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mikemo · 02-03-2009, 10:37 AM

I think some of the forum members may be interested in reading this email correspondence I received in December. The author has given me permission to share it publicly. Mr Meeks shares many of my concerns. By approving the clinc,the planning director did what was legally mandated. She also was able put in certain conditions that will make the operation of the clinic as safe as possible. Thank you.

Dear Chief Moyer,
Hi. My name is Michael Meeks, and I live in Louisiana. I'm writing you concerning the proposal to open a methadone clinic in Laconia. I also have been speaking with a family member of Raymond DeLucca for several months online. Your efforts have had a very positive impact on the lives of that family and hope to other families in their situation. Thank you for the work you have put into putting together the task force there, and I sincerely hope other departments use yours as a basis on how to react to the situation.
I am not, nor have I ever, been a patient at any methadone clinic. My wife, however, has been on mmt for over 3 years. And I have been to the clinic many times, and spoken with the doctor there, and much of the staff. And have read quite a bit of information online that leads me to believe that the clinic my wife attends is ran just as the majority of clinics in the United States. So I want to tell you of her experience there, and hopefully you can find something useful in my rambling (the condensed version).
My wife started on mmt after being referred there by an inpatient program here. The inpatient program no longer refers anyone to the clinic due to them never hearing from the patients afterward. When my wife first called the clinic, she was told that she would be inducted, stabilized, and then detoxed in a matter of a few months. Actually, after the third month, her dosage was still being raised. She started "nodding off" when she reached a dose of 60mg/day, and I said something to her about it, just to make certain she knew it was happening. She went to the clinic, and upon stating she was nodding off, the clinic nurse told her not to worry, that it was normal, and it would pass once she was on a "stable" dose, and that by looking at her, the nurse could easily see that she was in withdrawal. The very next week I went with my wife to the clinic to explain to the nurse what I was witnessing, and was immediately informed that the piece of paper on the wall behind her was proof that she knew what she was doing in making the dose adjustments for the patients there, and that they were a maintenance facility, not a detox facility. I read the paper, and it stated she was a certified LPN. So I began to wonder why she was the one in charge of making the dose adjustments, and not the doctor...
The nurse continued to convince her she needed to increase until she was at 169mg/day. At that point, she said she wasn't liking the way it made her feel. And that nodding effect that she was told would subside, had only gotten worse. At that dose, she was having to pull over after leaving the clinic and sleep anywhere from 4 to 5 hours before driving home. The clinic is a little over 90 miles from where we live, so the trips to the clinic would often take 6 - 8 hours if I was unable to drive her. She went to the clinic the next week and not only refused to go up on her dose, but demanded they decrease it. She asked for eight consecutive weeks, with nothing happening. The nurse would tell her that either she had asked for the decrease too late in the week, the doctor didn't get the order, the pharmacist didn't get the order, etc. There was always an excuse for her dose not being dropped. She stated to me that a couple of other patients had asked to decrease, and they were having the same problems. I found that odd, seeing how easy it was for the increases to happen. She was going to the clinic three days a week at that time, and on each visit the nurse was telling her she was in withdrawal and still not on a stable dose. She got decreased for three weeks, and then stated that the nurse could be right to me, and on the next visit, she started to increase. At which time she increased 5mg/week until she was on 199mg/day. Once she got to that dose, she became afraid that she was close to overdosing, and decided to decrease again. That time her dose was not decreased for the first four weeks of her asking for it. She started decreasing 2mg/week on the fifth week after requesting it. Five weeks after they started dropping her dose, we found out she was pregnant. Once she told the clinic, her dose was immediately increased back to 199/day. Upon finding out she was pregnant, the clinic doctor asked to have a consultation with her to discuss her