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UNITED STATES GOVERNMENT
Office for National Drug Control Policy
Substance Abuse and Mental Health Services Administration
US Surgeon General
National Institute on Drug Abuse
Addiction Technology Transfer Center Network
National Institute of Health
Federal Drug Administration (FDA)
American Association for the Treatment of Opiate Dependence
American Society for Addiction Medicine
American Medical Association
New York Academy of Science
National Alliance for Medication Assisted Recovery
Harm Reduction Coalition
Legal Action Center (New York & Washington, DC)
National Alliance for Pregnant Women
National Assn of County Behavioral Health and Developmental
Faces and Voices of Recovery
National Alliance of Advocates for Buprenorphine Treatment
The Rockefeller University of New York
Partnership for Drug Free Kids
National Association of State and Alcohol Abuse Directors
World Health Organization
United Nations Office on Drugs and Crime (UNODC)
International Doctors for Healthy Drug Policies (IDHDP)
Global Commission on Drug Policy
Open Society Institute
European Opiate Addiction Treatment Association
International Harm Reduction Coalition
Canadian Centre on Substance Abuse
European Association for the Treatment of Addiction
International AIDS Society
International Society of Addiction Medicine
Society for the Study of Addictions
Letter from Stop Stigma Now President: Sy Demsky
This year has been another great year for Medication Assisted Treatment (MAT). There seems to be no doubt that MAT has begun to catch on, and is better understood by the drug courts, the media, and the general public as being the gold standard for the treatment for opioid addiction. Drs. Dole, Nyswander, and Mary Jeanne Kreek should be very proud.
But we still have a long way to go and must continue to educate the public in order to save lives.
Recently, Stop Stigma Now (SSN) attended the New York State Association of Drug Court Professionals, setting up a booth and both distributing our free literature about MAT and answering questions about this form of treatment.
What a difference from previous years. They literally gobbled up all the literature. Judges, lawyers, social workers, and other court professionals said they now approved of MAT. It was wonderful to hear, and many requested that we send our staff to speak at their staff meetings. And we are doing so.
SSN is doing its part in educating the public. Our logo on our pins, “STIGMA,” seems to be an accepted brand name. We have given out over 20,000 pins and equal amount of literature to programs throughout the country to use at community meetings. And we will continue to do so until the battled is won.
Recently, the University of Arkansas became a member of SSN for $1000 for an agency. Individual membership is $25. We need more members to help cover our expenses. All our materials are free and we have no paid staff.
We have many people to thank for their tireless work at SSN, most notably some of the members who passed away: Dr. Beny Primm, Dr. Barry Stimmel, Dr. Elisabeth Khuri, Dr. Robert Newman, Bob Newberger, John Galea, Kathy Coughlin, and most recently, Dr. Herman Joseph.
Please help us help you. Join with us. Go to our webpage, www.stopstigmanow.orxzg. Press Donate.
From The Editor:
Robert Sage, Phd
Welcome to the next edition of the Stop Stigma Now Newsletter. SSN continues its work to advocate for the elimination of the stigma related to Medication Assisted Treatment by developing and distributing its Newsletter to stakeholders, SSN membership and all interested parties.
This edition, which includes many informative articles from several sources, highlights the expansion of MAT in Federal, State and City prisons and the provision to those addicted to opioids continuing treatment in the prison system. In addition, we are seeing a wider acceptance of MAT in Drug Courts and an increase in referrals to MAT programs as an alternative to incarceration.
This issue also highlights the MARS Program, a peer-to-peer MAT support network with 17 projects, offering advocacy and assistance to patients enrolled in MAT Programs. This program has helped thousands of patients and we wanted to inform our membership and stakeholders about their valuable services.We also are recognizing the loss of another pioneer in the field of MAT treatment and research, Dr. Herman Joseph, an SSN Board Member, who had dedicated his professional life to the study and advocacy of MAT.
As always, we hope you find our latest edition informative and helpful and we welcome your comments and suggestions.
MAT in the News
An Opioid Crisis Foretold
This Op-Ed article in The New York Times published on April 21, 2019 discusses the lessons ignored in the fight against opioid addiction in this country, considered the deadliest in human history. Read where the Times stands on prevention, addiction treatment, social services and research. Read More.
