Thursday, April 10, 2008

Knee Jerk Policy

Drug overdoses killed more people last year in NH than car crashes. NH had 168 overdose deaths, and 129 car related deaths. Of those overdose deaths, 57% were caused by methadone. NH is now tied for 4th place in the nation in methadone related deaths, according to a report released by the Centers for Disease Control and Prevention.

This has become a hot topic of discussion recently, since a company known as Community Substance Abuse has been investigating the possibility of opening a methadone clinic in Conway. Methadone is a synthetic opiate often used in the treatment of heroin addiction. The drug reduces withdrawal symptoms, without giving the same kind of high as heroin. Methadone is also used a pain reliever, particularly in managing long term chronic pain. It has a half life in the body of 24 hours, and it’s cheap compared to Oxycontin or Vicodin. A single Oxycontin tablet can cost $5.50, where a Methadone wafer costs about $0.33.

Heroin addiction is extremely difficult to overcome. Some addicts remain on a methadone maintenance for indefinite periods of time. It’s not the perfect cure, but, it does work for some people. A brave local woman recently wrote a letter to the Conway Daily Sun recounting her experience with addiction and methadone treatment. She’s able to be a mother and a productive member of society, thanks to methadone treatment. Two of our local pharmacists have written letters about dearth of treatment options for the addicted in our area. They both advocate suboxone as an alternative to methadone, but it is considerably more expensive than methadone, and since many local residents don’t have health or prescription drug insurance, it’s not within the reach of the average person. The potential methadone clinic has (if nothing else) opened the community wide discussion about addiction and treatment, issues that most people may not be experts in.

A recent Tele-Talk question asked “How prevalent or severe do you think the drug problem is in Carroll County?” Some of the answers were most illuminating. A number of people pointed out that prescription drug abuse is a real problem here. One caller addressed both the drug and the alcohol problems in the area. There were a few predictable comments about addicts being low income losers, and of course the jolly fellow who seems to think drug users dying is the optimum solution to the addiction problem. There were also a number of knee jerk responses to the possibility of a methadone clinic from callers - mirroring the knee jerk responses of the Conway Selectmen.

I didn’t spend endless hours doing research, but I did spend a few. I was unable to find any correlation between increased crime and methadone clinics. Crow Dickinson went on at great length about how a clinic would attract heroin addicts to the area. He seemed to be giving us his opinion. He did not back up that opinion by citing studies or facts. There are clinics in other parts of the state that don’t report any increase in crime. Mr. Dickinson may have a vast body of expertise in many areas, but addiction and treatment does not appear to be one of them. Most people who go on a methadone program do so because they want to end their addiction. They know they aren’t going to get high. Those who are enrolled in a methadone program take their drugs right there on the premises - there are no needles, and they aren’t wandering off with a bunch of drugs to sell on the street, which are some of the misconceptions that have been repeated by letter writers and Tele-Talk callers.

Dr. Wayne Cunningham had a letter in the April 8 issue of the Conway Daily Sun on the topic of substance abuse in the area. He pointed out that alcohol abuse is the most serious drug problem in our area. He also addressed the need for community discussion and involvement in the problems of treatment in Carroll County. The options for substance abusers are few. Dr. Cunningham expressed hope that the conversation about substance abuse and treatment will continue. I share that hope.

Another letter on this topic came from Daniel Bacon from Conway, who is running for state rep. He believes that addicts bring their problems on themselves, and that traveling to a clinic is a “sacrifice” they should have to make. Addiction has long been classified as a chronic disease, and it’s one with a strong genetic component. It’s not a “lifestyle choice,” which seems to be Mr. Bacon’s thesis. Making people drive hours for treatment may be a suitable punishment in Mr. Bacon’s opinion, but it’s not the best strategy for recovery. Drug addiction (I include alcohol in the category of drug) and the accompanying devastation have affected most families - and has a profound impact on our communities. Addicts can recover, and become successful, productive members of the community. Shouldn’t that be our goal? His emphasis on the “wholesome healthy lifestyle” of the area (repeated several times) indicates that Mr. Bacon is living in a fantasy world that isn’t reflective of local realities. I urge voters to pay a visit to Mr. Bacon’s website;, and check out the My Promise section. He makes two promises about health care - he’ll promote providing “for the special needs for our senior citizens.” (His grammar, not mine) and he’ll “promote the best healthcare needs of our children.” (Again, his grammar, not mine.) It seems he’ll also provide an ill-informed, knee-jerk response on some issues.

I’m not for or against the proposed clinic at this time. I’d like more information before I make a decision. I wish local elected officials would take the time to gather information from experts and study it before shooting from the uninformed lip.

“In this country, don't forget, a habit is no damn private hell. There's no solitary confinement outside of jail. A habit is hell for those you love. And in this country it's the worst kind of hell for those who love you.” Billie Holiday


Anonymous said...

Thanks for your open mind and thoughtful comments. You are very correct in that there is no association with clinics and crime increase--in fact there is an association with clinics and a decrease in crime. Methadone is the most effective opioid addiction treatment available today, and has a much higher success rate than traditional rehabs or 12 step groups, yet people usually welcome such groups and rehabs to their communities.

In addition, methadone, contrary to popular belief, does not impair driving ability on stable patients who are not using other drugs.

Thanks again!

Anonymous said...

Susan -

Thank you for your column "Knee Jerk Policy" that encourages your readers to secure accurate information before they approve or disapprove of policy and proposals.

A high-five for decision-making based on accurate evidence and facts also known as DMBAEF (For those who are initials-oriented (grin))

Short answer to this issue:
I wouldn't recommend this approach to helping folks who have addiction problems.

Response to the issue:
1) Evaluate the need to address this problem at the community level ie, What problems are going on in the community as a result of herion use?

2)Supposing heroin addiction is a community problem, is the proposed solution (Bringing in outside agencies) the best way to help people (the addict and those around them)? I am proposing that a more beneficial and successful solution would be to entrust the care of folks who struggle with addiction (including family and friends) to professionally trained medical staff in a hospital environment.

(End here if you just want to know my position on the subject. Read on for my reasons.)

Regarding the claim that there is no correlation between meth. clinics and increased crime, there is conflicing information on this claim.

Framingham, MA has implemented the use of meth. clinics for several years.

If you look at the numbers (and this is a tricky thing to do too), the crime rates in Framingham are not that bad even when they are compared to the 10 best places to live in the United States (See Money Magazine:

At the same time, if you listen to local police officials (See comments from Police Chief Steven Carl, you get a slightly different picture of what is happening in the areas where the shelters are located.

Though the crime stats. may not prove or disprove a correlation between meth clinics and crime, there are other important pieces of information that warrant evaluation before making a town decision one way or the other.

If you take a look at the issues for the Framingham residents

you can learn about their experience-based concerns such as:
- Tax increases
- More police (and consequent costs)in the areas where the shelters are located. 9The increased police presence seems to suggest a problem, doesn't it?)
- Lack of responsibility by the agencies that run the clinics to help ensure a safe area

Given the current situation in downtown Framingham and the ongoing struggle between the Framingham residents and the town on this issue, I recommend looking into what happened there; evaulating the effectiveness of the programs that were put in to place; and determining if such an approach would work in Conway.

There is a great deal involved in setting up meth. clinics, especially in an area that relies on the tourist industry for its economic well-being; not to mention the residents' rights by common law to "peaceful and quiet enjoyment of their property."


vijay said...

Addiction treatment and recovery resources for the addict and their families.