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Dora Weiner Foundation
Reports and Exhibits
Conferences and Meetings: 2004
20th Anniversary National Conference
American Association for the Treatment of Opioid Dependence
October 16 - 20, 2004
5th National Harm Reduction Conference
November 11 - 14, 2004
New Orleans, Louisiana
* * *
Certified Methadone Advocate
(CMA) Training Course
1. American Association for the Treatment
of Opioid Dependence
Dora Weiner Foundation (DWF) participation in conferences during 2004, allows the foundation to continue its mission of education in the fields of chemical dependence treatment and research as well as, supporting patient advocacy objectives. As with last year's anticipated work our schedule was simple, a single conference and presentation. This almost immediately expanded into a two conference schedule.
The Foundation's anticipated conference participation began in June when Patrick Kroupa, a colleague of Deborah Mash and Chairman of the Board of Mindvox.com was asked to organize an Ibogaine Roundtable by Allan Clear, Executive Director of the Harm Reduction Coalition for the 5th National Harm Reduction Conference. Patrick asked Howard Lotsof, DWF's President to be a panelist on the roundtable and to suggest some other presenters who might participate.
As organization for the Ibogaine Roundtable proceeded Chris Kelly of Advocates for Recovery Through Medicine (ARM) called Mr. Lotsof in September to ask him as a member of the Board of Directors of the National Alliance of Methadone Advocates (NAMA) to inform Walter Ginter, NAMA's Vice President that she would not be able to attend the American Association for the Treatment for Opioid Dependence (AATOD) Conference and that her scholarship provided by the Center for Substance Abuse Treatment (CSAT) may be available. Ginter suggested Lotsof attempt to obtain the vacant scholarship. The matter was resolved within a few weeks. CSAT agreed to provide funds for ground transportation and NAMA donated airfare and hotel costs. Registration fees were made possible by contributions from other donors who are acknowledged in the Ibogaine Roundtable brochure.
Due to limited financial resources DWF's directors chose to attend only two conferences this year. The American Association for the Treatment of Opioid Dependence 20th Anniversary conference was chosen because of our continuing interest in opioid agonist therapy and history of participation in AATOD conferences. The 5th National Harm Reduction conference was chosen because of DWF's growing interest in evaluating broad ranging harm reduction approaches that improve quality of life for drug users and society in general while decreasing drug use related mortality. The Harm Reduction Coalition generously provided hotel accommodations and reduced conference registration fees to allow Howard Lotsof, DWF's President and Norma Alexander Lotsof, DWF's Vice President to attend their 5th National Conference. The conference, as is harm reduction, was an affirmation of life.
Slide shows and other materials that are incorporated into this report were selected by interest of DWF's directors and the approval and cooperation of the presentation authors. In retrospect, both conferences offered many valuable presentations that are not included in this report and it is suggested that conference agendas be reviewed for content and interest by our readers. Return to index
The 20th Anniversary National Conference of the American Association for the Treatment of Opioid Dependence (AATOD) took place in Orlando, Florida, October 16 - 20, 2004. The officers and directors of the Dora Weiner Foundation thank the National Alliance of Methadone Advocates (NAMA), the Center for Substance Abuse Treatment (CSAT) and Chris Kelly of Advocates for Recovery Through Medicine (ARM) for specific contributions making participation in this conference possible.
Large conferences with concurrent breakout sessions often present difficulty in determining which workshop to attend. The Certified Methadone Advocacy (CMA) Training offered a full day of diverse subjects in linear form and comprehensive enough to take in the scope of the AATOD conference. CMA training is state of the art in methadone advocacy and was the concept of Walter Ginter, Vice-president of the National Alliance of Methadone Advocates. Mr. Ginter used his skills gained in business and teaching, to design the CMA training program from concept through content. Joycelyn S. Woods, NAMA's President had mentored Mr. Ginter into national methadone advocacy and supports CMA training as a next important step to advance opioid agonist therapy and patient rights.
There have been three training sessions thus far; two during the national AATOD conferences in Orlando, Florida and Washington, DC. and one at Beth Israel Hospital facilities in New York. Participation is by patients and professionals with presentations from academia, government, medicine and advocacy.
CMA training was developed to insure that individuals desiring to advocate for methadone and medicated assisted treatment at least have a basic understanding of the primary issues. Although the training was initially developed for patient advocates many professionals from physicians to counselors have taken the course with the belief that the certification training would complement their academic credentials. An unexpected outcome of the training has been a sense of community that has been created bringing together all persons, professionals and patient advocates, involved in opioid agonist therapy.
This year's CMA training took place between 9:00 AM and 5:00 PM, on Saturday, October 16, and was broken into ten sessions each on a different subject. Links to some additional information is available from the table below.
