Welcome to the Fifth Issue of The COMPA Bulletin

COMPA has established this newsletter to ensure that New York State providers of opioid treatment services have an effective mechanism of communication which facilitates the dissemination of information and encourages dialogue. The COMPA Bulletin includes information regarding best practices, research, demonstration projects, accreditation, training opportunities, conferences, and other items of interest to the field and will be distributed via email on a monthly basis. COMPA encourages readers to submit news, articles, research, and other items of interest for possible inclusion. Submissions should be titled "COMPA Bulletin Submission" and directed to info@compa-ny.org.

Please send us your email address. Addresses should be titled "Subscription List" and directed to info@compa-ny.org as well.

Past issues of the COMPA Bulletin are available on our web site www.compa-ny.com.

COMPA Hires New Executive Director

After a comprehensive search for a new Executive Director, the COMPA Board of Directors unanimously supported the candidacy of Henry Bartlett, who has accepted the position and will be stepping into his new role with COMPA this coming September. Henry is a graduate of SUNY Albany, has been employed by OASAS since 1977, and has for the last thirteen years been the Director of the Bureau of Costing and Revenue Development. He has also served as a consultant for Johnson, Basin, Shaw Inc. and Health Systems Research, Inc.. Henry has long been a strong advocate and supporter of methadone treatment, is well known and respected in the field, and brings to COMPA a wealth of knowledge and expertise.

CSAT Deadline Approaches: Final Accreditation Application Reminder

August 17^th is the deadline for all methadone treatment programs to complete and submit an Application for Certification to CSAT and CSAT is urging programs not to wait until last minute.

For purposes of accreditation, all programs in operation on May 18, 2001 will be considered by CSAT to be in transitional status. After submitting the application, programs will have two years to become accredited, although programs will be able to request a one year extension. All exemptions currently in place will carry over. For a copy of the application or new Federal regulations call CSAT directly at 301-443-7749.

Federal Certification of Inpatient Detoxification Programs

The new Federal Regulations define an Opioid Treatment Program or OTP as a "program or practitioner engaged in opioid treatment of individuals with methadone or LAAM," and Section 8.11(a)(1) of the new rules states that an OTP must have a current, valid certification from SAMHSA (CSAT) to be considered qualified by the Secretary, DHHS to dispense methadone and LAAM for the treatment of addiction. As such, hospital-based inpatient detoxification units that had been approved by the FDA under 21 CFR part 291.505 (and registered separately with the DEA as a narcotic treatment program) would be considered an OTP and subject to the requirements of the new regulations. Likewise, a unit of a hospital that intended to offer detoxification services using methadone would have to apply under the provisional certification requirements.

With the focus primarily on methadone treatment programs, many providers of inpatient detoxification services apparently were unaware that the new regulations applied to them as well and that they too will need to be certified under the new regulations covering the use of methadone and LAAM for addiction treatment.

Applications for transitional certification must be received by August 17 and CSAT will assist programs with completing the necessary SMA-162 Application, copies of which can be found and downloaded at www.opat.samhsa.gov. You may also call CSAT for additional information at 301-443-7745.

Physician Training Comes to NYC

A day long training course, Opioid Maintenance Pharmacotherapy: A Course for Clinicians, will be held on August 23, 2001 at the Marriott East Side Hotel on Lexington Avenue. Sponsored by the American Methadone Treatment Association and supported by a grant from the Center for Substance Abuse Treatment (CSAT), this training course has been specifically designed for physicians, physician assistants, and clinical nurse practitioners working in methadone treatment and other programs that provide services to methadone patients. Clinic administrators are urged to attend as well.

Opening comments will be offered by Dr. H. Westley Clark, Director of CSAT. Topics to be covered during the day will include: the pharmacology of opioids (including the latest research on opioid receptors, agonists, antagonists, and mixed agonist/antagonists, and the signs and symptoms of intoxication, withdrawal and overdose); opioid dependency and treatment options; the new Federal Regulations governing opioid treatment programs; medical issues such as HIV, Tuberculosis, Hepatitis, and sexually transmitted diseases; an overview of methadone treatment with a review of research, dosing practices, take home medication; a review of key issues such as pain management, urine drug screening, poly-substance abuse, dual diagnosis, and tapering; and an overview of new pharmacotherapies including LAAM and Buprenorphine. The workshop will then end with the presentation of case studies.

The faculty for this workshop will include Dr. J. Thomas Payte, Medical Dircector of Drug Dependence Associates in San Antonio Texas; Dr. Susan F. Neshin, Medical Director at Jersey Shore Addiction Services in Asbury Park New Jersey; Dr. Trusaandra Taylor, Associate Medical Director of Community Behavioral Health in Philadelphia Pennsylvania, and Dr. Laura McNicholas, Director of Education at the Philadelphia VA Hospital.

