[Ibogaine] Fw: Anniversary of methadone treatment for addiction. Untold savings in lives, suffering and spending.

Preston Peet ptpeet at nyc.rr.com
Fri Aug 12 19:49:20 EDT 2005


I actually agree with you Howard, but in a perfect world who would need 
methadone? We'd have legal opium and heroin. AND plenty of ibogaine too.
;-))

Peace and love,
Preston Peet

"Madness is not enlightenment, but the search for enlightenment is often 
mistaken for madness"
Richard Davenport-Hines

ptpeet at nyc.rr.com
Editor http://www.drugwar.com
Editor "Under the Influence- the Disinformation Guide to Drugs"
Editor "Underground- The Disinformation Guide to Ancient Civilizations, 
Astonishing Archeology and Hidden History" (due out Sept. 2005)
Cont. High Times mag/.com
Cont. Editor http://www.disinfo.com
Columnist New York Waste
Etc.

----- Original Message ----- 
From: <HSLotsof at aol.com>
To: <ibogaine at mindvox.com>
Sent: Friday, August 12, 2005 1:05 PM
Subject: Re: [Ibogaine] Fw: Anniversary of methadone treatment for 
addiction. Untold savings in lives, suffering and spending.


Hi Preston,

On this date in the US there are 215,000 people taken our of harms way of 
the
police for opoid use by their participation on methadone maintenance.  That
certainly is cause for celebration.  I saw your posting of Andrew Byrne's 
email
and called up Dr. Dole who has been quite supportive of and interested in
ibogaine to wish him a happy 40th.

Howard

In a message dated 8/12/05 2:05:15 AM, ptpeet at nyc.rr.com writes:

<< Oh boy, what a day for celebration, eh?



Peace and love,

Preston Peet


"Madness is not enlightenment, but the search for enlightenment is often
mistaken for madness"

Richard Davenport-Hines


ptpeet at nyc.rr.com

Editor http://www.drugwar.com

Editor "Under the Influence- the Disinformation Guide to Drugs"

Editor "Underground- The Disinformation Guide to Ancient Civilizations,
Astonishing Archeology and Hidden History" (due out Sept. 2005)

Cont. High Times mag/.com

Cont. Editor http://www.disinfo.com

Columnist New York Waste

Etc.


----- Original Message ----- 

From: Andrew Byrne

To: ajbyrne at ozemail.com.au

Sent: Thursday, August 11, 2005 9:20 PM

Subject: Anniversary of methadone treatment for addiction. Untold savings in
lives, suffering and spending.



Dear Readers,





It is 40 years on 23rd August since the first report of methadone treatment
for addiction.  Dole and Nyswander's seminal paper (below) is one of the 
most
cited in the medical literature.  It stands as a model for all medical
researchers, being a funded trial in a clinical research ward.  Although 
essentially a
simple report of 24 Manhattan heroin addicts treated with a new intensive
protocol utilising supervised oral daily methadone, it effectively defined 
the
field for decades with its foresight and thoroughness.  Having only two 
early
drop-outs, the 22 successful patients are described in detail, including
hospital ward induction, average daily doses over 100mg, daily urine testing 
and, in
addition to routine physical examinations, radio-iodine thyroid tests and 
bone
marrow findings.  These pioneers also tested for physical coordination to
determine safety at home and in the work place.  Patients were even given
laxatives for the ubiquitous constipation.





By 1970 Australian addicts were being offered similar treatment due to the
frontier work of Dr Stella Dalton.  The treatment is now available in 
virtually
every western country and is being introduced into some parts of the third
world.





