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Drug & Alcohol Headline Week in Review from MOMSTELL.COM

Febrary 4, 2005 Edition


(Past Editions)

CHICAGO (AP) 1/28/05-- Already known as a rural scourge, methamphetamine is becoming a problem in a number of U.S. cities. 
Meetings of the 12-step group Crystal Meth Anonymous have increased in Chicago from one night a week a few years ago to five
a week.
In the Atlanta area, methamphetamine users account for the fastest-growing segment of addicts seeking treatment. Rehabilitation 
centers there are seeing an uptick in the number of women 
meth addicts, while officials in Minneapolis-St. Paul say they're treating an alarming number of meth users younger than 18. “Most 
people just think it happens in the farmlands and the prairies or out back behind the barn,'' says Carol Falkowski, director of 
research communications at the Hazelden Foundation in Minnesota. But that's not the case anymore.
Falkowski found that meth addicts now represent about 10 percent of patients admitted to drug treatment programs in the Twin 
Cities, compared with 7.5 percent a year ago and about 3 percent in 1998. About a fifth of those meth users who sought help 
in the last year were minors. She and other experts who track urban drug trends for National Institute on Drug Abuse are meeting 
this week in Long Beach, Calif., to present their findings. Some have noted a big jump in the use of meth -- particularly in its potent 
crystal form --  in the past six months to a year.
“It's the new major drug threat,” says Jim Hall, director of the Center for the Study and Prevention of Substance Abuse at Nova 
Southeastern University in Florida. He monitors drug use for NIDA in Fort Lauderdale and Miami, where crystal meth is often more 
sought after than Ecstasy and cocaine. ``Here, it's almost like the early days of cocaine, when cocaine was the chic, expensive 
champagne of street drugs,'' says Hall, noting that many users come to Miami's trendy South Beach strip in search of the purest, 
most expensive meth available.
Methamphetamine -- long a problem on the West Coast -- made its way across the country in the last decade, often taking hold 
in rural areas, where it's usually made because the process creates a noticeable stench. Increasingly, drug enforcement officials 
say that mass quantities are also being shipped cross country from ``super labs'' in the Southwest and Mexico.
Experts say the drug started to catch on in urban areas in the club and rave scenes and sometimes among particular populations, 
such as gay men. That's been the case in such cities as Washington, D.C., and Chicago, says Thomas Lyons, a research associate 
with the Great Cities Institute at the University of Illinois at Chicago. Often, he says, meth use has been associated with increases 
in sexually transmitted diseases, including HIV.
One recovering addict who helps organize Chicago's Crystal Meth Anonymous meetings confirms that the gatherings are frequented 
by gay men -- but he says that, increasingly, he's seeing people from other backgrounds. “It's become more common that I cross 
paths with people who say, 'This is my drug of choice,'' says Mike, a 34-year-old former meth user whose organization does not 
reveal last names to protect group members' privacy. Experts elsewhere say their populations of meth users are diversifying, too.
Claire Sterk, an Emory University professor who tracks Atlanta's numbers for NIDA, says that while meth users there have 
traditionally been white, there are early signs that meth is making its way into the city's black and Hispanic communities. Experts 
in other cities also have noted that some young women are using methamphetamine as a way to lose weight.
“It's definitely everywhere,” says Adam, a 26-year-old former meth addict from suburban St. Louis who also asked that his last name 
not be used out of fear of embarrassing his family. ``Though I'm not using anymore, I'm sure it would only take me three phone 
calls to find it'' says Adam, who works in the retirement benefits industry and is getting a business management degree at Saint 
Louis University.
He also speaks on behalf of the Partnership for a Drug-Free America, which launched education campaigns in St. Louis and Phoenix 
last year to try to combat growing meth problems there. The nonprofit plans similar campaigns in at least four other states in the 
next year, says spokesman Steve Dnistrian. “Our fear has been that meth will catch on with a new generation of kids who haven't 
heard about it,'' he says.
But in some cases, that's already happening, says Dr. Rob Garofalo at Children's Memorial Hospital in Chicago. “It's the drug that
makes me cringe the most,'' says Garofalo, who's come across a growing number of meth users among the patients he treats at 
the hospital's clinic for older youth. At first, he says, these young meth users see the drug as a “brightener” -- one that helps 
them concentrate, stay up for hours and feel in control. In time, however, users become increasingly paranoid and aggressive.  
It's also highly addictive – “such a slippery slope,'” Garofalo says. “You can't just dabble in crystal meth.''