treatment during pregnancy. That was in May of 2007, after she had been at the clinic for over 2 years. It was the FIRST time she had met with the clinic doctor. I went, and discussed what dose she was on, and the clinic doctor informed us that the dose would probably be raised while she was pregnant, as was standard mmt protocol during pregnancy. We met with a perinatologist who advised different, and stated he had several mmt patients to taper completely off of methadone while pregnant. We went back an forth speaking with the two doctors until the clinic doctor agreed that no danger would come of a taper rate of 2mg every 4 days. However, after he agreed to that, the clinic staff called the owners of the clinic, who stated that a decrease would not happen there, and if she wanted to decrease while pregnant, then she should seek treatment elsewhere.
While in one of the consultations with the doctor while she was pregnant, we were discussing the way it seemed to me that they were only concerned with getting people hooked on methadone, and how it had been a battle to even get a small decrease before she became pregnant. The doctor replied by telling me there would be nothing he would rather see there than a patient who is walking out of the clinic door for the last time and abstinent from all drugs. And I made a comment that my wife had never failed a UA since starting at the clinic (which was true) and he said she was a very rare case, and that 90% of his patients there were using other substances while in mmt. The policy there now is to not allow any takehomes to those who fail the UA's, and that has not always been the case, from what I saw with a patient there when my wife first started. But it is now, so that's an improvement. In total, I have met four other patients from the clinic. Two from the town where the clinic is located, a mother and daughter who were using xanax on top of their methadone, and two from my area. One from my area had a brother die of methadone overdose last year, and the other died of Torsades de Pointes last year.
My wife is currently still a patient at the clinic, and was there yesterday. She had a meeting with her counselor, who was upset about having to put her car into the shop again. My wife asked why, and she stated that a patient had hit her car when leaving the parking lot last week, because he was allowed to remain at the clinic for over 20 minutes after he dosed, giving the effects of the methadone time to set in. She stated that she is really getting tired of this happening, that it happens "all the time." This sort of thing has been downplayed by clinics, and there are statements all over the internet saying methadone does not impair driving ability, but I have witnessed it first-hand, being in the passenger seat, and will say those statements are wrong. It does impair driving ability, and can say that in my wife's case, it was impairing her driving ability when her dose was one-third of her maximum dose. Please believe me when I say the clinics are very much a financial endeavor for the owners, and there is most definately a product for sale, and they have been working on the sales pitch for 3 decades.
When the time comes to make the decision about the clinic, please make some facts known about what is promoted as to what is true. First, the success rate used when promoting mmt is often 85%. What is used as basis for that rate, is 85% of mmt patients abstain from heroin use while on mmt. But nowadays, a great number of patients didn't use heroin before going on mmt. And that rate only includes heroin, and not all illicit drugs. Second, that rate is used to promote mmt success over the success rate of abstinence-based programs, when the mmt rate is based upon people IN treatment whereas in abstinence-based programs, the rate is of those remaining abstinent after LEAVING treatment. The actual rate of achieving long-term abstinence after leaving mmt is close to the same as the other modalities. Third, IF the clinic owners state that a clinic is protected under the ADA, please don't buy it. The ADA protects addicts who are not currently using any illicit drugs. So the clinic would have to be treating patients who no longer use illicit drugs in order to be covered. The doctor at the clinic here stated that 90% of the patients were still using other drugs, and I don't think that the clinic here is a rare example. Methadone maintenance is based upon harm reduction, which does not emphasize abstinence. That negates them belonging to a protected class under the ADA. Here is the link to the wording in which it is discussed, in which it is clearly stated that a person must be abstinent, along with being in treatment, in order to be protected (section 12114):
http://www.ada.gov/pubs/ada.htm#Anchor-43793

