial therapy because of its indefinite provision of a dependence-producing medication. Objective To compare outcomes of patients with opioid dependence treated with MMT vs an alternative treatment, psychosocially enriched 180-day methadone-assisted detoxification. Design Randomized controlled trial conducted from May 1995 to April 1999. Setting Research clinic in an established drug treatment service.

Patients Of 858 volunteers screened, 179 adults with diagnosed opioid dependence were randomized into the study; 154 completed 12 weeks of follow-up. Interventions Patients were randomized to MMT (n required 2 hours of psychosocial therapy per week during the first 6 months; or detoxification (n psychosocial therapy per week, 14 education sessions, and 1 hour of cocaine group therapy, if appropriate, for 6 months, and 6 months of (nonmethadone) aftercare services. Main Outcome Measures Treatment retention, heroin and cocaine abstinence (by self-report and monthly urinalysis), human immunodeficiency virus (HIV) risk behaviors (Risk of AIDS Behavior scale score), and function in 5 problem areas: employment, family, psychiatric, legal, and alcohol use (Addiction Severity Index), compared by intervention group. Results Methadone maintenance therapy resulted in greater treatment retention (median, 438.5 vs 174.0 days) and lower heroin use rates than did detoxification. Cocaine use was more closely related to study dropout in detoxification than in MMT. Methadone maintenance therapy resulted in a lower rate of drug-related (mean [SD] at 12 months, 2.17 [3.88] vs 3.73 [6.86]) but not sex-related HIV risk behaviors and in a lower severity score for legal status (mean [SD] at 12 months, 0.05 [0.13] vs 0.13 [0.19]). There were no differences between groups in employment or family functioning or alcohol use. In both groups, monthly heroin use rates were 50% or greater, but days of use per month dropped markedly from baseline. Conclusions Our results confirm the usefulness of MMT in reducing heroin use and HIV risk behaviors. Illicit opioid use continued in both groups, but frequency was reduced. Results do not provide support for diverting resources from MMT into long-term detoxification. Source: http://jama.ama-assn.org/issues/v283n10/toc.html

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********************************************************************** 9. Provision of Methadone Treatment in Primary Care Medical Practices: Review of the Scottish Experience and Implications for US Policy Policy Perspective Michael Weinrich, MD; Mary Stuart, ScD JAMA March 8, 2000;283:1343-1348 Context Under new proposed regulations, US physicians outside of traditional methadone clinics could prescribe methadone to patients with opioid dependence. No large-scale evaluations of US programs in which methadone maintenance is provided by primary care physicians are available, but primary care physicians in Scotland

have participated in such programs on a large scale. Objective To review the history, operation, and outcome data on the efficacy and safety of 2 Scottish primary care-based opioid agonist treatment programs to derive lessons for the US context. Design and Setting Naturalistic study of programs in Edinburgh and Glasgow, Scotland, with data obtained through site visits and interviews conducted in 1996 and 1998, as well as from published reports and retrospective analysis of electronic databases. Main Outcome Measures Proportions of injection drug users who were enrolled in the methadone maintenance programs, average methadone doses in the programs, and methadone-related deaths. Results A total of 60% to 80% of injection drug users in Edinburgh and 41% to 73% of those in Glasgow were enrolled in methadone maintenance in 1998-1999. Dose levels are consistent with US recommendations (for Edinburgh in 1998, 61 mg; for Glasgow in 1994-1996, 54 mg). The Glasgow program required supervised consumption of methadone in community pharmacies for the first year and experienced significantly fewer methadone-related deaths than Edinburgh in 1997 (17 vs 30 deaths; P<.0001). Programs in both Edinburgh and Glasgow provided support to primary care physicians and achieved levels of general practitioner participation of 59% (1998) and 30% (1999), respectively. Conclusions The Scottish experience indicates that prescription of methadone in office-based settings can expand access to an important treatment modality. Primary care physicians safely prescribed methadone for maintenance treatment when provided with adequate support. Diversion of methadone was minimized by requiring supervised consumption in community pharmacies. Source: http://jama.ama-assn.org/issues/v283n10/toc.html Back To Table of Contents *********************************************************************** ORGANIZATIONAL INFORMATION, FUNDING AND FUND RAISING Back To Contents 1. The SearchZone - new from The Foundation Center http://fdncenter.org/searchzone/ Tired of sifting through irrelevant search results returned by standard search engines? Then visit the SearchZone, where the new Grantmaker