It should have helped restore peace to the city, but instead unleashed mayhem. On Jan. 21, police in the drug-infested 
Secondigliano neighborhood on the outskirts of Naples arrested Cosimo Di Lauro, a ponytailed31-year-old suspected of being 
the new kingpin of a faction of the Camorra, the notorious Naples Mob. Di Lauro was wanted on suspicion of drug trafficking 
and ordering multiple homicides, including the Jan. 15 broad-daylight slaying of the 47-year-old mother of a member of a rival 
group. But as news of the bust spread, a crowd of about 400, mostly women, poured onto the street to hurl insults and 
crockery at the authorities who nabbed him. The episode shows just how far law and order have broken down in Naples.
This part of town, along with the adjoining Scampia neighborhood, has become the center of the regional drug trade, supplying 
much of the Campania region and other parts of southern Italy with cocaine, heroin and other narcotics.
This book contains a national overview of State-by-State information on licensing, certification, and credentialing standards for 
alcohol and drug treatment facilities, programs, counselors, and prevention professionals. Discussed are each State's substance 
abuse facility and program approval process, including steps in the application process, fees charged, types of treatment 
services approved by States, and the national accreditations accepted in lieu of State accreditations.
Canadian health officials are hoping that heroin addicts, freed from their daily pursuit of the next fix by a prescription-heroin plan, will 
find timeto make positive changes in their lives.  The Toronto Globe and Mail reported Jan. 31 that researcher will begin gathering 
applications for the program from addicts during the next few weeks. The experiment already is the talk of the streets in 
communities like Vancouver's Downtown Eastside. "They should have done this a long time ago," said Debbie Woelke, 
a heroin user living in a single-room occupancy hotel in the city's poorest neighborhood. "Sometimes you need something just to 
relax and get your mind together, instead of always being in a state of panic. That'swhat's killing everyone down here. They have to 
do things they wouldn't  normally do." The prescription heroin trial will take place in Vancouver,
Toronto, and Montreal. Researchers are looking to recruit 428 hard-core addicts, half of whom will receive daily doses of heroin for a 
ear, and half of whom will get methadone.   "What if you could say to an addict, 'For the next little while, you're not going to have 
to get your drugs from
Al Capone. You can get your drugs from Marcus Welby,' " said Dr. Martin Schechter, lead researcher on the project. "You don't 
have to worry about this afternoon and this evening. And therefore, you don't have to go and break in to cars or be a prostitute. 
You could actually come and talk to a counselor or ... get some skills training."
The experiment is unique in North America, although similar trials have been tried with some success in Europe. However, 
critics range from those concerned about lack of abstinence as a goal to those who say it is unfair to give addicts free heroin 
for a year and then cut them off. Overdoses also are a major ethical worry.  A spokesperson for U.S. drug czar John Walters 
called the trial an "inhumanemedical experiment.  "What you're doing is making it easier to be a heroin addict," said policy 
analyst David Murray. "These people won't get that much better in the long run. They will still be heroin addicts."
But Vancouver Mayor Larry Campbell, a former coroner and narcotics officer, said current treatments don't work for hard-core 
addicts. "The critical thing is to accept this as a medical condition," he said. "The side effects of this medical condition is that 
it forces you to ... do things that you would never do, be it work as a sex-trade worker, be a B and E [break-and-enter] artist or a 
purse snatcher. So if I can mitigate that byputting you on heroin, imagine the changes you could have."
February 3, 2005
A new Treatment Improvement protocol (TIP) released by the Substance Abuse and Mental Health Services Administration 
(SAMHSA)this week provides guidance on how to more effectively treat individuals with co-occurring mental health and 
substance abuse disorders. At a news briefing in Washington, D.C., SAMHSA officials said the TIP is part of an overall effort 
to encourage the development of an integrated approach to substance abuse treatment. Community organizations can 
play a  role in this by partnering with local health providers or medical societies to encourage integrating substance abuse 
and mental health treatment.
Substance Abuse Treatment for Persons with Co-Occurring Disorders, TIP 42, provides guidelines, assessment tools, strategies 
and models for treating patients for both mental health and substance abuse disorders in whichever setting they go for 
treatment-whether it's a substance abusetreatment facility, mental health provider or clinic.
"Many times people with co-occurring disorders cannot separate their addiction from their mental disorder and certainly should 
not have to negotiate separate service delivery systems for treatment," said SAMHSA Administrator Charles Curie. "We 
know that with appropriate treatment and supportive services people with co-occurring disorders can and do recover."