If you are still reading this, and haven't become bored because of the length (please believe me it IS the short version), I want to thank you again for getting involved and listening to the families involved in your area. I wish you all the best of luck in the future, and thanks for reading. Please feel free to forward this to anyone who you think might be interested.

Sincerely,

Michael Meeks

www.Angels4DrugAwareness.org

http://www.youtube.com/watch?v=_fr41Mf7_eo

www.HARMD.org

02-03-2009, 10:37 AM	#22
mikemo Junior Member Join Date: Jan 2009 Posts: 5 Thanks: 1 Thanked 7 Times in 3 Posts	Email Message I think some of the forum members may be interested in reading this email correspondence I received in December. The author has given me permission to share it publicly. Mr Meeks shares many of my concerns. By approving the clinc,the planning director did what was legally mandated. She also was able put in certain conditions that will make the operation of the clinic as safe as possible. Thank you. Dear Chief Moyer, Hi. My name is Michael Meeks, and I live in Louisiana. I'm writing you concerning the proposal to open a methadone clinic in Laconia. I also have been speaking with a family member of Raymond DeLucca for several months online. Your efforts have had a very positive impact on the lives of that family and hope to other families in their situation. Thank you for the work you have put into putting together the task force there, and I sincerely hope other departments use yours as a basis on how to react to the situation. I am not, nor have I ever, been a patient at any methadone clinic. My wife, however, has been on mmt for over 3 years. And I have been to the clinic many times, and spoken with the doctor there, and much of the staff. And have read quite a bit of information online that leads me to believe that the clinic my wife attends is ran just as the majority of clinics in the United States. So I want to tell you of her experience there, and hopefully you can find something useful in my rambling (the condensed version). My wife started on mmt after being referred there by an inpatient program here. The inpatient program no longer refers anyone to the clinic due to them never hearing from the patients afterward. When my wife first called the clinic, she was told that she would be inducted, stabilized, and then detoxed in a matter of a few months. Actually, after the third month, her dosage was still being raised. She started "nodding off" when she reached a dose of 60mg/day, and I said something to her about it, just to make certain she knew it was happening. She went to the clinic, and upon stating she was nodding off, the clinic nurse told her not to worry, that it was normal, and it would pass once she was on a "stable" dose, and that by looking at her, the nurse could easily see that she was in withdrawal. The very next week I went with my wife to the clinic to explain to the nurse what I was witnessing, and was immediately informed that the piece of paper on the wall behind her was proof that she knew what she was doing in making the dose adjustments for the patients there, and that they were a maintenance facility, not a detox facility. I read the paper, and it stated she was a certified LPN. So I began to wonder why she was the one in charge of making the dose adjustments, and not the doctor... The nurse continued to convince her she needed to increase until she was at 169mg/day. At that point, she said she wasn't liking the way it made her feel. And that nodding effect that she was told would subside, had only gotten worse. At that dose, she was having to pull over after leaving the clinic and sleep anywhere from 4 to 5 hours before driving home. The clinic is a little over 90 miles from where we live, so the trips to the clinic would often take 6 - 8 hours if I was unable to drive her. She went to the clinic the next week and not only refused to go up on her dose, but demanded they decrease it. She asked for eight consecutive weeks, with nothing happening. The nurse would tell her that either she had asked for the decrease too late in the week, the doctor didn't get the order, the pharmacist didn't get the order, etc. There was always an excuse for her dose not being dropped. She stated to me that a couple of other patients had asked to decrease, and they were having the same problems. I found that odd, seeing how easy it was for the increases to happen. She was going to the clinic three days a week at that time, and on each visit the nurse was telling her she was in withdrawal and still not on a stable dose. She got decreased for three weeks, and then stated that the nurse could be right to me, and on the next visit, she started to increase. At which time she increased 5mg/week until she was on 199mg/day. Once she got to that dose, she became afraid that she was close to overdosing, and decided to decrease again. That time her dose was not decreased for the first four weeks of her asking for it. She started decreasing 2mg/week on the fifth week after requesting it. Five weeks after they started dropping her dose, we found out she was pregnant. Once she told the clinic, her dose was immediately increased back to 199/day. Upon finding out she was pregnant, the clinic doctor asked to have a consultation