The JAMA paper speaks for itself.  It remains a lasting tribute to its
authors and acknowledged contributors:





Published in Journal of the American Medical Association (JAMA) on 23 August
1965





A Medical Treatment for Diacetylmorphine (Heroin) Addiction





A Clinical Trial With Methadone Hydrochloride





Vincent P. Dole, MD, and Marie Nyswander, MD





A group of 22 patients, previously addicted to diacetylmorphine (heroin),
have been stabilized with oral methadone hydrochloride. This medication 
appears
to have two useful effects: (1) relief of narcotic hunger, and (2) induction 
of
sufficient tolerance to block the euphoric effect of an average illegal dose
of diacetylmorphine. With this medication, and a comprehensive program of
rehabilitation, patients have shown marked improvement; they have returned 
to
school, obtained jobs, and have become reconciled with their families. 
Medical and
psychometric tests have disclosed no signs of toxicity, apart from
constipation. This treatment requires careful medical supervision and many 
social
services. In our opinion, both the medication and the supporting program are
essential.








The question of "maintenance treatment" of addicts is one that is often
argued but seldom clearly defined. If this procedure is conceived as no more 
than
an unsupervised distribution of narcotic drugs to addicts for
self-administration of doses and at times of their choosing, then few 
physicians could accept
it as proper medical practice. An uncontrolled supply of drugs would trap
confirmed addicts in a closed world of drug taking, and tend to spread 
addiction.
This procedure certainly would not qualify as "maintenance" in a medical 
sense.
Uncontrolled distribution is mentioned here only to reject it, and to
emphasize the distinction between distribution and medical prescription. The 
question
at issue in the present study was whether a narcotic medicine, prescribed by
physicians as part of a treatment program, could help in the return of 
addict
patients to normal society.





No definitive study of medical maintenance has yet been reported. The 
Council
on Mental Health of the American Medical Association, after a thorough 
review
of evidence available in 1957,1 concluded that "The advisability of
establishing clinics or some equivalent system to dispense opiates to 
addicts cannot be
settled on the basis of objective facts. Any position taken is necessarily
based in part on opinion, and on this question opinions are divided." With
respect to previous trials of maintenance treatment, the Council found that
"Assessment of the operations of the narcotic dispensor between 1919 and 
1923 is
difficult because of the paucity of published material. Much of the small 
amount
of data that is available is not sufficiently objective to be of great value 
in
formulating any clear-cut opinion of the purpose of the clinics, the way in
which they operated, or the results attained." No new studies bearing on the
question of maintenance treatment have appeared in the eight years since 
this
report was published. Meanwhile, various medical and legal committees have
called for additional research.2,6





See also page 673 ['Dependence on Barbiturates and Other Sedative Drugs']





The present study, conducted under the auspices of the departments of health
and hospitals, New York city, has yielded encouraging results; patients who
before treatment appeared hopelessly addicted are now engaged in useful
occupations and are not using diacetylmorphine (heroin). As measured by 
social
performance, these patients have ceased to be addicts. It must be emphasized 
that thi
s paper is only a progress report, based on treatment of 22 patients for
periods of 1 to 15 months. Such limited study obviously does not establish a 
new
treatment for general application. The results, however, appear sufficiently
promising to justify further trial of the procedure on a larger scale.





Procedure


The patients admitted to the program to date were men, aged 19 to 37,
"mainline" diacetylmorphine users for several years with history of failure 
of
withdrawal treatment. They have reported no substantial addictions to other 
agents
(although most of them had used barbiturates or tranquilizers when narcotic
drugs were unavailable), and they were not psychotic. Patients came from the
streets, from drug withdrawal units, from referrals by social agencies and
physicians who had heard of the program, and from recruitment of addicted 
friends by
patients under treatment. Further details of their history are given in the
Table.





Division of Program Into Three Phases.-PHASE 1.-The addict patients were
stabilized with methadone hydrochloride in an unlocked hospital ward, given 
a
complete medical workup, psychiatric evaluation, a review of family and 
housing
problems, and job-placement study. After the first week of they were free to
leave the ward for school, libraries, shopping, and various 
amusements-usually,
but not always, with one of the staff. Patients lacking a high school 
diploma
started in classes that prepare students for a high school equivalency
certificate. For the present study the time in this initial phase was 
arbitrarily set
at six weeks.





During this phase of hospitalization, the treatment unit was kept small 
(four
to nine patients). This was felt necessary because most patients started the
treatment with serious anxieties and doubts. The limitation of patient load
allowed the staff to individualize the daily ward activities and deal with 
the
special problems of each patient.