The publication notes that 50-75 percent of patients in substance abuse treatment programs have co-occurring mental illness, 
while 20-25 percent of those treated in mental health settings have co-occurring substance abuse. "But very few patients 
are ever treated for both disorders," Curie explained at the briefing. In total, according to SAMHSA's National Survey on 
Drug Use and Health, there were roughly 4 million Americans with co-occurring disorders in 2003.
The TIP provides assistance to help substance abuse treatment systems develop the capacity to treat individuals with co-occurring 
disorders, while mental health systems develop similar capacities. Dr. H. Westley Clark, Director of SAMHSA's Center for 
Substance Abuse Treatment, said working with state and communities across the country, SAMHSA will encourage a unified 
substance abuse and mental health approach. "What we're trying to do is to mobilize the community to address this issue, 
through events such as Recovery Month," he said.
For the full announcement about the TIP 42, visit 
Backed by wealthy philanthropists and embracing popular issues like medical 
marijuana, the drug-reform movement is stronger than it has been in years. Fox News reported Jan. 27 that groups like the 
MarijuanaPolicy  Project (MPP) and the Drug Policy Alliance have backers with deep pockets(billionaires Peter Lewis and 
George Soros, respectively), and both have  succeeded despite taking different tacks on the drug issue. MPP has focused 
mainly on the medical-marijuana issue, while the Drug Policy Alliance tackles a broader range of issues, including supporting 
drug treatment over incarceration for drug offenders.
Despite their differences, the two groups have worked well together in recent years. "I think it's a healthy sign in the 
drug-policy forum that there are different groups coming in with different backgrounds and point of view," said MPP director 
Bruce Mirken.
Critics say the groups have focused on medical marijuana because most Americans don't agree that pot should be legalized 
for recreational use.
"The fact they've been touting medical-marijuana initiatives shows what a failure they have had in the legalization movement," 
said Tom Riley, a spokesman for the Office of National Drug Control Policy. "The reason why they are still in business is they 
have these eccentric billionaires funding them. Or else they would dry up and float away." One group that hasn't shared the 
recent success in the drug-reform arena is the National Organization for the Reform of Marijuana Laws (NORML).
Once the spearhead of the legalization movement, NORML, launched in 1970, has struggled to get funding and recently 
lost its founder, Keith Stroup, to retirement. "The challenge we face, and I would have to say is the most frustrating failure, 
is we were never able to take that public support we know we enjoy and turn it into public policy," said Stroup, 61.  
"This issue carries with it so much baggage and it would be foolish for us not to recognize that."  Still, NORML will remain a 
grassroots, consumer-based group representing the interests of marijuana users and legalization sympathizers. "They continue 
to play an important role in this struggle. NORML remains relevant -- and if they are able to raise additional funds they will 
be even more relevant," said Drug Policy Alliance  head Ethan Nadelmann.
On Dec. 1, Gov. Ed Rendell signed into law Act 2004-233. Effective last month, it limits judicial discretion when sentencing 
addicts to intensive long-term treatment programs, or what is otherwise known as ''Intermediate  Punishment.'' Candidates 
will be ineligible if, in the last 10 years, they have had a single conviction for any one of 18 violent crimes. Most crimes  on 
the list, such as murder, kidnapping and any crime of a sexual nature, are not new additions. These safeguards are needed 
to prevent predatory or habitually violent criminals, who are not likely to change, from inflicting  harm on innocent citizens.
However, there are three new additions that should not exclude an offender from eligibility. As worded verbatim in Act 
2004-233: 'Any crime related to escape, aggravated assault and robbery.'' The sound of the words: ''escape, aggravated 
assault and robbery'' can conjure up visions of a hardened convict scaling a prison wall, a stabbing,  or an armed robbery  
respectively. Therefore, it is important to know that under existing law, failure to return to work release on time is also  
considered an escape. Taking a swing at, or striking a police officer or an emergency medical technician with a fist constitutes 
aggravated assault. And anything related to robbery can mean taking valuables directly from a person, transporting the robber, 
or simply conspiring to commit the offense.
Granted, these are serious offenses, but they are also symptoms of addiction. Here's why: As drug tolerance rises, so too 
does the intensity of withdrawal symptoms. Since larger doses are needed to obtain relief, a gripping sense of urgency 
to feed a growing dependence ultimately leads to desperate acts that often result in criminal convictions. In time, the 
seriousness of the offenses escalate in proportion to the growing severity of the addiction.
