Monday, 25 August 2008

Q & A: Kerry Wolf -Certified Methadone Advocate (USA)

This is the first in a series of Q & As for people who have some relationship or interest in illicit drugs. 

First up is Kerry Wolf, Director for the Texas chapter of Advocates For Recovery Through Medicine Medically Assisted Treatment (ARMMAT). Kerry is well known in cyber space for her active role in promoting and educating people about methadone maintenance treatment(MMT). Using the alias Zenith, Kerry moderates several websites and forums for MMT patients wanting to discuss methadone or seek help regarding treatment. 

Kerry is also a Certified Methadone Advocate(CMA) through the National Alliance of Methadone Advocates (NAMA)

NOTE: You can ask Kerry question via the comments.

Name:  Kerry Wolf
Role: Director of ARMMAT
Date: August 2008
Contact: ARMMATA.T. Watchdog NAMA

You are currently on MMT? What was your addiction? 
I have been on MMT for almost 4 years now. My primary addiction has always been Rx opiates, particularly a hydrocodone containing cough syrup called Tussionex. I also used IV heroin for about 7 months. 

Do you use drugs(including alcohol) recreationally? 
Not any more. I stopped all recreational drug use when I got on MMT. It was never really "recreational" for me anyhow--it was always severely compulsive and always an attempt to self medicate my depression. I always used alone (except for the heroin episode). I also drank pretty heavily when I could not get opiates. 

Do you consider you live a productive life in comparison to someone not with an addiction? 
Absolutely! As an MMT patient, I hold down a full time white collar job, pay all my bills, care for my family, and pursue my own dreams and goals. I am also able to give back to society. 

I have also known active addicts who were able to maintain fairly normal lives even while using--my husband worked steadily for 26 years while using IV heroin almost daily, and supported his then-family (this was before we met), and was never in any legal trouble. 

Are there obstacles being accepted into society for you as an ex addict on MMT? 
Many. In the USA, we have laws, both Federal and state, preventing those with any type of drug conviction from EVER obtaining housing assistance, food stamps, welfare, or student loans. This does not apply to murderers, rapists or child molesters--just drug convictions. In addition, in my state, my right to vote was removed. All employment applications now ask if you have ever been arrested or convicted and employers all do background checks. I was refused a job at Wal Mart because of this--a minimum wage job. Methadone prejudice is very strong. I used to be an RN, but I can never go back to nursing, because nurses in the USA are not allowed to take methadone--at least, not for addiction treatment. They are, however, allowed to take methadone for pain, so I suppose it only "impairs" the nurse when taken for addiction? Methadone is so heavily judged and frowned upon by every level of society that it just amazes me. 

Do you have difficulty telling people you are on MMT? 
Not really--not anymore. I feel strongly that people NEED to know--they need to see that I--a normal person with whom they interact daily--am a methadone patient, and am not a bum under a bridge somewhere looking to molest their kids and steal their rent money. 

You are a member of Advocates For Recovery Through Medicine Medically Assisted Treatment (ARMMAT). Can you tell us about it? 
As an ARM member I work locally and nationally to assist patients who need help with issues at their clinics and beyond. I work with agencies and help to educate people about methadone treatment, and empower patients by informing them of their rights and how to go about contacting the proper people to help them. 

Some people say ex addicts especially those on heavy medication like methadone don’t have a place discussing addiction treatment. Do you feel that being on OMT benefits you with your cause or are they correct. 
My feeling is that recovery has nothing to do with whether or not you take a prescribed medication to stabilize brain chemistry or not. Recovery is measured by the fruits of your life. Are you happy? Are you responsible, dependable? Can your loved ones count on you? Are you working (if able)? Are your bills paid? Do you have goals and dreams that you are working on? Do you give back to others? Do you feel good about yourself? Do your loved ones see the positive changes in your life? If you can answer "yes" to these things, then in my opinion, THAT is recovery. When I was abstinent and following an abstinence based program, I was drug-free, yes. I was also deeply depressed, unemployed, exhausted, had no hopes and dreams, and spent most of my day in bed. THAT was NOT "recovery" in my book. 