with her to discuss her treatment during pregnancy. That was in May of 2007, after she had been at the clinic for over 2 years. It was the FIRST time she had met with the clinic doctor. I went, and discussed what dose she was on, and the clinic doctor informed us that the dose would probably be raised while she was pregnant, as was standard mmt protocol during pregnancy. We met with a perinatologist who advised different, and stated he had several mmt patients to taper completely off of methadone while pregnant. We went back an forth speaking with the two doctors until the clinic doctor agreed that no danger would come of a taper rate of 2mg every 4 days. However, after he agreed to that, the clinic staff called the owners of the clinic, who stated that a decrease would not happen there, and if she wanted to decrease while pregnant, then she should seek treatment elsewhere. While in one of the consultations with the doctor while she was pregnant, we were discussing the way it seemed to me that they were only concerned with getting people hooked on methadone, and how it had been a battle to even get a small decrease before she became pregnant. The doctor replied by telling me there would be nothing he would rather see there than a patient who is walking out of the clinic door for the last time and abstinent from all drugs. And I made a comment that my wife had never failed a UA since starting at the clinic (which was true) and he said she was a very rare case, and that 90% of his patients there were using other substances while in mmt. The policy there now is to not allow any takehomes to those who fail the UA's, and that has not always been the case, from what I saw with a patient there when my wife first started. But it is now, so that's an improvement. In total, I have met four other patients from the clinic. Two from the town where the clinic is located, a mother and daughter who were using xanax on top of their methadone, and two from my area. One from my area had a brother die of methadone overdose last year, and the other died of Torsades de Pointes last year. My wife is currently still a patient at the clinic, and was there yesterday. She had a meeting with her counselor, who was upset about having to put her car into the shop again. My wife asked why, and she stated that a patient had hit her car when leaving the parking lot last week, because he was allowed to remain at the clinic for over 20 minutes after he dosed, giving the effects of the methadone time to set in. She stated that she is really getting tired of this happening, that it happens "all the time." This sort of thing has been downplayed by clinics, and there are statements all over the internet saying methadone does not impair driving ability, but I have witnessed it first-hand, being in the passenger seat, and will say those statements are wrong. It does impair driving ability, and can say that in my wife's case, it was impairing her driving ability when her dose was one-third of her maximum dose. Please believe me when I say the clinics are very much a financial endeavor for the owners, and there is most definately a product for sale, and they have been working on the sales pitch for 3 decades. When the time comes to make the decision about the clinic, please make some facts known about what is promoted as to what is true. First, the success rate used when promoting mmt is often 85%. What is used as basis for that rate, is 85% of mmt patients abstain from heroin use while on mmt. But nowadays, a great number of patients didn't use heroin before going on mmt. And that rate only includes heroin, and not all illicit drugs. Second, that rate is used to promote mmt success over the success rate of abstinence-based programs, when the mmt rate is based upon people IN treatment whereas in abstinence-based programs, the rate is of those remaining abstinent after LEAVING treatment. The actual rate of achieving long-term abstinence after leaving mmt is close to the same as the other modalities. Third, IF the clinic owners state that a clinic is protected under the ADA, please don't buy it. The ADA protects addicts who are not currently using any illicit drugs. So the clinic would have to be treating patients who no longer use illicit drugs in order to be covered. The doctor at the clinic here stated that 90% of the patients were still using other drugs, and I don't think that the clinic here is a rare example. Methadone maintenance is based upon harm reduction, which does not emphasize abstinence. That negates them belonging to a protected class under the ADA. Here is the link to the wording in which it is discussed, in which it is clearly stated that a person must be abstinent, along with being in treatment, in order to be protected (section 12114): http://www.ada.gov/pubs/ada.htm#Anchor-43793 If you are still reading this, and haven't become bored because of the length (please believe me it IS the short version), I want to thank you again for getting involved and listening to the families involved in your area. I wish you all the best of luck in the future, and thanks for reading. Please feel free to forward this to anyone who you think might be interested. Sincerely, Michael Meeks www.Angels4DrugAwareness.org http://www.youtube.com/watch?v=_fr41Mf7_eo www.HARMD.org