Intermediate Punishment was designed to reintegrate back into society those addicts whose crimes are addiction-driven. 
Research has shown that the longer addicts are kept in treatment, the greater the probability of a successful outcome. 
Lehigh County's Intermediate Punishment program is called Treatment Continuum Alternative Project (TCAP). When 
defendants are sentenced to TCAP, they're admitted to Keenan House, where they must spend four to six months 
in residential treatment, then two to four months in a half-way house, followed by up to one year of outpatient treatment 
at Confront. The first half of the year is spent in house arrest. In the second six months, clients are intensively supervised 
by adult probation.
The gradual re-entry design allows a recovering addict adaptation time for assuming the added responsibility that comes 
with each new phase, while maintaining access to needed supports. Thanks to the joint efforts of Treatment Trends, the 
Lehigh County judiciary, Adult Probation, Pretrial Services, the public defenders and county administration, TCAP has helped 
an increasing number of addiction-based criminals to get well. Addicts who were once a burden on their families and society 
have become contributing members of our community by playing an active role as fathers, mothers, and good neighbors.
Punishment does not rehabilitate. If it did, the Pennsylvania Department of Corrections would be able to easily accommodate 
the low number of re-offenders that its successful rehabilitation efforts would have produced. Instead, it is forever expanding. 
According to the Pennsylvania Department of Corrections population report, as of Jan. 31, 2004, the prison population was 4
0,836, an increase of only 394 inmates from the previous year. These numbers may seem to indicate a fairly stable crime rate. 
However, the day-to-day operations within the department are dependent upon  maintaining a state of relative homeostasis 
by controlling inmate population. Therefore, it is a revolving door.
Inmates, many of whom are actually more violent than those now excluded from Intermediate Punishment by Act 2004-233, 
are granted early parole and released into the community to make room for the ever-growing number of the newly convicted. 
Like many, ''get tough on crime, ''laws before it, Act 2004-233 was designed to give our citizenry added protection from violent 
predators. Ironically, it will only compromise our
safety. Bruce J. Walters works for Treatment Trends in Allentown as an evaluator for the Treatment Continuum Alternative 
Project. Robert Csandl,  director of Treatment Trends, contributed to this article.
From:           Calvin B. Johnson, M.D., M.P.H. Secretary of Health
This transmission is a "Health Alert", conveys the highest level of importance; warrants immediate action or attention.  
The Pennsylvania Department of Health (PADOH), and the Philadelphia Department of Public Health (PDPH) are releasing 
the following
information regarding probable Cyanide intoxication in heroin users. The New Jersey Poison Control Center has reported 
seven cases of probable cyanide intoxication in heroin users who are currently hospitalized in three different healthcare 
facilities in central New Jersey.
The first case presented early on January 29, and the most recent case was admitted early on January 30.  All reported 
nasally insufflating heroin.
One presented with a lactic acidosis and hypotension and was found to have an elevated pVO2, the rest presented with 
nausea, headache, low potassium and elevated pVO2.  The venous blood specimens appeared to be arterial although 2 had 
blood drawn from central venous lines, confirmed by pressure and radiography.  The illness is also characterized by agitation, 
tachypneia, and tachycardia.  Venous blood from these case patients has the characteristic appearance of oxygenated blood.  
Three of the six received thiosulfate infusions and transiently improved; they rebounded and then all received sodium nitrite 
after which their pVO2 levels dropped to within the normal range. Rebound was seen in two of the patients with pVO2 
again over 100.  The source of the heroin has at this time been reported only as from dealers in Easton, PA and Asbury 
Park, NJ.  Laboratory confirmation of cyanide in clinical specimens is pending.  Criminal and public health investigations are 
in progress and the presence of cyanide has not yet been established in heroin used by the case patients.  The source 
of this heroin, and the extent of its distribution are unknown at this time. Clinicians and emergency medical responders 
aring for individuals with similar illness and recent history of heroin abuse should consider cyanide intoxication, and initiate 
empiric therapy if their diagnostic evaluation suggests this diagnosis.
Information about cyanide is available at 
www.bt.cdc.gov/agent/cyanide/basics/facts.asp <

http:// www.bt.cdc.gov/agent/cyanide/basics/facts.asp>,
and at www.atsdr.cdc.gov and http://www.atsdr.cdc.gov
A national policy panel has issued a detailed list of recommendations aimed at cutting recidivism and reintegrating released 
offenders back into society, Stateline reported Jan. 14. The Re-Entry Policy Council (RPC), noting that two-thirds of released 
prisoners swiftly end up back in custody, gave hundreds of recommendations for addressing the problem. "Nearly 650,000 
people will be released from prison this year, and 7 million will be released from jails. Every policymaker should be concerned 
about the public safety and fiscal implications of these extraordinary numbers," said Timothy Ryan, chief of the Orange County, 
Florida Corrections Department, and past president of the American Jail Association.