The cost of the training is $165, which includes lunch and, when approved, CME credits from the American Society of Addiction Medicine. Registration will be handled by the AMTA Office in New York at 217 Broadway, Suite 304, New York, N.Y. 10007. For more information call AMTA at 212-566-5555.

JCAHO Accreditation Workshop

On Friday, September 28^th COMPA, in cooperation with the Beth Israel Medical Center, will sponsor a day long workshop focused on the JCAHO accreditation process, the JCAHO standards that have been developed for opiate treatment programs, and what programs should be doing to prepare for accreditation surveys. Sharon Dow, director of the opioid treatment accreditation project of the Joint Commission will be the primary presenter. The workshop will be held in the 2^nd Floor Conference Room at the Beth Israel Medical Center Phillips Ambulatory Care Center on 14^th Street, Union Square in Manhattan from 9:00 to 4:00 pm. and refreshments will be provided. The cost of the session is $25 for participants from member organizations and $50 for those who are not. Due to space limitations, registration will be limited to 100 individuals. Registration forms will be sent out shortly.

Due to requests from a number of member organizations, we are also attempting to set up a similar session with representatives from CARF.

Pataki Offers Revised Plan on Drug Laws

New York Times, July 23, 2001, by Richard Perez-Pena - Reviving moribund efforts to soften New York's Rockefeller era drug laws, Gov. George E. Pataki is making a new offer, one that would give many more defendants the opportunity to undergo drug treatment rather than long prison terms. The new plan goes beyond what Mr. Pataki advocated in a bill he proposed earlier this year. The Democrats who control the Assembly

had said the governor's earlier proposal did not go far enough, and countered with their own bill, which the governor dismissed as extreme. But there has been little substantive discussion between them, and critics of the drug laws had begun to fear that the issue was dead for the year.

Aides to Mr. Pataki, a Republican, and Democrats who have been leading advocates of change today described the governor's new plan, which retains many of the elements from his earlier one, as a good faith effort to find middle ground and start serious negotiations. "This shows the governor is serious about reforming the Rockefeller era drug laws that I think everybody universally considers to be draconian," said Randy Daniels, the governor's secretary of state.

The governor is calling, for the first time, for giving second time offenders charged with drug dealing a chance at greatly reduced sentences through treatment, according to top aides. His earlier proposal dealt only with people who were charged with possession, not sale. The governor's new plan includes treatment options for people charged with a group of serious offenses known as class B felonies, which carry sentences of as long as 12 1/2 to 25 years, who were largely left out of his earlier plan. And he would, in comparison to his original plan, increase the role of judges and reduce the role of prosecutors in deciding which defendants would qualify for treatment over mandatory sentences.

In all, aides to Mr. Pataki said, the changes would give 2,800 defendants each year a chance to avoid or cut short mandatory prison sentences. The treatment option could cost millions of dollars if thousands more are routed into drug rehabilitation, but no estimate of the cost has been disclosed yet. The governor's office has not drafted a bill, making it difficult to assess the proposal in detail, and the plan has not yet been presented to the Assembly speaker, Sheldon Silver, or to the Senate majority leader, Joseph L. Bruno.

The governor's counsel, James McGuire, gave an hourlong briefing today on the new offer to Assemblymen Jeffrion L. Aubry and Keith Wright, influential Democrats who have called for easing the state's system of long mandatory drug sentences. "They're trying to find a balance," said Mr. Aubry, of Queens. "They've made a proposal that's a good starting point for talks." Mr. Wright, of Manhattan, said, "There's no doubt there's been a lot of movement on their part." Both men stressed that they wanted to see more detail, particularly on the costs of treatment.

Even with a renewed focus on the issue, reaching a consensus will not be easy. Even among the Assembly Democrats, where there is broad support for drug law reform, there are widely divergent views on the particulars. Many Democrats will have trouble accepting some elements of the governor's original plan, like increased penalties for some marijuana offenses. In the Republican controlled Senate, Mr. Bruno is reluctant to go even as far as the governor's initial proposal, so Mr. Pataki's new plan will be a tough sell. And then there are the state's district attorneys, who have lobbied against changing the laws. Tough mandatory sentences give prosecutors a powerful threat in persuading defendants to plead guilty to lesser charges, or to serve as witnesses against others.