PHASE 2.-This began when subjects left the hospital and became outpatients,
returning every day for methadone medication. They were asked to drink their
medication in the presence of a clinic nurse, and to leave a daily urine
specimen for analysis. When indicated, this rule has been relaxed; reliable 
patients
who have been on the program for several months have been given enough
medication for a weekend at home or a short trip. Continued contact with the 
hospital
staff was provided as required. The most important services needed during
this phase of treatment were help in obtaining jobs, housing, and education.





PHASE 3.-This phase is the goal of treatment, the stage in which an 
ex-addict
has become a socially normal, self-supporting person. The two patients who
are considered to have arrived at this phase are still receiving maintenance
medication since the physicians in charge of their treatment feel that 
withdrawal
at this time would be premature. Supervision of their medication is as
careful as in phase 2; the only distinction between patients in phases 2 and 
3 is in
the degree of social advancement.





PHASE 1A.-This phase designates a special group of four patients who are
being maintained on high doses under close and continuing observation to 
reveal
any delayed toxic effects of methadone (Table). So far, none have been 
found.
These patients live on a metabolic ward, and so are still classified in 
phase 1,
but as measured by social adjustment they have progressed to phase 2 or 3,
since all are either employed or going to school. The ward serves mainly as
their residence, which they are free to leave as they wish subject only to 
the
general routine of hospital activities.





Narcotic Medication.-Patients have differed markedly in tolerance to
narcotics at the beginning of treatment, and in the rate with which they 
have adapted
to increasing doses of medication. Individualization of treatment thus has
been necessary. A rough estimate of initial tolerance was made from each new
patient's history of drug usage, with allowance for exaggeration since 
addicts
coming to a maintenance program usually fear that physicians will not 
prescribe
enough medication, and with recognition of the fact that the number of 
"bags"
used by an addict is not a reliable measure of narcotic tolerance. The
diacetylmorphine content of a "bag" obtained on the street today is low and 
variable.
This estimate provided a guide to initial dosage, but the only sure way to
measure tolerance is to observe the reaction to test doses of narcotic 
drugs. The
schedule, therefore, differed for each patient.





On admission patients usually have shown mild or moderately severe symptoms
of abstinence, the last shot of diacetylmorphine having been taken some 
hours
before. These patients were relieved promptly by one or two doses of 
morphine
sulfate (10 mg) or dihydromorphone (Dilaudid) hydrochloride (4 mg), given
intramuscularly, and then started on oral methadone hydrochloride therapy 
(10 to 20
mg, twice daily). Patients coming to treatment without symptoms were started
on a regimen of methadone without other medication, but were watched 
carefully
for appearance of symptoms after admission. After the first 24 hours most
patients could be maintained comfortably on the oral medication alone. The 
dose
of methadone hydrochloride was increased gradually over the next four weeks 
to
stabilization level (50 to 150 mg/ day). Two patients in whom tolerance at 
the
expected rate failed to develop have been held at lower doses (Table). With
some patients, treated early in the study, the buildup of dosage was too 
rapid;
they became overly sedated for a few days, and two of them had transient
episodes of urinary retention and abdominal distention. Other patients, 
given too
little, have become abstinent, exhibiting malaise, nausea, sweating,
lacrimation, and restlessness. With more accurate prescription, patients 
have not
become euphoric, sedated, or sick from abstinence at any stage of treatment. 
They
have simply felt normal, and have not asked for more medication.





After the patients reached maintenance level, the morning and evening doses
were combined by progressive reduction of the evening medication with an 
equal
addition to the methadone taken in the morning. After discharge from the
hospital patients could thus be maintained by a single daily visit to the
outpatient clinic. The patients who have had difficulty in spanning a 
24-hour period
with a single dose have been given medication to take at home; this has been 
a
minor problem, limited to those who could visit the clinic only in the 
evening.
In all cases it has been made clear to the patients (and accepted by them as
a condition of treatment) that the amount of medication and the dosage
schedule were the responsibility of the medical staff. Physicians did not 
discuss
dosage with the patients, although of course they listened carefully to any
report of symptoms that might suggest excess or lack of medication.