Web Search engine lets you to search more than 1,000 grantmaker Web sites and tens of thousands of documents related to grantmakers and their grantmaking. Just follow the link below and look for the "powered by Ultraseek server" logo at the top of the page." Please note: other search features on The Foundation Center's website can also be accessed from the SearchZone page.) Source: "THE INTERNET INSIDER - For Grantseekers & Fundraisers" Issue #12 - March 1, 2000 Back To Contents 2. The Philanthropy News Network (PNN) http://www.pnnonline.org The Philanthropy News Network (PNN) produces a Web site that delivers informative, relevant news about the nonprofit sector as a whole and the role technology is playing in reshaping philanthropy in America and throughout the world. This free site -- updated every business day -- features a wide range of topics and PNN's original feature stories. Visit PNN Online at: http://www.pnnonline.org Back To Contents 3. CharityVillage.Com Named As Best Site for Email Discussion Lists http://www.charityvillage.com/charityvillage/stand1.html Phoenix - March 6 - Arizona State University's Nonprofit Management Institute announced today that it is ranking CharityVillage.Com as the nonprofit sector's best website for its comprehensive listing of email discussion listservs that focus on issues affecting the nonprofit sector. While there are a number of websites that maintain listerv information on the nonprofit sector there is none as comprehensive as this. CharityVillage's listing of listservs can be found at http://www.charityvillage.com/charityvillage/stand1.html NAMA recommends this site for any group that needs information about nonprofit and organizational issues. There are over 20 lists at this sitethat include topices from starting a non-profit to board of directors to fund raising. Fundraising? Hunting for products or services? Organization building? Looking for program ideas, discussion forums, online publications, how-to advice, current trends? 3,000 pages of news, ideas, resources, and services for fundraisers and

nonprofit managers. It's at: http://www.charityvillage.com The ASU Nonprofit Management Institute Enhancing Organizational Effectiveness Through Training, Research and Management Assistance Since 1993 http://www.asu.edu/xed/npmi Source: Starting Non-profit List, March 05, 2000 Back To Contents 4. "SNAPSHOT": SAMHSA PROVIDES A FREEZE-FRAME OF UPCOMING EXTRAMURAL GRANT OPPORTUNITIES The Substance Abuse and Mental Health Services Administration (SAMHSA) today announced the availability of the first issue of Snapshot a new series dedicated to simplifying and amplifying information about SAMHSA's grant programs. Service providers, state and local substance abuse and mental health administrators, educators, consumers and family organizations will find that Snapshot provides all the information they need about SAMHSA's grant programs in one readable and compact source. This issue of Snapshot gives potential grant applicants a preliminary view of funding opportunities in substance abuse prevention, addiction treatment, and mental health services for Fiscal Year 2000. The volume provides a brief overview of just how SAMHSA's grant review process works, providing suggestions about how to get started in grant writing, identification of what an application packet should contain, and tips about "what works" in the development and presentation of applications. Snapshot details all of SAMHSA's planned FY 2000 Guidance for Applications (GFAs) from the Center for Mental Health Services, the Center for Substance Abuse Prevention, and the Center for Substance Abuse Treatment. In addition to eligibility criteria, project descriptions, and funding priorities, readers will find information about anticipated announcement, receipt and award dates for each GFA. The volume also provides contact information for the SAMHSA program staff for the particular GFA, and an application to attend one of three scheduled Technical Assistance Workshops. While some changes may occur in the scope and emphasis of some of the grant announcements between today and their publication in the Federal Register and on line at the SAMHSA web site, the Agency hopes that this installment of Snapshot will stimulate the field, encourage new grant applicants, and build stronger and more competitive applications.