New York's drug laws were enacted in 1973, at the urging of Gov. Nelson A. Rockefeller, and put into place mandatory prison sentences for nonviolent drug offenses. In limited cases known as Class A1 felonies, a conviction for sale or possession of drugs carries a mandatory penalty of 15 years to life in prison, even if no violence was involved. Those laws fueled an explosion in the population of the state's prisons, from 12,000 to about 70,000 in recent years.

In his earlier proposal, Mr. Pataki proposed reducing the minimum sentence for A1 drug offenses to as low as eight and a third years to life in some cases, and allowing 500 people serving 15 year to life terms to apply for sentence reductions. The governor's new proposal would retain that and most other elements of his earlier plan, including giving judges the discretion to send second time offenders convicted of Class C, D or E drug possession felonies to residential treatment programs rather than prison. Mr. Pataki's initial plan would require the consent of the prosecutor for judges to choose treatment over prison in the case of people charged with more serious Class B possession felonies, or Class C, D or E charges of selling drugs or possession with intent to sell. People facing Class B sales charges would not be eligible.

Drug law reform advocates responded to that plan with complaints that district attorneys would rarely agree to forgo prison, and that by excluding people charged with Class B felonies, the governor was leaving out the largest group of felony drug defendants. The result of the governor's plan, they said, would be to make residential treatment available to only a small fraction of drug defendants, a charge the governor's office disputes.

Mr. Pataki's new plan would keep that first path to treatment and add a new one for that same group of defendants, covering second time nonviolent offenders, both buyers and sellers, up to and including people facing Class B felony charges. Those defendants could ask judges to declare them candidates for treatment. Prosecutors could argue against those findings, but would not be able to block them unilaterally. Each side could have the decision taken out of the hands of the trial judge and given to a judge specially trained for such cases, and each side could appeal a judge's decision. A defendant who is found eligible for treatment would have to plead guilty to the felony charged and would be sentenced to prison anywhere from 4 to 16 years for a Class B felony under the governor's plan, and shorter terms for lesser felonies. In prison, the inmate would immediately go into a treatment program. If a panel of prison administrators found that the prisoner had completed the program, the inmate would be released after nine months, and would then have to complete a six month residential treatment program.

Vermont Continues to Resists Methadone Treatment

Last year the Vermont Legislature recognized the plight of opiate addicts living in Vermont and passed a bill to open methadone treatment programs in the state. However, Governor Dean, who is also a physician, opposed the bill and refused to sign it into law until a compromise was reached which requires programs to be hospital based and offer no take home. Methadone treatment programs have yet to open in the state, however, and the issue remains quite controversial as witnessed by recent events that erupted in Vermont’s criminal justice system. Keith Griggs, who lives in Vermont but travels weekly to a clinic in Massachusetts for methadone treatment, was held in a Woodstock, VT jail without access to his methadone while serving a 15 day "penalty" for a parole violation. When he complained, a lower court ruled that he should not be taken off methadone without his doctor's consent. The Department of Corrections, however, continued to refuse to provide Griggs with methadone citing their concerns about being in conflict with a state law passed in 2000 that specifies that only hospitals may administer the drug. While jailed, Griggs developed intense flu-like withdrawal systems as well as stomach cramps, diarrhea, tremors, sweating, inability to sleep, confusion, fatigue and anxiety. The Vermont State Supreme Court ultimately upheld the lower court ruling allowing an inmate to receive methadone treatment in jail. In response, the state’s Department of Corrections released Griggs 7 days early, justifying their action by saying that "it would be unethical to resume treating and cruel to readdict someone (to Methadone)." DOC was cited for contempt of court and AMTA, the Legal Action Center, the Lindesmith Center, and the National Alliance of Methadone Advocates are considering further action.

Meanwhile, in a related matter, the New York Times reported on July 20 that Vermont’s Governor Howard Dean ordered the state welfare program to stop paying for the prescription painkiller OxyContin, saying it had too much potential for abuse and that it had created a wave of pharmacy robberies. The decision to cut off coverage for OxyContin affects about 70 people and is the first such action by a state.

Legal Action Center Seeks Liver Transplant Denials

Hepatitis C is a potentially life threatening disease which affects the liver, and for some the only hope remaining is liver transplant. Unfortunately, it is being reported from around the country that patients on methadone programs are being denied access to transplants all together or are being told that they will have to taper off of methadone prior to being considered. The Legal Action Center is interested in pursuing litigation in discrimination cases related to liver transplants, and is asking that they be contacted should programs become aware of any such cases. Criteria for acceptance of cases include patients enrolled in methadone treatment programs who are HCV+, doing well in treatment, and have no positive toxicology results. The Legal Action Center can be reached at 212-243-1313.