The US is infamous for it’s drug policy and opposition to Harm Reduction. Though the US has about 10 times the number of HIV/AIDS sufferers amongst injecting drug users compared to Australia, only recently has federal funding been allowed for needle exchange programs. Does this US approach effect OMT from what you have seen? 
My state (Texas) is the last state in the country to refuse to allow needle exchange programs, something I am deeply ashamed of for them. I also see that whenever a clinic tries to open anywhere in the USA there is an onerous protest with the people all saying the same thing..."It will increase crime, attract addicts to our area, and they will steal, rob and molest our children, nod out in the streets, urinate and defecate on the sidewalks, drive away like drug crazed madmen and kill us all, etc etc". Although it almost always turns out that the clinic is a good neighbor and none of these fears come to pass, this continues to happen with very few defending the patients, and so there are not enough clinics to treat those who need treatment--not even 1/4 of them. 

I have heard some horror stories about MMT clinics in the US. What is your experience? 
My clinic is fantastic! I am truly blessed to have a clinic director who is focused on her patients and on empowering them to speak up for themselves and to NOT buy into the stigma that surrounds MMT. The counsellors there are wonderful as well--some of them are also MMT patients. We have no security guard and no need for one. I have never once been offered drugs there or asked to buy any, nor have I seen anything "suspicious" going on. The clinic believes in adequate dosing, and truly pays attention to their patients. But I know that many clinics are NOT like this, and I am very lucky indeed. 

What is the worst case you know of? 
There is a clinic in Paducah, Kentucky that is just beyond awful. I have dealt with several patients there who have had to fight tooth and nail and wait for many agonizing months just to get to a dose of 50mg, only to be told that no one needs more than 50mg (average adequate dose for most patients in the USA is 80-120mg). Their patients are often told to "pray to God" if they are experiencing withdrawals and cravings from these substandard doses, and are forced to attend NA meetings if they want any takehome doses, despite the fact that NA has a written policy stating that MMT patients are "in active addiction" and are not allowed to speak at meetings. This clinic is directly violating the Best Practices standards that disallow dose capping, and almost seems to be an abstinence based treatment program masquerading as a methadone clinic. 

There has been a huge increase in methadone deaths recently in the US. Why is this? 
Actually, there has been a huge increase in the PRESCRIBING of methadone for pain in the past few years, primarily due to the recent Oxycontin scandals. Doctors turned to methadone because it was cheap, long lasting, and does not produce a strong high. However, many doctors were not aware of the special properties and need to carefully titrate this drug in new patients. In addition, the FDA prescribing insert advised doctors that they could give new patients as much as 80mg a day in divided doses--over twice as much as is prescribed as a starting dose to opiate tolerant patients at a methadone clinic! As a result, patients began dying from methadone overdoses. Often, they were not warned about combining the drug with other meds like benzodiazepines which can be a deadly combination. In addition, due to the increase in prescribing methadone for pain, it was much more readily available on pharmacy shelves and medicine cabinets, and curious teens and young people began experimenting with it. Often they would take more and more hoping to get the high they expected with other opiates, only to die without ever getting there. 

Studies by SAMHSA and other organizations show unequivocally that the majority of this diverted methadone comes NOT from the MMT clinics but from pain management and people who steal from pain management patients, or from higher up the chain. Diversion from clinics DOES occur, but it has been low and stable for the past 45 years, and occurs mainly to other opiate tolerant addicts who cannot get their drug of choice and want to avoid being sick. 

What do you see as the main problems with OMT in the US? 
The clinic system itself. There is no standard of care--rules are applied haphazardly across the board and enforcement of accreditation standards is almost non existent. There is no one to speak for the patients. Methadone is grossly over-regulated, to the point that only 10% of those who need and would benefit from MMT can access treatment. Costs are exorbitant in private pay clinics--often over $400 a month, and this continues even when the patient gets only 5 minutes of unneeded "counseling" per month and no other services besides the medicine itself, which is less than 1/8th the cost of the monthly bill. Patients who have been stable in treatment for years--decades, even--have to continue to attend the clinic and pay for ancillary services they neither need or use, rather than receiving the medication from their own doctors, despite decades of evidence that this works and works well for stable patients. 