Snapshot is available at no cost from SAMHSA. Send an e-mail to snapshot@samhsa.gov; a copy will be mailed to you or check the SAMHSA web site www.samhsa.gov for a copy. Alternatively, call or fax SAMHSA's Division of Extramural Activities, Policy, and Review (301/443-4266; 301/443-1587-Fax) Source: Press Release 2/29/00 Back To Contents 5. CyberGrants http://www.cybergrants.com/ CyberGrants.com is a new venture which brings together the needs and the communications of grantseeker AND foundation or corporate grantmaker. Grantseekers can research grant guidelines and develop on-line proposals,while, member foundations can review proposals -- right online. Source: "THE INTERNET INSIDER - For Grantseekers & Fundraisers" Issue #10 - January 30, 2000 Back To Contents 6. Fundraising for Small NonProfits http://www.resolveinc.com/NEWS.htm Fundraising for Small NonProfit - It's Right There in the Palm of Your Hand!(c) - by Hildy Gottlieb - ReSolve, Inc. (Problem-solving and Strategy for NonProfits and Tribes) A good "de-mystification" of the fundraising process! Source: "THE INTERNET INSIDER - For Grantseekers & Fundraisers" Issue #12 - March 1, 2000 Back To Contents 7. Techportal.org http://www.techportal.org Search for funding and grants, in-kind donations, training, volunteers, or more…. for nonprofits with needs in technology. >From TeamTech in San Francisco (a program from AmeriCorps)

Source: "THE INTERNET INSIDER - For Grantseekers & Fundraisers" Issue #12 - March 1, 2000 Back To Contents 8. The People Tab InfoPieces, Requests... People! http://www.infostry.com The People tab, Infostry.com's latest feature, allows you to find a person to ask a question, or to post your credentials into a particular category to make your expertise known to potential buyers. The People tab is the fastest way to find an expert capable of answering your particular information needs. You can check each person's qualifications and rating before placing a request. After you place a request, you will be notified via email when the person answers it. The People tab is also an excellent means to offer your Online Consulting Services™. Buyers can view your credentials and directly enter into Negotiations with you by clicking "Place a Request". It is in your interest to be as accurate and compelling in your Personal Description as possible. To place your Identity under the People tab in a particular Category, you will need to log in and fill out "Areas of Expertise" located under My Identity on the left hand tool bar under Profiles. Click Update My Identity and then scroll down to select a Category in which you would like your Areas of Expertise to appear. Finalize the process by clicking Update Category Selections and your Areas of Expertise will appear in the proper categories on the site. Back to Table Of Contents

********************************************************************** ANNOUNCEMENTS CONFERENCES AND MEETINGS 1. Sessions from Preventing Heroin Overdose: Pragmatic Approaches are Available on the Internet "Preventing Heroin Overdose: Pragmatic Approaches" on January 13 and 14, 2000 in Seattle, Washington and sponsored by the University of Washington Alcohol and Drug Abuse Institute and The Lindesmith Center

You can now hear (with the proper hardware and software installed on your computer) recordings of these sessions online. Please point your browser to: http://www.lindesmith.org/library/ODconferenceaudio.html This two day conference brought together leading experts from around the world -- scholars, service providers, outreach workers and others who deal with and are affected by heroin overdoses -- to present and discuss a wide range of topics including heroin overdose risk factors, naloxone distribution, the epidemiology of overdose deaths, outreach and education, and international innovations in heroin overdose prevention. Back to Contents 2. Free Charles Garrett Campaign at Critical Juncture http://www.drcnet.org/wol/127.html#garrettcampaign In 1970, Charles Edward Garrett, an African American man from Texas, was sentenced to life in prison for possession of two grams of heroin. Garrett, at the time addicted, anticipated an unjust sentence from the all-white jury, fled. Starting a new life, Garrett beat his addiction, joined the working world and started a family. In 1998, Garrett was arrested by Texas authorities. Though current law does not provide for this harsh a sentence for the offense, prosecuting attorneys refused to go along with a defense motion that would have allowed Garrett to serve a term of community service instead of incarceration. Garrett began to serve his life sentence, leaving behind his wife and two year old daughter, Ernestine. Texas governor and presidential candidate George W. Bush may or may not have used illegal drugs during his youth at the time Garrett was originally sentenced; he has only guaranteed his abstinence as far back as 1974, and refuses to answer regarding the years before. Bush, who has increased drug penalties during his tenure as governor, has the power to grant Garrett clemency. Garrett's lawyers have filed an appeal with the Texas Board of Pardons and Paroles, which could be ruled on at any time. Please visit http://www.freecharlesgarrett.org/ to sign an electronic petition calling for his release, and/or write to: Texas Board of Pardons and Paroles Attn: Mr. Gerald Garrett, Chairman P.O. Box 13401 Austin, TX 78711-3401