Risk Management in the OTP - Barbara A.M. Maloney, Esq. and Catherine H. O'Neill, Esq.
Preparing to report on attorneys Barbara A.M. Maloney and Catherine H. O'Neill's (Legal Action Center) presentations on Risk Management in the Opioid Treatment Program left the Foundation with a concern that has still not been put to rest; balancing risk management for the treatment program and risk management for the patient. While Catherine O'Neill indicated that risk can best be managed by following best practices guidelines, the Dora Weiner Foundation has often received reports of patients being sacrificed to administrative discharge for displaying signs of their disorders whether substance-related or mental health. With research indicating that concurrent psychiatric disorders may be seen in as many as sixty-five percent of methadone patients these are not matters to be taken lightly. That being said, OTPs both corporately and privately by way of their medical directors are increasingly finding themselves as targets of litigation for acts of their patients outside of clinic premises. These acts may involve automobile accidents or diversion of drugs issues or acts of drug use other than methadone or buprenorphine by patients.
The disparity of power, however, between the opioid agonist patient and the opioid treatment program, is more and more a picture of corporate America. The provider being protected by legal council while the patient has little or no legal representation demonstrates distinctions from a greater equality that exists in other areas of medicine between patient and provider with the exception of that area treating psychiatric patients.
Digressing a step further there must be concern that though there is greater funding to the area of psychiatric patient advocacy; with the Substance Abuse and Mental Health Services Administration (SAMHSA) indicating that it may be to the advantage of opioid agonist patient advocates to seek alliances within the mental health advocacy community, it is not an advocacy controlled by psychiatric patients and that should give opioid maintenance patient advocates some concern both from a pragmatic and an ethical point of view.
Unless a balance can be obtained between risk management for the patient and risk management for the provider ethical dilemmas that plague this area of medicine will remain. In a society as litigious as ours there is no avoiding the risk of law suits in the practice of medicine anymore than in any other endeavor. That OTPs are made easy targets is a matter of prejudice resulting from government policy over the last century. It will likely take a significant amount of time to reverse the bias and stigma that has resulted.
Approximately two months later Catherine H. O'Neill presented on behalf of the Legal Action Center at a training titled, "Know Your Rights" describing the legal rights of people with alcohol and drug problems. A booklet, on the same topic and having the same title is available from the Substance Abuse and Mental Health Services Administration. Return to index
Hepatitis C Treatment: Support, Empowerment and Education- Alain Litwin, MD
Alain Litwin presented on a topic of enormous importance not only to methadone maintenance therapy but to the entire field of chemical dependence treatment due to the prevalence of hepatitis C and the integral requirement of advocacy, empowerment and education to overcome the prejudice and stigma that are principal impediments to the recovery of patients experiencing substance-related disorders. There is a century's worth of government precipitated prejudice to be overcome and being able to direct a response to that prejudice and the stigma it produces from two points rather than one offers the patient population, society as a whole and the advocacy movements for both chemical dependence and hepatitis C a better opportunity to make their case in a manner that is normal to patient advocacy movements in the area of medical disorders. Advocacy by cancer patients and survivors offers an excellent example of how other patients are making their case with community support.
Alain Litwin's PowerPoint slide show is an educational presentation that should prove useful as a training tool for the hepatitis C patient advocacy movement. The download is 3.5mb in size. (Approximately 2 minutes download time with a high speed connection and 15 minutes with a 56k modem.) Return to index
Contingency Management Approach: Implementation and Outcomes
Peter Coleman, MS, CASAC, Marylee Burns, MEd, MA, CRC, Scott Kellogg, PhD
This presentation, from the 20th Annual AATOD Conference (the Methadone Conference), tells the story of the adoption of contingency management or motivational incentives by the New York City Health and Hospitals Corporation (HHC), an adoption that was probably the largest ever done. It is our hope that these slides will inspire others to consider introducing this very effective intervention into their treatment program or practice.
Contingency management is the use of operant conditioning principles, particularly positive reinforcements, in the treatment of addictive behaviors. Based on the work of B. F. Skinner and growing out of work done in token economy settings, contingency management was first applied to the treatment of alcohol problems in the late sixties (Bigelow & Silverman, 1999) and then to drug addiction problems in the mid- to late-seventies (Stitzer, 1993). The approach began to gain more momentum in the early nineties when its effectiveness in the treatment of cocaine addiction became apparent (Higgins, Heil, & Lussier, 2004). As Skinner (1983) emphasized, the best way to change behavior is through the use of positive reinforcements, and this kind of intervention has become the norm in motivational incentive studies.
The slides cover three areas. The first group (2-23) is a description of the HHC Addiction Treatment Service, and an overview of the steps that the behavioral health leadership to improve addiction treatment in their methadone and medication-free treatment programs.