What do you want to see changed first and foremost with OMT? 
Office Based Opioid Treatment for stable patients, and required, standardized training for all medical and counseling practitioners in MMT. 

What are your views on other OMT’s in use or on trial in Europe like slow release morphine, injectable hydromorphone and prescription heroin? 
I feel that these are needed therapies. No one treatment works for everyone. As with diabetes, some patients are able to control their disease with exercise and diet, others require oral medications, others need injectable insulin, and still others are extremely brittle diabetics and may not do well even on insulin, yet it does improve their outcome to some degree. With opioid addiction, some may do well with abstinence based treatment. Others may need an oral partial agonist like Suboxone. Still others may need a full agonist like methadone. And there are those who do not do well even on methadone, yet who are able to maintain a more stable life on controlled doses of heroin or morphine. My feeling is that opiates are a naturally occurring chemical in our brains (endorphins) and seeing them as some type of evil substance is erroneous. In a sense, we are all "opiate addicts" in that we need a normal level of natural opiates to be able to feel pleasure and enjoy life. When that level is depleted, whether genetically or by long term drug usage, supplementing it with exogenous opiates simply restores the patient to normal function. Giving the same amount of opiates to a patient who already has normal endorphin function will simply cause the "cup to run over" so to speak, but for those who need it it simply stabilizes them. I feel there is a place in addiction treatment for these therapies for carefully selected patients. 

"War on Drugs" and prohibition has been a huge failure. Do you support legalising drugs in anyway? 
Yes, I do. I feel that legalizing drugs would remove the criminal element from it, stop the black market trade, provide a purer and less deadly form of drugs for those who use them, and would not, as many fear, increase the addiction rate. I don't think there are tons of people out there who are holding back from using drugs simply because they are illegal and who would run out tomorrow and shoot up heroin were it to be legalized. I think our prisons and jails are full to bursting with petty drug offenders whose lives have been ruined forever, and this costs taxpayers an incredible amount of money. 

I do not think people should be able to do things which impact others, however, such as driving while intoxicated, using drugs in the presence of children, ignoring responsibilities, etc. 

In 1999, John McCain proposed a plan to remove most methadone programs for abstinence based treatment. Do you feel Barack Obama follows the same ideology as McCain or will he support a more evidence based drug policy if he wins office? 
I hope that Obama will have a more open minded drug policy, but I don't think it will be as open as I hope for. However, it will surely be an improvement over what we just had or over McCain's closed minded ideas. 

Finally, if you were President Zenith and you could change one law relating to drugs or drug treatment, what would it be?
I would decriminalize all drug possession for personal use, while making it clear that the person is responsible for their behavior while taking the drug. 


Q and A: Dr. James Rowe - Lecturer at RMIT, School of Global Studies, Social Science and Planning
Q and A: Gino Vumbaca - Executive Director of the Australian National Council on Drugs
Q and A: Sandra Kanck - Former South Australian MLC. South Australia spokesperson for Families and Friends for Drug Law Reform (FFDLR)
Q and A: Tony Trimingham - Chief Executive Officer, Family Drug Support


KMac said...

Informative interview.
Kerry Wolf seems intelligent, articulate and a good role model for others in her position.

Couple questions for MsWolf:

What is the role of the "certified methadone advocate" in today's market for medication assisted treatment?

How can the average patient help to show support when it comes to educating the youth of today with the dangers associated with using a strong medication such as methadone?

Do you think that there is enough "room" in our addiction treatment market for both suboxone and methadone or do you think that bupe will push methadone off the market in the USA?
What are your reasons?

Zenith said...

I think that ANY methadone advocate, "certified" or not, has a duty to act in the interests of those he or she assists, within the confines of the system, and with their informed consent, to better their situation and assist in resolving conflicts with the clinic, the family, etc. I also feel we have a duty to work to change the system for the better from the inside out, including working for things like OBOT, increased accessibility to treatment, harm reduction, patient and provider education, etc. Certification simply provides an overview of how to advocate for another patient, what the rules are, confidentiality, etc.