Laboratory Control.-The urine of every patient was collected daily in the
hospital and at each clinic visit, to be analyzed for methadone, morphine 
(the
chief metabolite of diacetylmorphine), and quinine (a regular constituent of 
the
street "bag"). The thin layer chromatographic method of Cochin and Daly7 was
used, after preliminary extraction of the alkaloids from urine with cation
exchange resin. The sensitivity of the procedure was such that it would give 
a
definite positive if a patient had taken an average "bag" of 
diacetylmorphine
during the preceding 24 hours.





Results


The most dramatic effect of this treatment has been the disappearance of
narcotic hunger. All of the patients previously had made efforts to remain
drug-free after withdrawal, but were unable to resist the craving. Drug 
hunger became
intolerable for most of them shortly after discharge from withdrawal unit 
and
return to their neighborhood. It became especially severe when they were
exposed to emotional stress. With methadone maintenance, however, patients 
found
that they could meet addict friends, and even watch them inject
diacetylmorphine, without great difficulty. They have tolerated frustrating 
episodes without
feeling a need for diacetylmorphine. They have stopped dreaming about drugs,
and seldom talk about drugs when together. Patients have even become so
indifferent to narcotics as to forget to take a scheduled dose of medication 
when
busy at home.





The extent to which the patients have ceased to behave as addicts, and their
reliability in reporting illegal drug use, were verified by the results of
urinanalysis. Negative results in almost all analyses showed that use of
diacetylmorphine has been rare and sporadic, although the patients have had 
ample
exposure to addict friends and pushers. Remarkably, the episodes of drug 
taking
were reported by the patients spontaneously, and their reports have 
correlated
with the laboratory evidence.





An interesting phenomenon, which has been seen in several patients, was the
production of symptoms typical of drug deficiency by acute emotional stress.
Anxiety in some susceptible patients caused malaise, nausea, yawning, and
sweating, indistinguishable from the effects of abstinence, even though the 
patients
were being maintained on large doses of medication. After experiencing 
relief
with reassurance but without additional medication, susceptible patients 
have
become less alarmed by these symptoms, and the episodes have occurred less
frequently. In two other patients symptoms suggesting abstinence have 
appeared
in the course of mild respiratory-tract infections. These symptoms, not
associated with anxiety, were difficult to evaluate, but in any event 
disappeared in
a few days without need for increase in medication. These observations 
suggest
that the effectiveness of methadone can vary with changes in psychological
and metabolic state.





The degree of tolerance established by methadone was titrated in six 
patients
by giving diacetylmorphine, morphine, dilaudid, or methadone intravenously 
in
a double-blind study. The drugs were given in randomized order and various
doses six hours after the last administration of methadone. Stabilization 
with
methadone, as here described, was found to make patients refractory to 40 to 
80
mg diacetylmorphine (which would cost $10 to $25 if purchased on the 
street).
Larger amounts were not systematically tested; probably blocking would 
extend
to greater doses since two patients with high tolerance showed little
reaction to intravenous injection of 200 mg of diacetylmorphine-a huge 
amount,
possibly enough to kill a nontolerant individual.





Unscheduled, but perhaps necessary, experiments in drug usage were made by
four patients. These subjects found that they did not "get high" when 
"shooting"
diacetylmorphine with addict friends on the street. Both the patients and
their friends were astounded at their lack of reaction to the drug. They
discontinued these unrewarding experiments without need for disciplinary 
measures, and
have discouraged other patients from repeating the experiment. So long as
patients take methadone as scheduled, they apparently cannot feel the 
euphoria of
an addict taking a street bag of diacetylmorphine.