Remember, you are writing an appeal for an individual case of clemency, so please limit the content of your letter to calling for basic justice. Don't talk about the drug war, Gov. Bush's history, racism or other issues; the board members to whom you are writing couldn't do anything about those things if they wanted. There will be plenty of time to discuss those issues in the larger venue of the media once he is freed. Most of all, please make your letters polite; the board members and the governor hold Charles Garrett's fate in their hands. Back to Contents 3. Is Our Drug Policy Effective? Are There Alternatives?," New York March 17-18, 2000 Sponsored by the Assn of the Bar of the City of New York, NY Academy of Medicine and NY Academy of Sciences A two-day multidisciplinary conference. Featured speakers will include Nicholas de B. Katzenbach, former US Attorney General Kurt L. Schmoke, former Mayor of Baltimore Robert Sweet, US District Court Judge Edward H. Jurith, General Counsel ONDCP Sally Satel, Psychiatrist David Musto, Yale University Robert Newman, Continuum Health Partners and many others. Early registration (3/13) $30 or $20/day on site $20/day, includes lunch Send check made out to NYAS to: Henry Moss, NYAS 2 E. 63rd Street New York NY 10021 March 17 will be held at 1216 5th Ave. at 103rd St., March 18 will be held at 42 W. 44th St. For further information, contact Henry Moss at (212) 838-0230 ext. 410. Back to Contents 4.. ORGANIZE! AN ACTIVIST-ACADEMIC CONFERENCE ON SOCIAL MOVEMENTS AND ORGANIZING New York City, COLUMBIA UNIVERSITY APRIL 8-9th, 2000 What kinds of insights can organizers lend to academics?

What kinds of insights can academics provide on questions about organization that are relevant for activists? ****** REGISTRATION FORM****** PLEASE EMAIL TO: organize_1999@yahoo.com or mail/fax to address above: Name: Address: Phone: E-mail: Affiliation (if relevant): REGISTRATION FEE IS $10, CHECKS PAYABLE TO ORGANIZE! (Scholarships available by advance request) Please indicate if you will send your check by mail or pay at the door (the former is encouraged). Back to Contents 5. Conference 2000 National Methadone Conference American Methadone Treatment Association April 9-12, 2000 San Francisco NAMA Events and Activities NAMA Preconference Meeting How Can We Develop and Strengthen Patient Advocacy Groups? Day: Sunday Date: April 9, 2000 Time: 1 - 5 PM Moderator: John Finger, TexNAMA Presenters: Joycelyn Woods, NAMA Diane Fleury-Seaman, MALTA Fred Christie, AFIRM Chris Kelly, ARM Howard Lotsof, NAMA Lisa Torres, NAMA James DePasquale,NAMA This special preconference meeting was developed by the National Alliance of Methadone Advocates (NAMA) in collaboration with other advocacy groups to present concepts that programs can use to promote positive patient outcomes and consumer satisfaction that will be a major focus for the

new accreditation system. Ways for providers to develop consumer satisfaction including patient recognition ceremonies, 12 step groups, patient advisory boards, patient advocacy groups and patient organizing drives are some of the strategies that can be utilized by providers and patients to work together and the enormous benefits that will come from this. The intended audience for this presentation includes program directors, medical personnel, doctors, nurses, counselors, social workers, administrative staff, patients, advocates and anyone else included in the methadone field. This meeting will greatly enhance the ability of providers and patients to become one community with the common goal of creating the best methadone system possible. Supported by the Center for Substance Abuse Treatment Conference Workshops Facilitated by NAMA D4 Planting the Seeds and Watching the Patients Grow Day: Tuesday Date: April 11 2000 Time: 1 - 2:30 PM Presenters: Alice Diorio New England NAMA Diane Fleury-Seaman, S.D.C., MALTA John McCarthy, M.D., Bi-Valley Medical Clinic (and NAMA Advisory Board) This interactive workshop uses harm reduction principles and sensitivity training to improve outcomes. Presenters will give a patient's perspective on how to create individualized treatment based on communication and respect. They will discuss ways to enhance a trusting, therapeutic relationship that conveys compassion and understanding. Visit NAMA at the Consumer Advocacy Booth during the conference. NAMA would like to thank AFIRM for the donation of the booth. Booth Manager: Greg Keller, WI NAMA NAMA Organization Meeting To be determined. Visit the AMTA website at