I think the average patient can show suppport by first and foremost NEVER diverting their medications!!

I also think that if they have teenagers in the home they need to talk with them about the great dangers associated with methadone abuse, in a very serious way. My own son told me yesterday that he overheard a man at Burger King talking with another person about drug usage and the man stated that methadone was a good drug to abuse. My son is 16 and knows how deadly methadone abuse can be from me, and he spoke up and said something to the man. I was very proud of him for doing that.

In addition, patients can work to alert others in their circle of contacts about methadone abuse, can keep their meds in a secure location, and can get involved with community educational efforts.

I do think there is plenty of room for both Bupe and Methadone--and even more! Not all patients respond well to methadone--or to Bupe, for that matter. Bupe works particularly well for those who are able to be maintained at the lower end of the methadone dosages--60mg and below. That is not to say that no one above 60mg can do well on Bupe--this is a general guideline. But a recent study that took patients who were using IV heroin and put them on Bupe with an option to be stepped up to MMT if the bupe was not controlling their symptoms. About half needed to be moved up.

Bupe is an additional tool in the toolbox, but contrary to what many rehabs and doctors who Rx Bupe will say, it is NOT a replacement for MMT--it simply does not work well enough for enough people to say that. However, it provides a valuable alternative for those it can help, so that they can avoid the clinic system and stigma that come with MMT. I find, oddly enough, that Bupe is marketed in such a way that many people do not even realize it IS an opiate drug that produces a dependency of it's own, and as a result, the stigma, at least so far, is much less that that of MMT.

As I said in the article, I feel there is a place for a variety of medication assisted treatment therapies, as are used in other countries, for carefully selected patients.

Kristina(Liloleme) said...

Kerry was one of the first people I come to know after I entered into MMT. Before then I didn't know what a Methadone Advocate was. Since that time I have found my own "niche" in the MMT community after I made a video called "Finding Normal" based on dispelling some of the myths about MMT. I still refer others to "Zenith" whenever there is a question I can't answer and I trust in what she says wholeheartedly. She has handled some attacks by the anti methadone community with more tact and class than I ever could, never resorting to mud slinging and name calling and discouraging others to avoid it also. That takes a good woman. She is a wonderful example of what an advocate for any cause should be. I believe we can all learn something from her example.

KMac said...

Thank you Zenith for that informative response.

I often wondered about the process for representation in the OTP in the USA.
I'm excited to understand that there are EDUCATED patients out there helping others to manuver thru the complex system.
It seems to me that methadone treatment for addiction in the USA is very stigmatized thru myths and external hysteria in media reporting.
It saddens me to know that there isn't more patient empowering support generally from the providers.

I also think that bupe is a great addition to the toolbox and won't replace MMT. I think there is so many complex considerations in opiate addiction and that "one size" don't fit all.
In todays world we need choices and options.

Thanks again

Terry Wright said...

kristina(liloleme) said... "She is a wonderful example of what an advocate for any cause should be. I believe we can all learn something from her example."

How true.

Kerry's answers were excellent.

Rhinestone Vintage Dress said...

Miss Kerry Wolf-
My clinic is doing me dirty. I started treatment 2-21-11 and have been a model patient, I am in school and had problems with my counselor getting me takehomes, so i am on step 1. I just got approved for step 2, but I was under the assumption I could be on step 5, the manager wont let me skip steps, but i feel like it was their fault for not moving me through the steps the way they were supposed to in the first place. I dont know if i should quit but I feel I can't come in 5 days a week anymore, what is your recommendation?

Rhinestone Vintage Dress said...

Miss Kerry Wolf-
My clinic is doing me dirty. I started treatment 2-21-11 and have been a model patient, I am in school and had problems with my counselor getting me takehomes, so i am on step 1. I just got approved for step 2, but I was under the assumption I could be on step 5, the manager wont let me skip steps, but i feel like it was their fault for not moving me through the steps the way they were supposed to in the first place. I dont know if i should quit but I feel I can't come in 5 days a week anymore, what is your recommendation?