MAT Profile: Medication-Assisted Recovery Services
Learn about Medication-Assisted Recovery Services (MARS), a Medication-Assisted Treatment program that takes a holistic approach. Learn about the services by doing directly to the source. Read More.
Do You Need Help Accessing Addiction or Mental Health Care?
In Memoriam: Herman Joseph, PhD (1931-2019)
By Steve Magura, PhD. Andrew Rosenblum, PhD.
Herman Joseph, a pioneer in advancing methadone maintenance and other interventions for the treatment for opioid addiction, passed away on April 20, 2019 in New York City. Dr. Joseph had a seminal influence on addiction and criminal justice during the latter 20th and early 21st century. For more than 50 years he worked as a social research scientist in the interrelated fields of addiction treatment and harm reduction, criminal justice, street studies, homelessness, and program development at the New York City Office of Probation, Rockefeller University, the New York State Office of Alcoholism and Substance Abuse Services (OASAS), and National Development and Research Institutes, Inc. (NDRI). He was also a founding board member of Stop Stigma Now, an organization dedicated to eliminating negative attitudes towards people suffering from opioid addiction, which hinder them from entering into and remaining in treatment.
Herman is notable for initiating several innovative practices to address opioid addiction. In the 1960’s and early 1970’s heroin use was pervasive, overdose the leading cause of death among young adults in New York City, and the availability of effective treatment extremely limited. Herman, as a young probation officer, recognized that his heroin-addicted probationers would quickly relapse after release from custody. Despite having little previous exposure to addiction issues and not yet having received formal scientific training, he was attentive to data, intellectually curious, and never shy about challenging the status quo. Initially enthusiastic about therapeutic communities (TCs) such as Synanon and Phoenix House, he became disillusioned when he observed that most of his probationers would relapse after leaving a TC and that these TCs had low retention rates. Frustrated with the limited interventions provided by the city probation department he implemented alternative methods. As described in his remarkable interview with the addiction historian Nancy Campbell (2013), Herman advised his probationers to contact him once they relapsed so that he could escort them to inpatient detoxification rather than have them remanded to jail. And, after learning about the pioneering work of Drs. Vincent Dole, Marie Nyswander and Mary Jean Kreek (1965; 1966) that recognized opioid addiction as a brain disorder and identified methadone as an effective maintenance medication, he lobbied for services, personnel and facilities to develop a citywide network of five probation methadone clinics. With the now closed Federation and Guidance Service he developed the first vocational guidance and employment service for unemployed probationers, and, with the NYC Department of Health, the first urine testing service in probation. These initiatives changed heroin addiction from an intractable problem for probation into a manageable issue. As documented in one of his early papers (Joseph and Dole, 1970), heroin-addicted parolee/probationers admitted into methadone maintenance showed reductions in criminal convictions and high treatment retention rates, especially when compared with similar patients not admitted into maintenance therapy. In the mid-1970s Dr. Joseph joined Dr. Dole and his laboratory at Rockefeller University to plan, conduct and supervise large scale follow-up studies of methadone patients, including a study of that documented high rates of relapse among patients who left methadone maintenance (Dole and Joseph, 1978). This finding, which has been replicated in several subsequent studies, underscored the importance of providing time unlimited opioid agonist therapy (much as insulin is used to treat diabetes) and served as a cautionary tale of the counter-therapeutic factors, such as stigma and costs, that contribute to ending treatment.
Herman continued with his innovative criminal justice activities after he left the probation office. For more than 30 years he promoted the importance of maintenance treatment (first methadone and later methadone and buprenorphine) in jails and at post-release (Magura et al., 2009). At a 1997 National Institutes of Health (NIH)- sponsored meeting, although he was not an invited speaker, Herman was able to convince the conference chair that the official publication from this conference recommend that opioid-dependent persons under legal supervision should have access to methadone treatment. Herman was a member of the team that developed the first “in jail” methadone maintenance program, the Key Extended Entry Program (KEEP), for addicted inmates at New York City’s Rikers Island Jail (Magura et al., 1993), an intervention that has been implemented in many countries throughout the world, and is finally being accepted by other states in the U.S. to address the current opioid abuse epidemic (Vestel, 2018).
