Volume
I, Issue 3
June 4, 2001
Enacted in 1973, New York's Rockefeller Drug Laws
are among the harshest mandatory minimum sentencing laws in the nation. As a
result of these laws, the criminal justice system loses the discretionary power
to divert offenders to treatment and thousands have been needlessly jailed. These draconian laws have sparked a movement
for reform that includes original sponsors of the Rockefeller Drug Laws,
lawmakers, judges, members of the New York Bar Association, community leaders,
civil rights activists, and clergy
In support of reform of the Rockefeller Drug Laws, the
Statewide Black & Puerto Rican / Latino Substance Abuse Task Force and
other advocacy groups are sponsoring a Treatment Works Rally on the Capitol
steps in Albany, New York. The rally
will be held on Wednesday - June 13, 2001 from
9:00 a.m. - 4:00 p.m..
Legislators, treatment providers, recovering people, ex-offenders, and
advocacy groups will be speaking at rally.
Contact the Statewide Black & Puerto Rican / Latino Substance Abuse
Task Force for more information: (718)
322 - 7341 or 7359.
The Correctional Association of NY has announced a
rally, march and festival to repeal the Rockefeller Drug Laws for Friday, June
15th. Beginning with a rally
from 2:00-4:00 pm in front of the
Harlem State Office Building (125th and Adam Clayton Powell Blvd), participants
will then march to Marcus Garvey Park (124th and Madison) where there will be a
cultural educational festival from
5:00-7:30 pm which features speeches, performances, workshops, music, and food. For more information call Tamar Kraft-Stolar
at the Correctional Association of NY, (212) 254-5700 x306.
The study, begun in the mid-1970's by researchers at the University of California at Los Angeles, followed male heroin addicts admitted to a court-ordered drug treatment program in California in the early 1960's. The men were interviewed in 1974 and 1975 and again in the mid-1980's. The report presented the findings of a 33- year follow-up, carried out in 1996 and 1997.
Of the 581 men in the original study, the researchers found, 284 had died, 21.6 percent from drug overdoses or from poisonings by adulterants added to the drug. Another 38.6 percent died from cancer or from heart or liver disease. Three died of AIDS. Homicides, suicides or accidents killed 55 of them.
Yet as disturbing as these numbers were — the death rates were higher, by several orders of magnitude than those for the general population — the struggles of the men who were still living were equally troubling. For example, of the 242 subjects interviewed in the 33-year follow-up, at the time in their late 40's to mid-60's, 40.5 percent reported using heroin within the last year and 20.7 percent tested positive for the drug in the urinalysis required for the study. Abuse of other illicit drugs was also frequent (19.4 percent had used cocaine in the last year; 35.5 percent had used marijuana), as was the use of nicotine and alcohol.
"The striking thing for me is that a good proportion of this group continues using," said Dr. Yih-Ing Hser, an adjunct professor at U.C.L.A.'s Neuropsychiatry Institute and the lead author of the study. "Ordinarily," she said, "you'd think that when people are reaching old age that they cannot continue to do the things they used to, like hustling for drugs. But that didn't happen."
Among the men in the study who still used drugs, health problems, unemployment, criminal involvement, social isolation and broken family relationships were common, as they were for a similar group of addicted men who took part in focus groups organized by the researchers. "Some men in the study did manage to attain abstinence, and the difference was striking when they came into the interview," said Dr. Christine Grella, also an adjunct professor at the neuropsychiatry institute and an author of the study. "They were well-functioning and they looked good," Dr. Grella said. "Those who continued to use didn't look good, and they had many physical problems that were hard for them."
The study, financed in part by the National Institute on Drug Abuse, found that even the men who achieved periods of abstinence were still vulnerable to relapse. Those who had abstained for at least five years were less likely to relapse, but even in this group, 25 percent resumed heroin use, some after 15 years of abstinence. And among those abstinent for more than five years, many abused alcohol or other drugs.
The findings, the researchers said, make it clear that surmounting heroin addiction can be a long and circuitous process, and that treatment programs need to take this into account. "Most people think that those who go to treatment will be immediately cured," she said, but "heroin is a difficult drug to kick, and therefore treatment and recovery has to take incremental steps."
Results from the 20-year follow-up, the researchers said, showed that methadone maintenance therapy helped the men refrain from heroin use. But only 10 percent of the subjects were enrolled in methadone maintenance in any given year. Many researchers believe that methadone maintenance therapy is an essential component of treatment but say that, for a variety of reasons, it is often not readily available to addicts. Many programs, for example, discontinue treatment if a client fails a drug test or cannot meet the fee, Dr. Hser said. "That kind of barrier to treatment, is partly responsible for the outcome we are seeing," she said.