Complications.-The chief medical problem has been constipation. The tonus of
the sigmoid and the defecation reflex remain depressed even in patients with
high tolerance to the narcotic effects of methadone, while the motility of 
the
upper gastrointestinal tract appears to be unaffected. Five patients, given 
a
barium sulfate meal and followed with daily x-ray examinations for a week,
showed normal or only slightly delayed passage of barium through the small
intestine, but in three of the five, the evacuation of barium from the colon 
was
abnormally slow. Fecal impaction has occurred when patients have made no 
effort
to defecate for several days. Patients therefore were instructed to take a
hydrophilic colloid every day, and a supplementary laxative or enema if 
bowels
have not moved for three days. With these precautions patients have had no
further difficulty.





Apart from constipation, patients have shown no major ill effects ascribable
to use of methadone. The tendency of addicts to leukocytosis (9,000 to 
14,000
white blood cells/cu mm with 60% to 80% polymorphonuclear cells10 continued,
apparently unaffected by this medication. Bone marrow biopsies in four 
patients
after eight months of treatment were normal. No effect of methadone on renal
function was disclosed by repeated urinanalyses. Liver-function tests, when
originally normal, remained so. Results of basal metabolic rate, thyroid 
uptake
of sodium iodide I 131, red blood cell uptake of labelled triiodothyronine,
and plasma protein-bound iodine were normal in three patients who had been
stabilized on methadone hydrochloride (100 to 150 mg/day) for four to six 
months.
Some patients have reported excess sweating in hot weather, but no one has 
been
unable to work for this reason. Mental and neuromuscular functions appear
unaffected. Patients have performed well in school and at various jobs. 
Studies
of motor skill (accuracy in tracking moving targets) showed normal
coordination. We have not yet been able to find a medical or psychological 
test capable of
distinguishing patients on methadone therapy from normal controls. They can,
of course, be distinguished by urinanalysis.


There has been no problem so far in holding patients. Only two of the
patients who started treatment have been discharged. These uncooperative and
disruptive psychopaths were transfered to withdrawal units. Two others who 
were
admitted specifically for tolerance tests at an early stage of the study 
were
returned (as originally planned) to the withdrawal unit from which they 
came; both
subsequently have asked to return to the program. A fifth patient signed out
after only four days on the ward, and also asked to return.





Comment


Previous efforts to treat addict patients with narcotic medication have been
handicapped by lack of sufficiently long-acting agents. The Council's report
noted that in 1919 to 1923 experience, "in all instances it was eventually
found necessary to give drugs to addicts for self-administration." This is
inherent in the pharmacology of parenterally administered morphine, which 
was used in
these clinics and would probably apply to other agents with short periods of
action such as diacetylmorphine, dihydromorphine, or meperidine. If addict
patients are to be maintained with any of these drugs, they would need 
several
injections per day; otherwise they would return to the street for additional
drugs.





Projected into large-scale treatment, a medical use of short-acting narcotic
drugs would require dispensaries staffed to give thousands of injections per
day, with rooms or park benches in the neighborhood for addicts to wait 
between
shots. Alternatively, physicians would have to yield control of drug
administration to the addicts themselves. Neither alternative is acceptable. 
With
methadone, however, the situation is much different since patients can be
stabilized with a single daily dose, taken orally, under medical control. 
Maintenance
of patients with methadone is no more difficult than maintaining diabetics
with oral hypoglycemic agents, and in both cases the patient should be able 
to
live a normal life.





We believe that methadone has contributed in an essential way to the
favorable results, although it is quite clear that giving of medicine has 
been only
part of the program. This drug appears to relieve narcotic hunger, and thus 
free
the patient for other interests, as well as protect him against readdiction
to diacetylmorphine by establishing a pharmacological block. A previous 
attempt
by one of us (M.N.) to treat addict patients without narcotic medication
ended in failure. Other clinics, attempting to rehabilitate patients after
withdrawal, have had equally poor results. These, however, are indirect 
arguments.
When the treatment program is sufficiently well established, the necessary
control studies with social support, but without medication, must be made.





This study was supported by the Health Research Council grant U-1501 of New
York city, and by the National Association for Prevention of Addiction to 
Nar
cotics.