With support from OASAS he organized the Crack Cocaine Research Working Group, later known as the Chemical Dependency Research Working Group. And with the support of grants from the Aaron Diamond Foundation, Dr. Joseph organized a series of symposia and conferences covering major aspects of addiction, research and treatment, including a consortium of major medical centers to study neonates exposed to cocaine/crack in utero. Other projects and studies included addressing the HIV epidemic in NYC such as the need for harm reduction services and the spread of hepatitis B and C among the street/homeless population who used shelters, soup kitchens and medical vans. He also presented the first conference on chemical dependency and disability as well as conferences on hepatitis C and the addicted patient; assisting mentally ill homeless people to obtain housing; studies of the biology of crack cocaine, and pain management and chemically dependent patients. Recognizing the burden of being a methadone maintenance patient especially for employed patients (e.g., required to attend a clinic several times a month), he helped set up and evaluate methadone medical maintenance programs in NY State where methadone could be dispensed by an office-based physician or pharmacist once per month.
Dr. Joseph authored or co-authored more than 125 papers and government reports and, with David Courtwright and Don Des Jarlais, co-authored the book, Addicts Who Survived. With Dr. Barry Stimmel he edited the book, The Neurobiology of Cocaine Addiction. He was editor or co-editor of special issues of the Mount Sinai Journal of Medicine, the Journal of Addictive Diseases and Substance Use and Misuse, and also gave numerous presentations on addiction and other topics at national and international conferences. Throughout his long, productive career, Dr. Joseph collaborated with several NDRI investigators and was instrumental in helping them craft NIH grant proposals that received funding, including the authors of this obituary.
Herman also received many commendations and awards including a paper introduced into the Congressional Record in 1971; a 1974 commendation from the NYC probation commissioner for developing probation methadone clinics and a vocational guidance program; a Nyswander/Dole “Marie” Award from the American Association for the Treatment of Opioid Dependence (AATOD); a Life-time Legacy Award and Proclamation from the City of Cleveland; a Recovery Award as Honorary Patient from the National Alliance for Medication Assisted Recovery (NAMA-Recovery); and a 2007 award from the International Association for Pain and Chemical Dependency Herman received a Ph.D. in Sociology from the City University of New York in 1995.
In addition to his professional activities (setting up new programs, designing and conducting research and evaluation studies) that advanced knowledge to reduce the burden of drug-related problems, Herman had a life/career altering influence on many people whom he encountered. Early in his criminal justice career, one of his probationers, Julio Martinez, who Herman admitted to treatment 6-7 times, eventually became the commissioner of the New York State Narcotic Addiction Control Commission, the predecessor of OASAS. Herman also helped guide the career path of the late Robert Newman, former president of Beth Israel Medical Center in NYC. Dr. Newman often recounted how a 1968 serendipitous encounter with Herman spurred him to devote his career to expanding and destigmatizing methadone maintenance treatment. As described in Dr. Newman’s obituary (Roberts, 2018), he was approached by Herman in the elevator of his apartment building who told him that as a public health physician he should learn how to effectively treat opioid addiction. That encounter led to an introduction with Drs. Nyswander and Dole and captivated his interest in methadone. Dr. Newman subsequently greatly expanded the number of methadone maintenance programs throughout New York City and introduced methadone in many countries throughout the world.