The second set of slides (24-63) come from the Clinical Trials Network of the National Institute on Drug Abuse (Mid-Atlantic Node, 2000). These slides describe the exciting work of contemporary contingency management researchers (Higgins, Silverman, and Petry).
The third set of slides (64-106) describe the implementation process at the HHC clinics and the positive reactions of the patients, staff, and administrators to the adoption of these interventions. Of note, the use of positive reinforcements became a centerpiece of the psychosocial part of these programs.
For more information, please contact Scott Kellogg, PhD, at email@example.com
Bigelow, G. E., & Silverman, K. (1999). Theoretical and empirical foundations of contingency management treatments for drug abuse. In S. T. Higgins & K. Silverman (Eds.). Motivating behavior change among illicit-drug abuses (pp. 15-31). Washington, DC: American Psychological Association.
Higgins, S. T., Heil, S. H., & Lussier, J. P. (2004). Clinical implications of reinforcement as a determinant of substance use disorders. Annual Review of Psychology, 55, 15.1-15.31.
Mid-Atlantic Node (2000). Motivational incentives for enhanced drug abuse recovery: Pre-protocol training manual. Baltimore, MD: NIDA CTN Mid-Atlantic Node.
Skinner, B. F. (1983). A matter of consequences. New York: Alfred A. Knopf.
Stitzer, M. L., Iguchi, M. Y., Kidorf, M., & Bigelow, G. E. (1993). Contingency management in methadone treatment: The case for positive incentives. In L. S. Onken, J. D. Blaine, & J. J. Boren (Eds.). Behavioral treatments for drug abuse and dependence: NIDA research monograph 137 (pp.19-35). Rockville, MD: National Institute on Drug Abuse.
This slide presentation is 2.3mb in size. (Approximately 2 minutes download time with a high speed connection and 10 minutes with a 56k modem.) Return to index
Contingency Management Approach: Implementation and Outcomes (ppt presentation)
Analgesia in the Buprenorphine Maintained Patient
The Dora Weiner Foundation (DWF) and the National Alliance of Methadone Advocates (NAMA) have collaborated for the last year to obtain a determination of medical practice and art in responding to the questions of pain management and post operative pain management in the Buprenorphine maintained patient.
Following a series of discussions and communications that took place during and after the 20th Anniversary Conference of the American Association for the Treatment of Opioid Dependence (AATOD) between DWF's President Howard Lotsof and Rolley E. Johnson, Vice President Clinical, Scientific & Regulatory Affairs of Reckitt Benckiser, the manufacturer of Buprenorphine, Subutex and Suboxone; Reckitt made available a PDF file as an official response of their company from Tim Baxter, MD, Global Medical Director for doctors seeking information on the treatment of pain in patients taking Buprenorphine
The Dora Weiner Foundation and the National Alliance of Methadone Advocates proudly make that response of a generic letter available to doctors and patients in need of such information as an official Reckitt Benckiser document.. Return to index
Pre-Conference Institute - USING WOMEN: Harm Reduction Makes a Difference
The title of the pre-conference institute, Using Women: Harm Reduction Makes a Difference was thought provoking. Were the presentations to concern themselves with women using drugs or the inhumane use to which drug using women are subjected? Possibly the two are inseparable in our times. DWF's president Howard Lotsof had met Dr. Stephanie Tortu of Tulane University when she worked for Narcotic and Drug Research, Inc. (NDRI) in New York during a period when Lotsof presented on ibogaine at NDRI. Tortu's presentation on Women and Drug use and particularly of the HCV and HIV seriopositive populations provide vital information on transmission vectors including that between significant others. A slide show and PDF presentation on these matters are included in this report. Co-authors include Enrique R. Pouget, Rahul Hamid, Leilani Torres, James M. McMahon and Alan Neaigus. Return to index
Ethics and Clinical Harm Reduction - Fred Rotgers, PsyD
Sessions at a conference may be chosen for any number of reasons; interest in the subject, interest in the presenter, an intent to learn something. Fred Rotgers, PsyD is an excellent presenter. As the Dora Weiner Foundation is studying aspects of medical ethics, Dr. Rotgers presentation, Ethics and Clinical Harm Reduction, was of particular interest. The slide show herein made available by Rotgers is a brief course not only on the issue of clinical harm reduction and ethics but, on ethical concepts as they may be generally applied and understood. Topics considered include ethics and metaethics, causisity, deontologies and informed consents. A dictionary or an open window to google.com may be helpful for those not familiar with the field. A fast download of 76k and well worth reviewing. Return to index
Junkies in the House of the Lord - Andria Efthimiou-Mordaunt
The Dora Weiner Foundation has taken an interest in drug user organizations for close to two decades. Our first contact was through Nico Adriaans, founder of the Rotterdam Junkiebond and shortly thereafter, during meetings at the MDHG, its Amsterdam counterpart. In 2003, officers of DWF attended the Invitational Conference on Drug User Activism in Copenhagen that was sponsored by the Dutch National Group of Drug Users, Landelijk Steunpunt Druggebruikers ( LSD) and the Danish Drug Users Union, BrugerForeningen (BF). The meetings were held in a complex of more than twenty modern offices that was the headquarters of BrugerForeningen. BF's situation is somewhat unique, the organization being extremely well organized and run on a budget of approximately a half million euros a year provided by national, city and private sources. The Danish and Dutch users groups are made up of active drug users. No organizations of this kind exist in the United States or most likely would be allowed to exist under the current war-on-drugs mentality, yet they provide important public health services and education not supplied by entities involved in prevention or treatment alone.