Physical Plant Audit

Responding to concerns expressed by New York State providers regarding their ability to meet accreditation standards related to physical plant, COMPA sent a letter to H. Westley Clark, Director of CSAT, to bring this issue to his attention. In the letter, COMPA observed that many NYS clinics operate out of trailers, basements, storefronts, or the back corridors of hospitals deemed no longer suitable for medical services and noted that these spaces are often cramped and inadequate, with an absence of privacy, insufficient air flow, a lack of natural lighting, little room for storage, and limited space for meetings, community and/or group activities. In bringing this issue to the forefront, COMPA noted that due to physical plant issues, the ability of some clinics to provide an appropriate therapeutic environment which supports the recovery of patients is severely hampered, and that even where the facility itself is in acceptable condition, additional space needed for enhancing services is often unavailable, thereby obstructing the ability of programs to expand and precluding the institution of activities such as group counseling, educational programs, vocational services and specialized care.

COMPA suggested that a study which would provide for a system-wide assessment of physical plant issues and comprehensive evaluation of needs be undertaken as the first step towards obtaining capital funds that would allow for the renovation of existing facilities. It is our understanding that CSAT viewed our recommendation favorably and is in discussion with OASAS regarding technical assistance funds to complete this task

Treatment In New York State

Did you know that New York State has 125 licensed methadone treatment programs which are operated by 56 providers and serve over 45,224 patients. Manhattan is home to 46 programs, the Bronx 21, Brooklyn 20, Queen 6, Staten Island 2, Long Island 10, Westchester 7 and the upsate counties 13. There are also 3 PRU’s at Riker’s Island serving over 4,000 inmates a year and another 3 programs located at VA hospitals. 36 of the providers, which operate 101 methadone treatment programs, are members of COMPA.

COMPA General Membership Meetings Scheduled for Fall

General membership meetings have been scheduled for the Fall in both downstate and upstate locations. Come meet our new Executive Director, listen to what you can expect from COMPA in the future, hear the latest regarding accreditation and other key issues, share your thoughts and concerns as we look towards the future, and meet your colleagues.

Friday September 7^th, 10-12 noon

Greenwich House, 55 Fifth Avenue, 18^th Floor, Manhattan

Friday, November 2

Greenwich House, 55 Fifth Avenue, 18^th Floor, Manhattan

Wednesday, November 7^th 10-12 noon

Crouse Memorial Hospital, Syracuse

During the upcoming months COMPA will also be convening several member forums intended to begin a dialogue regarding critical issues such as community relations and dealing with chronic resistive patients which contributing to the stigma facing methadone treatment. These working forums will seek to identify key issues and problem areas, and then focus on developing recommendations for solutions. Schedules will be announced in a future issue of the COMPA Bulletin.

COMPA Business Plan Approved

COMPA’s Board of Directors has recently approved a comprehensive business plan for COMPA, a copy of which will be mailed to members shortly. This business plan is the result of considerable feedback and discussion on the part of our membership and the Board, and its development fulfills a key recommendation of Neil Cash, the National Leadership Institute consultant engaged to assist with the restructuring of COMPA. The business plan will provide a blueprint for COMPA during the next several years as we seek to increase our value to our membership and our effectiveness in addressing issues facing the methadone treatment field in New York State. The business plan will also fulfill a second recommendations to implement a Performance Based Appraisal system for our Executive Director.

Methadone Treatment: The Hope for a New Life

COMPA’s new video, Methadone Treatment: The Hope for New Life is an informative documentary focused on the role of methadone in saving lives and benefiting society. Presenting the real story of opiate addiction and its devastating effect on both the user and the community, the video examines the disease of addiction, addresses the question of who becomes an addict, and highlights the role of treatment in rebuilding the lives of users.

This 30 minute presentation, which is ideal for new staff as well as those unfamiliar with methadone treatment, is built around interviews with several patients as well as some of the key researchers and practitioners in the field, including Dr. Vincent Dole, Dr. Mary Jean Kreek, Dr. Beny Primm, Dr. Edward Salsitz and many others.

The video may be purchased from COMPA for $90 each. Discounts are available for quantity purchases: $75 for 4 – 10 copies; $60 for 11 or more. Please add $5 shipping and handling for the first copy and $2 for each additional video. To order, mail your request to COMPA at 250 Fifth Avenue, Suite 210, New York, NY 10001. Please include either a check payable to COMPA or a purchase order with your order.

CONFERENCE AND TRAINING OPPORTUNITIES

2001 AMTA Conference

This year’s American Methadone Treatment Association Conference will be held at the Regal Riverfront Hotel in St. Louis from October 7 – 10.