http://www.assnmethworks.org Visit the NAMA Events Page http://www.methadone.org/events.html Back to Contents 6. 11th International Conference on the Reduction of Drug Related Harm April 9-13, 2000 Jersey Channel Islands, British Isles NAMA will not be attending this conference however many of our international affiliates will be participating in the conference and the Users Meeting held during the conference and report back. Back to Contents 7. Drug Use, HIV and Hepatitis: Bringing It All Together Baltimore May 7-10, 2000 Sponsored by NIDA, CSAT, and CDC This conference on drug use, HIV, and hepatitis will unite researchers and practitioners from across the country to address these inter-related and urgent public health issues. The goal of this conference is to reduce the incidence of chronic infectious diseases among drug users, to facilitate entry of drug users into drug treatment, and to link them to appropriate medical care. The conference has the overall goal of advancing the integration of best practices in prevention, outreach, assessment, case management, medical treatment, and monitoring to ensure that people with drug problems, who are at risk for or have contracted chronic infections, will receive timely, coordinated, and comprehensive services. "Drug Use, HIV and Hepatitis: Bringing It All Together" is designed to provide and produce practical strategies for implementing an integrated approach to prevention, treatment, and policy issues. Hotel, travel and registration information is available online (www.chhatt.net) or call toll-free 800-937-8728. Back to Contents 8. 13th International Conference on Drug Policy Reform, Washington, DC May 17-20, 2000

Sponsored by the Drug Policy Foundation. Visit http://www.dpf.org or call (202) 537-5005 for further information. The deadline for scholarship requests is Monday, April 3. Back to Contents 9. Communities Respond to Drug Related Harm . 3rd National Harm Reduction Conference Miami October 21-25, 2000 Harm Reduction Coalition Communities Respond to Drug Related Harm AIDS, Hepatitis, Prison, Overdose & Beyond Wyndham Hotel Miami-Biscayne Bay For Information Contact: (212) 213-6376 Fax: (212) 213-6582 Email: hrcconf@harmreduction.org Website: http://www.harmreduction.org *Deadlines Abstracts: May 15, 2000 Scholarships: July 3, 2000 NAMA is a sponsor of this conference. *Conference Meetings 3rd Annual National Methadone Consumer's Meeting From this meeting have come vanguard declarations and ideas such as the Methadone Consumer's Platform and the Dedication for the New Millenium. For our third meeting NAMA expects nothing less as the methadone community begins the change to an accreditation system. Sponsored by: NAMA and MALTA Committee Chair: Carlos Franco Franco33139ca@hotmail.com Visit NAMA's Events Website at: http://www.methadone.org/events.html Back to Contents

10. Lindesmith Seminars Lindesmith Center Seminars are held at the Open Society Inst 400 West 59th Street (between 9th and 10th Avenues), 3rd Floor. March 14, 4:00-6:00pm "Let's Get Real: New Directions in Drug Education." Marsha Rosenbaum, PhD and Lynn Zimmer, PhD. March 30, 4:00-6:00pm "MDMA ('Ecstasy') Research: When Science and Politics Collide." Julie Holland, MD, John P. Morgan, MD and Rick Doblin. Call (212)548-0695 to reserve a place or e-mail lbeniquez@sorosny.org Return To Table Of Contents ********************************************************************** INTERNET RESOURCE 1. KnowX

http://www.knowx.com/ "The Most Comprehensive Source of Public Records on the Web" "Search public records, such as business records, or locate a friend. Most searches are free, although registration is required for some." Source: "THE INTERNET INSIDER - For Grantseekers & Fundraisers" Issue #12 - March 1, 2000