While several national studies have followed addicts over a period of years, the U.C.L.A. study is the first to track them over three decades.
AIDS Clinical Trial Directory
The Community Research Initiative on AIDS (CRIA) has
just announced the publication of a new
resource guide, HIV/AIDS Clinical Trials: A Directory for New York
State. This resource has been developed to help consumers, service
providers, and medical providers find enrolling studies within the tri-state
region and better understand the clinical trials process. This directory
is a continuation of The Experimental Treatment Guide, formerly published by
the AIDS Treatment Data Network. CRIA will publish two editions of this
directory each year, with updated listings of enrolling studies in the region.
For information go to www.criany.org or 212/924-3934.
CHAPEL HILL, N.C., May 22 /PRNewswire/ -- New
findings from a large international study led by researchers at the University
of North Carolina at Chapel Hill suggest that a combination treatment with a
new long-acting interferon drug and an antiviral medication may be more
effective than the current standard of care for hepatitis C.
The multi-center Phase III clinical trial found a
significantly higher sustained viral response rate among hepatitis C patients
treated with the investigational drug PEG interferon alfa-2a (Pegasys) in
combination with the oral antiviral medication, ribavirin, than among those
treated with interferon alfa-2b plus ribavirin (Rebetron), the current standard
of care. Patients treated with the new combination attained a 56 percent
sustained response rate (SVR), while those receiving standard care attained a
45 percent SVR. Those on PEG interferon
alpha-2a plus placebo attained a 30 percent SVR. "And sustained response
means clearance of the virus with normal liver enzymes six months after the end
of treatment, which at that point implies
a cure," said Michael W. Fried, MD, Associate Professor of Medicine and
Director of Clinical Hepatology at the University of North Carolina Chapel Hill
School of Medicine.
Fried presented the results today, May 22, at the plenary session of Digestive Disease Week, the largest international medical meeting in the fields of hepatology and gastroenterology. "These data go a long way in furthering our understanding of Pegylated interferon alfa-2a," said Fried. "The combination of this drug plus ribavirin was clearly shown to be superior to our standard of care."
In his presentation, Fried also discussed data
suggesting that response to PEG interferon alpha-2a plus ribavirin is
predictable. At week 12, 86 percent of
patients treated with PEG interferon will show a viral response; of these, 65
percent will go on to attain a sustained viral response. "This means that physicians can create
an alternate treatment plan for patients who do not show any response by week
12," said Fried. "And for
those who to respond, it can be a motivation to continue to adhere to their
treatment regimens."
Patient tolerance data to the new combination versus
tolerability data in the standard treatment were also presented at the plenary
session. Investigators found that the most common and troublesome side effects
-- depression and flu-like symptoms -- were less frequent in the PEG interferon
alpha-2a plus ribavirin group than in the comparison group. Depression occurred in 21 percent of those
taking the new combination, compared with 30 percent in the other group, and 20
percent in the PEG interferon alpha-2a plus placebo arm.
The study was conducted at 81 clinical sites in 18
countries. It involved over 1100
patients in one of three study arms: 453 were treated with PEG interferon
alpha-2a plus oral ribavirin; 224, with PEG interferon alpha-2a plus placebo;
and 444 with interferon alfa-2b plus ribavirin. Patients were treated for 48 weeks and then monitored for an
additional 24 weeks.
Sustained viral response (SVR) was defined as
undetectable serum HCV RNA (<50 IU/ml) after the treatment-free follow-up
period. Sixty-five percent of patients were infected with hepatitis C genotype
1, And 14 percent had cirrhosis, or scarring of the liver. Among those infected with genotype 1, 46
percent of those treated with the new combination (n=298) attained an SVR, as
compared to 37 percent of those treated with the standard care (n=285).
"This is the most difficult-to-treat population
and the most prevalent genotype in the United States. We are very pleased with this impressive response rate for
gentotype 1 in those treated with the PEG interferon alfa-2a combination," Fried said.
The hepatitis C virus (HCV) is a life-threatening
viral infection of the liver transmitted primarily through infected blood and
blood products. Approximately 2.7 million Americans and 170 million people
worldwide are chronically infected with HCV.
HCV is often described as "silent" because people may be
infected for 10 to 30 years and not exhibit symptoms, yet still be carrying the
virus. While many patients with HCV
will not develop complications from their liver disease, chronic hepatitis C is
still a leading cause of cirrhosis and liver cancer and is the major indication
for liver transplants in this country.
