Pubdate: Sat, 04 Nov 2000
Source: Bangor Daily News (ME)
Copyright: 2000, Bangor Daily News Inc.
Author: Claude P.M. O'Donnell
Note: Claude P.M. O'Donnell is the chairman of the Board of Trustees 
at Acadia Hospital.


The pros and cons of establishing a methadone treatment program in Bangor
are currently being debated in the media.

There has been much discussion of the presently available and possible
future modes of opioid addiction treatment.

Now is a good time to revisit the central treatment issues at the heart of
this important community discussion.

A core issue in this discussion is the basic acceptance of the reality of
significant and rapidly growing opioid addiction problems across all income
levels and age groups in our community region.

Over the past few years, it has become clear to community treatment
providers and law enforcement officials that opioid use, including heroin,
has become epidemic in northeastern Maine.

Another fundamental consideration is a willingness to face the harsh truths
of opioid addiction.

This is not a short-term problem with a quick-fix answer.

People affected by opioid addiction can progress into a lifelong affliction
that requires consistent and appropriate medical and psychological treatment
to be adequately controlled or overcome. The addicted population must be

We have fortunately opened the doors to treatment for those afflicted by
cancer, degenerative conditions and medical illness.

As a community, do we shut the door on treatment for an afflicted patient
population? As we have done before, we must face this illness and the vital
need for treatment.

Third, no single treatment, prevention, education or intervention approach
will be sufficient to stem the tide. Individual patients will require some
treatment and not others.

Some patients will be appropriate for methadone, LAAM or buprenorphine, in
addition to counseling. Other patients will not need medication, but will do
well with a careful detox and follow-up support.

All patients should be approached as individuals with their own unique set
of problems and solutions. What is important is to have the appropriate
treatments available.

Given the very limited success of the "war" on drugs waged over the past 30
years, it is now evident that narcotic addiction cannot be eliminated by
simple prohibition. Attempting to limit the supply of narcotics, without
also significantly reducing the demand for illegal use of opioids, will not
achieve any long-term reduction in drug addiction or the illegal use of

Demand needs to be reduced by effective treatment.

Methadone has been repeatedly demonstrated in medical studies to be a
valuable and necessary tool for the effective treatment of opioid addiction.
It is a particularly potent treatment when used in conjunction with a broad
range of counseling and support services. Gen. Barry R. McCaffrey and
Attorney General Janet Reno have both endorsed and promoted the
establishment of methadone treatment programs as an important and necessary
step in controlling the spread of opioid addiction.

In addition to methadone, other pharmacological interventions have been
shown to have efficacy in treating chronic opioid dependence. LAAM
(levo-alpha-acetyl-methadol) is an opioid agonist similar to methadone but
longer acting, requiring less frequent visits to the treatment program.

It can only be dispensed through a licensed narcotic treatment program, not
by individual practitioners.

Buprenorphine is a unique opioid agonist-antagonist drug currently in the
process of receiving approval by the FDA for the treatment of opioid
dependence. Under the provisions of the Drug Addiction Treatment Act of
2000, this medication will potentially soon be available through licensed
doctors as well as through existing methadone programs.

The professionals at Acadia Hospital look forward to the introduction of
this new medication and will be offering it as a treatment alternative to
appropriate patients once guidelines for responsibly prescribing it have
been issued.

However, buprenorphine does not replace methadone, LAAM or counseling. It
represents another treatment option.

Methadone and LAAM will continue to remain an important part of a carefully
designed continuum of treatment that the Acadia Narcotic Treatment Program
plans to offer. It is hoped that buprenorphine, rather than replacing
methadone, will reach a new set of opioid-dependent patients who have less
chronic addictions and are therefore not appropriate for methadone.

It is important that law enforcement, community leaders, treatment providers
and the community at large have an opportunity to ask and have answered
questions they may have regarding the establishment of a program that offers
medical treatment such as methadone, LAAM and buprenorphine. We invite your
efforts to understand the challenges facing those who have tragically become
addicted to opioids and ask you to express your support for the careful
efforts of the Special Committee on Opiate Addiction. Acadia supports, and
indeed joined in recommending, a committee study as the best means to
respond to the very challenging questions on the complex but vital need to
provide treatment to those suffering from long-term opiate addiction.

The Special Committee on Opiate Addiction, with membership from both the
Bangor City Council and the Acadia Hospital Board of Trustees, is currently
working on a report addressing community concerns relating to methadone
treatment and opioid addiction more generally.

Hopefully this report will be a springboard to thoughtful action in our
communities and at the state level regarding the complex issues of opioid
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