In addition to the usual conference activities, both NIDA and CSAT are sponsoring numerous Pre-Conference Sessions which will begin on Saturday, October 6. These sessions include:

Physician Training for Buprenorphine Treatment of Opiate Dependence

Saturday, October 6, 8:30 – 5:30, sponsored by American Society of Addiction Medicine, (fee)

What do Opioid Treatment Programs Need to know about new federal regulations

Saturday, October 6, 11:30-5:00, sponsored by CSAT

How are state methadone authorities roles changing (closed session)

Saturday, October 6, 9-12 noon, sponsored by CSAT

Clinical Guidelines for Buprenorphine in Office-based Treatment of Opioid Addiction

Sunday, October 7, 9-12, sponsored by CSAT

Staff training accreditation for opioid Treatment Programs

Sunday, October Oct 7, 9-3:30, sponsored by CSAT

Empowering Treatment Communities Through Education

Sunday, October Oct 7, 9-5:00, sponsored by CSAT

Opioid Maintenance Pharmacotherapy Course for Clinicians

Sunday, October Oct 7, 9-5:00, sponsored by NIDA

European Opiate Addiction Treatment Association Sunday Oct 7 1-5

NIDA Clinical Trails Network "Blending clinical practice and research to improve treatment Sunday, October Oct 7, 1-5:00, sponsored by NIDA

Women and Leadership

Sunday, October Oct 7, 1:30-5:00, sponsored by CSAT.

Those planning on attending the Conference are encouraged to attend the pre-conference sessions, and by adding a Saturday night stay will benefit from reduced airfares as well. And for fun, there is an exhibit on Miles Davis at the St. Louis Historical Museum, a spectacular Missouri Botanical Garden, riverboats, an art museum, a zoo full of lions and tigers and bears, and the Arch and Museum of Westward Expansion. St. Louis is also the home of the Cardinals and Rams, a welcome reception Sunday evening will feature a Motown review, and this year’s Nyswander- Dole and Richard Lane Awards will be given at the Conference Awards Banquet on Tuesday evening.

For Conference information contact Anthony Celenza at Tally Management, phone number 856-423-7222 ext. 224 (acelnza@talley.com), or Maria Gonzalez at 856.423.7222, ext. 263, (mgonzalez@talley.com).

"Advancing the Conversation" has been selected as the theme of this year’s Alcoholism and Substance Abuse Providers of NYS (ASAP) conference, which will be held in Saratoga Springs from October 21 – 24, 2001. Conference information can be obtained by calling 518-426-3122 or through their web site at www.asapnys.org

ABOUT COMPA

The Committee of Methadone Program Administrators of New York State is a not-for-profit coalition representing New York State’s methadone treatment system which serves over 46,000 individuals suffering from opioid addiction and other substance abuse disorders.

Opioid addiction is a chronic, relapsing medical disorder, with serious consequences related to public health and safety. Methadone treatment has proven to be the most effective means of treating this disorder.

COMPA’s mission is to further the treatment of opioid addiction and other substance abuse disorders in order to address the medical, social and psychological consequences of use, prevent the spread of HIV and other infectious diseases, reduce criminal behavior, promote employment and self-sufficiency, and support the return to a healthy and productive lifestyle.

In order to support this mission, COMPA and its member organizations are committed to the promotion and expansion of methadone treatment through education of elected officials, providers, consumers, and the public at large. COMPA advocates for expanded models of service delivery, co-located services and consumer empowerment to provide increased access to treatment. COMPA supports enhanced services, a comprehensive continuum of care, the provision of high quality treatment and ongoing professional staff development. COMPA encourages the involvement of membership in the development of public policy, standards of care, and regulatory oversight.

Peter Coleman, NYC Health and Hospitals Corporation, President

Ira Marion, AECOM-Montefiore, Vice President

Johanne Morne, Whitney Young MMTP, Secretary

Richard Woytek, Long Island Jewish MMTP, Treasurer

Herbert Barish, Lower Eastside Service Center

Willard Campbell, Suffolk County Division of Alcohol and Substance Abuse Services

Robert Krauss, Long Beach Hospital MMTP

Robert Sage, A.R.T.C.

Sheila Tierney, Crouse Hospital

Ira Wolfe, St. Luke’s Hospital

Organization members of COMPA are automatically members of the American Methadone Treatment Association as well.

The COMPA Bulletin is compiled, written and distributed by:

The Committee of Methadone Program Administrators of NYS Inc.

250 Fifth Avenue, Suite 210

New York, N.Y. 10001

212-447-6682