More information about Hepatitus C can also be found in NIH Publication No. 99-4230 Issued May 1999 / Updated: November 2000 at: http://www.niddk.nih.gov/health/digest/pubs/chrnhepc/chrnhepc.htm
NYC HRA Update
On May 17th, OASAS Commissioner Jean Miller
met with New York City providers to discuss the recent agreement reached
between OASAS, OTDA, and HRA regarding HRA’s Letter of Agreement and the newly
revised and renamed Program Standards For Moving Individuals With Substance
Abuse Disorders From Welfare to Work.
Calling for a collaboration of effort based on mutual respect and
professionalism, Commissioner Miller told the audience that under the revised
language contained within the agreements, OASAS had achieved their goals
related to the integrity of the treatment system, the protection of OASAS
funds, and the protection of patients in treatment. Miller also stated that the revised language regarding the MTA
provision was in terms of a utilization review procedure consistent with good
clinical practice, and felt that it would not result in patients being tapered
from methadone against their will.
Given this agreement, Commissioner Miller stated that providers wishing
to continue working with HRA mandated clients should feel comfortable in signing
the revised Letter of Agreement. John
Coppola, Executive Director of the Association of Alcohol and Substance Abuse
Providers of NYS (ASAP) also stated the Association’s support for the agreement
but cautioned that programs cannot allow interference with good clinical
judgment, which he noted was the sole purview of OASAS and the state’s licensed
treatment providers under NYS Mental Hygiene Law.
In a subsequent meeting with representatives of OASAS
and New York City coalition groups, the Legal Action Center stressed the
difference between participation, which can be required by HRA of those
individuals mandated by them to treatment,
and compliance, as determined by the provider. Programs were urged to cooperate but when necessary, challenge on
a case by case basis, and the need for a fair hearing process was noted. It was
also suggested that programs need to fully inform patients of their rights,
including the potential risks of disclosure to HRA, and to closely monitor HRA
decisions for adverse impact on the patient. Concern was also expressed
regarding HRA’s lack of response in addressing the issue of chronic relapsing
patients, and it was noted that a
majority of patients classified as work ready by treatment programs have yet to
be placed in WEP assignments by HRA.
Mentioning that the reauthorization of the Welfare
Reform Law provides the next real opportunity for addressing provider concerns,
Coppola stated that ASAP will continue to work with OASAS, HRA, OTDA and the
Governor’s Office to present both sides of the issue as well as begin exploring
statutory remedies. ASAP also promised to get correspondence out to all
agencies which will include fact sheets regarding the scope of HRA’s authority,
areas that need attention and vigilance on the part of providers, clients
rights and risks related to informed consent, and key phone numbers. ASAP also requested that OASAS undertake a
legal review of the confidentiality issues surrounding STARS, particularly in
terms of safeguards against redisclosure.
Queens Clinic Closes
On May 25, 2001 Beth Israel Medical Center closed the
doors of their Queens Hospital MMTP for good.
As a result of this closing, 430 patients had to be transferred to other
clinics and many programs in the borough now have waiting lists. Symptomatic of some of the problems facing
methadone treatment programs in New York City, the clinic had been asked to
relocate due to construction of a new
hospital on the Queens Hospital campus. Beth Israel, however, was unable to find
alternative space for the clinic and ultimately ran out of time.
Insurance Parity Bill
Introduced in State Senate
Senator Marchi
has introduced a comprehensive Parity Bill that is identical to the bill
introduced by Assemblyman Luster.
Passage of this bill, the "fair insurance treatment act of
2001", would require health
insurers and health maintenance organizations to provide insurance coverage for
the treatment and diagnosis of mental nervous and emotional disorders, and
ailments of alcoholism, alcohol abuse, substance abuse, substance dependence
and chemical dependence which shall be comparable to the coverage provided for
other health care and medical services. The bills also eliminate certain
limitations on mental health and chemical dependence coverage so as to expand
the basic level of coverage to be required; and makes it an unlawful
discriminatory act to limit health care insurance coverage for any specific
disease or condition which is inconsistent with other health care services
which are covered.
People are encouraged to call Senator Marchi and let
him know how happy you are with his leadership on this issue. Encourage your
Senator and Assemblyperson to support S5381 and A4506. The Senate switchboard # is 518-455-2800.
The Assembly switchboard # is 455-4100.