Herman Joseph was born on September 2, 1931 to a working class Jewish family in Patterson, NJ. He described his upbringing as very sheltered – he didn’t even learn about marijuana until he became a probation officer. Although he was legally blind in one eye, had Erb’s palsy which limited the use of his right arm and experienced stigma as a child, he reported that he did not consider himself disabled. In fact as a child Herman aspired to become a concert pianist; throughout his life he was a great lover of music, particularly opera. However, though piano practice gave him discipline and helped him gain coordination and strength, his right arm would tighten up and spasm. Herman reported that he did not allow his physical problems to deter him- “the only thing that my physical difficulties did was make it so I persevered to achieve something in my life“ (Campbell, 2013). The challenges he faced helped him to understand others’ difficulties. He attributed his childhood experiences with stigma as making him able to empathize with his probationers and later with methadone patients for whom stigma remains an overwhelming issue. His interest and early engagement in civil rights – he was very active integrating schools in New York City – also helped him to quickly recognize that recovering persons deserve respect and frequently encounter discrimination. And, according to his long-time friend Sy Demsky, Herman was very generous donating money to charitable organizations. We also remember Herman for his lifelong interest in art and photography, including a gallery display of his photographs taken as he discovered subjects of interest during many walks around Manhattan.
Although Herman was not able to pursue a music career, the contributions he made as a relentless patient advocate and toward advancing addiction treatment and harm reduction is a legacy from which many have benefited. His voice and inspiring presence will be greatly missed.
ASAM Vice President Testifies at Congressional Oversight Hearing on Federal Response to Addiction and Overdose Crisis
Yngvild Olsen, MD, MPH urged lawmakers to expand access to evidence-based addiction treatment and invest more resources to address the addiction and overdose crisis during today’s House Committee on Oversight and Reform Hearing. Read more.
National Alliance of Medication Assisted Recovery (NAMA)
NAMA Recovery is an organization composed of medication assisted treatment patients and health care professionals that are supporters of quality opiate agonist treatment. We have thousands of members worldwide with a network of international affiliated organizations and chapters in many places in the United States.
New Momentum for Addiction Treatment Behind Bars
New scientific evidence may cause prison officials to reconsider their long-held opposition to medication-assisted treatment in prison, a position that’s resulted in painful withdrawal episodes from users. Read more.
Monthly Buprenorphine Injections Effective
For Opioid Use Disorders
A newly published study suggests the long-acting buprenorphine formulation BUP-XR is more effective than placebo in helping patients struggling with addiction to opioids. BUP-XR is a monthly extended-release injection. Read more.
Public Perception is Tough to Overcome in Battle Against Opioid Addiction
A report by Modern Healthcare looks at strides made in prison facilities across the country with respect to Medication-Assisted Treatment, which saw deaths in Rhode Island’s prison system drop 61 percent in one year. Read more.
Three Barriers to Medication-Assisted Treatment for Drug Court Participants And How They Can Be Overcome
The Institute for Research, Education, and Training of Addicitions chronicles the availability of drug courts and why, despite their successes, continually face barriers. Read more.
More on the MARS Project
The MARS Project by Walter Ginter
MARS™ Project is a peer-initiated and peer-based recovery support project sponsored by NAMA Recovery (http://www.methadone.org/). NAMA-Recovery was created through methadone patients and health care professionals working together and has been maintained by successful patients.
Patients absorb the stigma of the greater society and that in turn creates problems regarding relationships with their families, feelings of their self-worth and their ability to compete in society.Successful patients who abstain from use of heroin and other illegal opioids may not tell their families they are in methadone or buprenorphine treatment. They may tell their families that it is their will power which resulted in their ability to abstain from drugs rather than the prescribed medications. If opioid agonist treatment is ever going to be understood it must start with educating the patients and giving them the information and support, they need to validate the treatment. Several attempts have been made at training the counselors or staff of programs but the knowledge does not trickle down to have an impact on the patients.
NAMA-Recovery realized the need to do something more. Therefore, in 2005 the organization developed and wrote a grant to create a peer-to-peer Recovery Center specifically for patients receiving methadone and buprenorphine. NAMA-Recovery had recognized that patients needed knowledge and advocacy for when they are confronted with prejudice and bigotry so that they can overcome it. The Medication Assisted Recovery Support (MARS) Project in collaboration with the Albert Einstein College of Medicine (Bronx, NY) began operation in 2007. Important to the MARS Project is the Core Training for patients, their families and interested others that include education on:
1) Medications used in opiate addiction treatment and their rationale
2) Science of opiate addiction and treatment
4) That methadone and buprenorphine patients are candidates for recovery
Patients have been made to feel bad about the one thing they should feel good about: getting into treatment and improving their lives. Their relationships with family and friends become invalid because they feel that they are “somehow” cheating because of their medication and being a contributing member of the community becomes to their mind “a lie” and untruthful. The original premise of the MARS Project is that knowledge would give patients a better chance at a positive outcome because they would understand substance use disorder and their medications.