One of the sessions held during the HRC 5th National Conference was, Drug Users: Harm Reduction and Organizing. Presenters were Andria Efthimiou-Mordaunt, Drugscope, London, England; Jon Paul Hammond and Kathleen Rigby, University of Pennsylvania, Center for Studies of Addiction, Philadelphia, PA; and Peter Vanderkloot, Drug User Activist, New York, NY. Quoted from their conference presentation abstracts, Hammond states, "So much of the relentless and challenging effort to get drug users to adopt and incorporate meaningful harm reduction in their lives never seems to get beyond the systematic disenfranchisement we experience constantly in the US. Vanderkloot adds, "Many activists have likened the struggle of the illicit drug using community to those of other oppressed minority groups and have argued that all such efforts are essentially similar in their nature and face similar obstacles." While no written or graphic materials were presented during this session, Andria Efthimiou-Mordaunt has provided her dissertation, Junkies in the House of the Lord, the context of which is in keeping with her conference presentation: Can Drug User Organizing Influence Drug Policy? One has to wonder if humanity will ever move beyond the oppression of minorities? Return to index
Ibogaine Roundtable Overview
Patrick Kroupa, moderator and organizer of the Ibogaine Roundtable did a job that can only be described as exceptional. Kroupa, Chairman of the Board and co-founder of Mindvox, with the cooperation of Allan Clear, Executive Director of the Harm Reduction Coalition scheduled an end of the day meeting that would run for three hours but, with the possibility of extending the time if required. Patrick was chosen to organize the roundtable because of his neutral position in the world of ibogaine and to that neutrality Kroupa opened the session to all persons within the ibogaine community who wished to present. The number of presenters quickly jumped from an anticipated five or six to nine. While there was only one presentation of hard science by Jeffrey Kamlet, MD, the roundtable represented the most important series of ibogaine presentations since the 1999, New York School of Medicine Ibogaine Conference. In keeping with his brilliant understanding of the needs of the presenters and the importance of what they were presenting Patrick Kroupa threw the agenda to the wind and allowed each presenter to run over their allotted time pushing the roundtable to a four hour mark. The room remained standing room only throughout.
Returning to the organization of the Ibogaine Roundtable, Mr. Lotsof suggested inviting Dr. Peter Cohen of the University of Amsterdam's Center for Drug Research to introduce some counterpoint to the presentations of the other members of the roundtable who can only be described as very pro ibogaine. Professor Cohen's position is one in which he has concern that ibogaine presented as a medication to treat chemical dependence has fallen victim to a war on drugs mentality and as such may be viewed as a DEA agent in disguise. Other panel members were to be Deborah Mash, PhD, University of Miami; Jeffrey Kamlet, MD, the attending physician for Healing Transitions, an ibogaine treatment facility; Dana Beal, Founder of Cures-Not-Wars; Dmitri Mugianis, an expert on ibogaine therapy in urban settings; Valerie Mojeiko, Multidisciplinary Association for Psychedelic Studies and Jon Freedlander, Towson University. Professor Mash withdrew at the last moment allowing a longer period to Dr. Kamlet whose presentation dealing with cardiac safety of ibogaine may have been one of the most important clinical presentations to date. In addition to written works that are included in the roundtable brochure, PowerPoint presentations are included for Lotsof, Mojeiko and Freedlander. Return to index
Donations make it possible for the Dora Weiner Foundation (DWF) to participate in conferences, symposia and forums and provide for the garnering and exchange of information between medical doctors, scientists and patients. We are able to bring you state of the art information by participating in conferences and forums and maintaining contact with patients being treated for chemical dependence. All of DWF's funding drives have been project specific allowing us to direct your gifts to projects for which donations have been solicited and to provide reports like this for your benefit.
Please visit our donation page for information on giving tax deductible gifts to the Dora Weiner Foundation.