Major contributions to this investigation were made by the following: Mary
Jeanne Kreek, MD, bone marrow biopsies and tests of narcotic tolerance; 
Joyce
Lowinson. MD. and George Lowen, MD, expansion of the program at Manhattan
General Hospital; Nathan Poker, MD, measurements of intestinal motility; 
David
Becker, MD, and Eugene Furth, MD. tests for thyroid function; and Norman 
Gordon,
MD, Alan Warner, and Ann Henderson, measurements of motor skills of patients 
and
ratings with intelligence tests and mood scales.





Generic and Trade Names of Drug


Sodium iodide I 131-Iodotope-1 131, Oriodide-131, Radiocaps131,
Theriodide-131, Tracervial-131.





References:


1. Council on Mental Health: Report on Narcotic Addiction, JAM/i
165:1707-1713 (Nov 30); 1834-1841 cDec 7 1968-1974 (Dec 14) 1957.


2. Joint Committee of American Bar Association and American Medical
Association of Narcotic Drugs. Interim and Final Reports: Drug Addiction: 
Crime or
Disease? Bloomington, MD: Indiana University Press, 1961.


3. Presidents Advisory Commission on Narcotic and Drug Abuse. Appendix 1.
Final Report, US Government Printing Office. Nov 1963.


4. New York Academy of Medicine, Committee on Public Health: Report on Drug
Addiction: II, Bull NY Aced Med 39:417-473 (July) 1963.


5. Eldridge, W.B.: Narcotics and Law, Chicago: American Bar Foundation, 
1962.


6. National Council on Crime and Delinquency. Advisory Council of Judges.
Narcotics Law Violations: Policy Statement, New York. 1964.


7. Cochin. J.. and Daly, ,J.: Rapid Identification of Analgesic Drugs in
Urine With Thin-Layer Chromatography, Experientia 18:294-295 (June 15) 1962.


8. Light. AB., and Torrance. E.G.: Opium Addiction: VI. Effects of Abrupt
Withdrawal Followed by Readministration of Morphine in Human Addicts With
Spectral Reference to Composition of Blood, Circulation, and Metabolism, 
Arch Intern
Med 44:1-16 (July) 1929.


9. Ishell, H.. et al: Liability of Addiction of 6-Dimethylamino-


4.4-diphenyl-3-heptanone (Methadon, "Amidone" or "10820") in Man. Arch 
Intern
Med 82:362-392 (Oct) 1948.


10. Berle, B., and Nyswander, M.: Ambulatory Withdrawal Treatment of Heroin
Addicts, New York J Med 64:1846-1848 (July) 1964.





Citation:


Dole VP, Nyswander ME. A medical treatment for diacetylmorphine (heroin)
addiction. J Amer Med Assoc 1965;193:646-50







Table 1. (legend) see attached xls file.





Maintenance Therapy of Ex-Addicts With Methadone Hydrochloride, Summary of
First


15 Months (February 1964 to May 1965).





*For comparison with other treatment series, patients classified into three
groups: Western European ancestry (E), Puerto Rican and Cuban (F), and Negro
(N).





~ Age first used diacetylmorphine (FD); age at admission (A).





d Number of admissions to Federal Hospital-Lexington, Ky (F), state
hospitals-Manhattan State, Central Islip (S), municipal hospital -Manhattan 
General,
Metropolitan, Riverside (M), private clinics and groups, including Synanon 
(P).





§ All but two patients were employed at time of admission. Job indicated is
best position ever held,





Time in Army (A), Navy (N), Marines (M), or Air Force (AF).





¶ Dose methadone hydrochloride given orally, mg/day.





# Phases of treatment: la-four patients, residents on metabolic ward of
Rockefeller Institute; 1-new patients being stabilized on methadone therapy, 
they
sleep in hospital but may leave during day for school, shopping, or job;
2-patients newly discharged, living at home or rooming house, needing social 
support
; 3-ambulatory patients who are self-supporting.





** High school equivalency status: If not a high school graduate, each
patient was encouraged to enroll in night school to prepare for high school
equivalency certificate. Those who have completed this course, passed 
examination, and
received certificate are indicated by 'Cert'; those now in night school
indicated by NS."








Posted by Andrew Byrne, Sydney addiction doctor.  >>



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