AMTA Conference Awards
Announced
John Perez
has been selected as this year’s New York State recipient of the prestigious
Nyswander-Dole (Marie) Award which will be presented at the AMTA Conference
Awards Banquet on the evening of Tuesday, October 9, 2001. John Perez has worked in the methadone
treatment field for more than 20 years and since 1992 has been the director
of Methadone Planning and Policy at the
NYS Office of Alcoholism and Substance Abuse Services. Over the years, John has
been instrumental in insuring that NYS programs provide high quality care, that
individuals in need of treatment have access to needed services, and that the
rights of patients are respected. He
was involved in the creation of the KEEP Program at NYC's Rikers Island Prison,
worked tirelessly to integrate methadone treatment with other modalities,
created a patient hotline for complaints, pushed programs to provide adequate
dosing, and is currently working on a number of initiatives to further expand access to treatment. New York State's programs and patients have
benefited tremendously as a result of John's efforts.
Joycelyn Wood, head of
the National Association of Methadone Advocates (NAMA), has been selected to
receive the Richard Lane Advocacy Award for her advocacy work with NAMA on behalf
of methadone patients everywhere. Richard Lane was a long term
heroin user who upon release from prison in 1967 was instrumental in
establishing one of the nation’s first methadone treatment programs. In 1974 he
became the Executive Director of Man Alive and later served as the Vice
President of the American Methadone Treatment Association and as Vice Chairman
of the Governor’s Council on Alcohol and Drug Abuse in Maryland. Richard was a passionate advocate for
methadone treatment and by disclosing his own treatment experiences, provided
inspiration to patients and colleagues alike.
Established in 1995, this will be only the second time that this award
has been given. Ms. Wood’s commitment to working in
partnership with government regulators and treatment providers has been an
inspiration to many, particularly those individuals who are themselves in
treatment and who seek to contribute to the debate on effective treatments for
those who are opiate-dependent.
Methadone Treatment: The
Hope for a New Life
COMPA’s new video, Methadone Treatment: The Hope for
New Life focuses on methadone treatment and its role in saving lives and
benefiting society. Presenting real
stories of opiate addiction and its devastating effects on both the user and
the community, the film examines the disease of addiction, the question of who
becomes an addict, and what treatments are available that can change the user’s
life.
This 30 minute presentation is built around interviews
with patients as well as some of the key researchers and practitioners in the
field, such as Dr. Vincent Dole, Dr. Mary Jean Kreek, Dr. Beny Primm, and Dr.
Edward Salsitz.
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 for the first
video and $2 for each additional video to cover the cost of shipping and
handling. Requests should be sent to The Hope For New Life, COMPA, 250 Fifth
Avenue Suite 210, New York, NY 10001.
Include with your request either a check made out to COMPA in the
correct amount or an agency purchase order.
COMPA Nurses’ Training
COMPA’s
Nurses’ Committee is sponsoring
a full day conference focused on the role of nursing in methadone treatment
programs on Wednesday June 6,
2001. For more information contact Rita
Williams (212-387-3949), Joanne Filoia (845-486-2860), or Sandy O’Brien
(212-206-0635).
The
Legal Action Center recently announced a training session on patient
confidentiality has been scheduled for Friday, June 15th from 1:00
pm – 4:00 pm. The session is to be held
at the Beth Israel Medical Center Podell Auditorium, which is located on the
first floor of the Dazian Building at 16th Street and First
Avenue. Registration is free but space
is limited. For further information and
registration call Jennifer Mason at 212-243-1313 x40.
OASAS
and the NYS Division of Criminal Justice Services (DCJS) will once again join
forces to sponsor a conference to be held on June 18-20, 2001 at the Holiday
Inn Turf on Wolf Road in Albany. This
year’s Conference is titled: What Works – Successful and Promising Treatment
Interventions with the Criminal Justice Population. There is a $100 registration fee and CASAC hours will be
available. Contact Andy Evans at
518-485-2116 for more information.
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. For Conference information contact Kathleen
Hamilton at Tally Management, khamilton@talley.com or by phone at 856.423.7222,
X254.
“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
At a recent meeting of the COMPA Board of Directors, the Mission Statement of the organization was reviewed and revised as follows:
COMPA 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
Eugenia Curet, NY
Presbyterian Cornell Medical Center MTP
Robert Krauss, Long Beach
Hospital MMTP
Robert Sage, A.R.T.C.
Sheila Tierney, Crouse
Hospital
Ira Wolfe, St. Luke’s
Hospital
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
News, articles, research, events and other items of
interest to the field, as well as announcements regarding conferences,
trainings, personnel changes and job openings may be submitted for possible
inclusion in the COMPA Bulletin.
Submissions should be directed to info@compa-ny.org.