Training Others to Implement MARS Projects
As the success of the MARS Project became known NAMA-Recovery began to receive calls from providers about wanting to start their own MARS Project. Therefore, Beyond MARS was created whose purpose is to train patients and professionals to operate a MARS Project. As of 2014 there are 17 operating MARS Projects in the United States.
Example: MARS in Vietnam
Beyond MARS was invited by Vietnam to train their methadone patients and professionals to operate a MARS Project. When the Beyond MARS group arrived in Vietnam and met with the government authorities, they were told that education was needed in Vietnam. The authorities then listed the exact Core Training that is conducted at the MARS Project. Later when the Beyond MARS trainers were speaking with patients it became even more interesting as they asked about help in telling their families about methadone. Vietnamese patients, like American patients were concerned about their employers finding out. In fact, Vietnamese patients had essentially the same issues as those of their American patients in the United States. Even though the Vietnam government has declared that opiate use disorder is a brain condition that does not mean the average citizen will believe it and Vietnamese patients experience the same stigma, prejudice and alienation that patients do in the United States.
NAMA Recovery discovered that the misunderstandings about opioid use disorder and its treatment are not confined to the United States. Stigma and prejudice against patients are evident in many countries around the world. NAMA Recovery and the MARS Project help Medication-Assisted Treatment Programs develop a holistic approach that includes MAT education and a supportive peer community. We help drug-free programs to integrate medication-assisted treatment into their other services. We help anyone from any organization that is interested in promoting an effective approach to medication-assisted treatment and recovery efforts.
Join the MARS Project Community
Whether we are traveling for speaking engagements, participating in meetings to advance advocacy efforts, or providing consultation services, members of the growing MARS™ Community are working together to enhance medication-assisted treatment efforts and fight stigma and prejudice. The original MARS™ project has expanded from its humble beginnings at the Einstein College of Medicine in the Bronx, NY, to include patients and staff at 17 programs across the United States and 2 in Haiphong, Vietnam. We hope you’ll join us too!
Visit our website at http://www.marspoject.org/
The National Development and Research Institutes (NDRI) Reorganized as NDRI-USA and SSIC
NDRI, a private, not-for-profit research company, has produced ground-breaking medical and social sciences research for over 50 years. NDRI historically has focused on drug and HIV research and received a majority of its funding from the National Institute of Drug Abuse (NIDA).
However, over the past decade, NDRI scientists have developed internationally recognized programs of research targeting military and veteran population, first responder, and security services health and readiness, homeland security, health disparities, and international public health and infectious diseases, in addition to substance abuse research. While our research continues to be funded by the National Institutes of Health (NIH), partnerships with the Department of Homeland Security (DHS), Department of Defense (DoD), and other foundations have grown exponentially.
To reflect our organization’s exciting evolution and to increase institutional efficiency, NDRI has been reorganized as NDRI-USA, also as a non-profit 501(c)(3) and the Social Sciences Innovation Corporation (SSIC), a for-profit company offering consulting services and product development and marketing.
Together, the NDRI-USA/SSIC companies will conduct research and provide solutions for pressing health and safety issues nationally and internationally. In addition to our broader research mission, NDRI-USA/SSIC will expand the services it offers to the business and scientific community for Research and Grants Management Services and Consultation, Data Science Core Management and Analytics Services, and Product Development and Testing. For example, our companies will offer focused training for the US Fire Service (e.g., increasing diversity, reducing bullying and hazing, and surviving the impact of repeated traumatic and physical stresses) and Law Enforcement Agencies (e.g., Narcan training for first responders on how to respond to and reduce the impact of opioid overdoses).
The scientists at NDRI-USA and SSIC are excited about this evolution which builds on the over half-century history of achievements and innovations that were the hallmark of NDRI.
If you have any comments about our newsletter please email our editor, Robert Sage at email@example.com.
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