2. The Ultimate People Finder Search (from KnowX)

http://kf.knowx.com/infoam.exe?form=pf/search.htm "Locate people via a residence directory, death records, and databases of home buyers and sellers." Source: "THE INTERNET INSIDER - For Grantseekers & Fundraisers" Issue #12 - March 1, 2000 Back To Contents

3 REFDESK.COM

http://www.refdesk.com Best Source for Facts on the Net and a great website for everything! It's a virtual reference desk! A collection of you-name-it references.

You'll find website links for everything from area code finder, 260 search engines, Bartlett's Quotes, Find a Lawyer, Geneology, Learn to do Anything, How Stuff Works, Daily Almanac, etc! etc! etc! Source: "THE INTERNET INSIDER - For Grantseekers & Fundraisers" Issue #12 - March 1, 2000

4. Website AcronymFinderCom

http://www.acronymfinder.com/ The Acronym Finder is a world wide web searchable database of more than 131,000 common abbreviations and acronyms about computers, technology, telecommunications, and military acronyms and abbreviations. The Acronym Finder is not a glossary of terms, web search engine, dictionary, or a thesaurus -- it is only designed to search for and expand acronyms and abbreviations.

5. HANDSNET

http://www.handsnet.org HandsNet has been helping busy Human Services Professionals use online networking to access the information they need since 1987. WebClipper is the easiest, fastest way to keep up with developments in your field and take advantage of all the Internet has to offer with personalized clippings, custom searches, job bank, events calendar, funding information, discussions, professional directory, networking, and more! Back To Contents

6. Contacting Congress

http://www.visi.com/juan/congress/ This is a wonderful nationwide tool. "Contacting the Congress !!" just click on a state on the map, and do it! Source: DrugSense Weekly, March 3, 2000, #139

7. Physician Leadership on National Drug Policy

http://www.caas.brown.edu/plndp/ Physician Leadership on National Drug Policy has a web site

at http://www.caas.brown.edu/plndp/ where physicians can register as PLNDP Associates, endorse PLNDP's consensus statement and receive updates on the organization's activities and the issue. Physician Leadership on National Drug Policy is comprised of a broad range of national leaders in the fields of medicine and public health, including high-ranking officials from the Reagan, Bush and Clinton administrations. Members include Louis Sullivan, M.D., Secretary of Health and Human Services under President Bush, Edward Brandt, MD, Assistant Secretary of HHS under President Reagan, and David Kessler, MD, former Commissioner of the Food and Drug Administration under President Clinton. The group also includes a former Surgeon General, a Nobel laureate, and the editors of the New England Journal of Medicine and the Journal of The American Medical Association. Back To Contents 8 List of Journals & Publications American Psychological Assoc. Div.50 (Addictive Behaviors) (Full text). http://www.kumc.edu/addictions_newsletter American Journal of Drug and Alcohol Abuse (TOC with Abstracts) http://www.dekker.com/e/p.pl/0095-2990 International Journal of Drug Testing (Online Journal, Full Text) http://www.criminology.fsu.edu/journal/ The Journal, Addiction Research Foundation (Full Text Select Articles) (Replaced by The Journal of Addicton and Mental Health) http://www.arf.org/Intropage.html Journal of Addiction and Mental Health (Full Text) Centre for Addiction and Mental Health. (Formerly The Journal, published by Addiction Research Foundation) http://www.camh.net/journal/ Journal of Addictive Diseases (TOC, Abstracts) Official journal of ASAM http://www.haworthpressinc.com/ http://www.asam.org/jol/journal.htm NIDA Notes National Institute on Drug Abuse (Full Text) http://www.nida.nih.gov/NIDA_Notes/NNindex.html

Self-Help and Psychology Magazine (Full Text Articles) http://www.shpm.com/ Drugs, Brains and Behavior (Book, Full Text) By C. R. Timmons & L. W. Hamilton (Previously published as Principles of Behavioral Pharmacology) http://www-rci.rutgers.edu/~lwh/drugs/ Back To Table Of Contents

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