The bipartisan RPC, which included more than 100 state and federal law-enforcement, corrections, health, and social-service 
experts, noted that at least three of every four released offenders have a history of alcohol or other drug abuse and need 
treatment. Many also lack even a high-school education, have mental or physical disabilities, and are faced with child-support 
payments and low incomes when they get out of jail or prison.

Associated Press 1/28/2005
LAS VEGAS - A federal judge ruled Friday that the Nevada Secretary of State was wrong to disqualify a petition to legalize 
marijuana possession, giving new life to the initiative and two proposed anti-smoking  measures.  An aide said Nevada Secretary 
of State Dean Heller would comply with the judge's order in the marijuana case and would concede a state court case 
challenging his decision to reject the two anti-smoking initiative petitions.
"We will move to drop the other court case and move the three petitions forward to the Legislature," Heller's spokesman Steve 
George said. U.S. District Court Judge James Mahan's ruling on the Marijuana Policy Project's petition came in a challenge filed 
with the backing of the American Civil Liberties Union of Nevada. The ACLU supports letting adults possess up to 1 ounce of 
marijuana for personal use. But Gary
Peck, executive director of the ACLU office in Las Vegas, said the organization filed the federal lawsuit to highlight a "lack of 
consistency, predictability and fairness in the process."
The judge ruled Heller violated the marijuana petition-gatherers' First Amendment, due process and equal protection 
constitutional rights, ACLU
lawyer Allen Lichtenstein said. The ruling sends the measures to the 2005 Legislature, which convenes Feb. 7 in Carson City. 
It will have 40 days to act on the measures, or they automatically go on the 2006 election 
In deciding Heller set the criteria for the number of required signatures too high, Mahan referred to a precedent established 
when Heller qualified a medical malpractice petition for the ballot in 2002, and to a petition guide Heller's office gave to 
signature-gatherers this year.
"Both by precedent and governmental pronouncement, they were given the information that they would need to get 10 
percent of the 2002 total,"
 Lichtenstein said. "The judge ruled they can't change the rules in the middle of the game." Similar arguments were raised by 
Robert Crowell,l lawyer for the Nevada Clean Air initiative petition. Supported by the American Cancer Society, the American 
Heart Association and the American
Lung Association, it seeks to limit smoking in public buildings.  A third petition, with less restrictive anti-smoking rules, is supported 
by casinos and bars. The petition guide said backers needed to submit 51,337 
signatures, based on 10 percent of the voter turnout in the 2002 election.
Proponents of the clean air petition submitted 64,871 valid signatures on Nov. 9 - a week after the 2004 election. Advocates of 
the marijuana proposal submitted 69,261 signatures, and the casinos' smoking petition had 74,348 signatures. Heller, acting on 
state Attorney General Brian andoval's advice, decided the Nov. 2, 2004, general election had become the yardstick for signatures, 
and said the petitions needed 83,156 valid signatures. A spokesman for Sandoval declined immediate comment Friday.  Crowell 
welcomed word that a Feb. 9 hearing on the Cancer Society smoking petition may not be necessary in Carson City District Court. 
"I would say it's over," he said.
Co-occurring substance abuse and mental disorders are more common than most professional counselors, medical personnel or 
the general public realize. A new Treatment Improvement Protocol released today by the  Substance Abuse and Mental Health 
Services Administration (SAMHSA) estimates 
that 50-75 percent of patients in substance abuse treatment programs have co-occurring mental illness while 20-50 percent of 
those treated in mental health settings have co-occurring substance abuse. Most people with co-occurring disorders do not receive 
treatment for both mental disorders  and substance abuse. Many receive no treatment of any kind.
The new Treatment Improvement Protocol is designed for substance abuse treatment counselors and mental health providers who 
usually treat one or the other of the two ailments, but it will also be useful for administrators, primary care providers, criminal justice 
staff and other health care and social service personnel who work with people with co-occurring disorders.
Substance Abuse Treatment for Persons with Co-Occurring Disorders, TIP 42, provides counselors with principles, assessment 
instruments, strategies, settings and models for treating patients wherever they show for treatment, whether it be in substance 
abuse treatment facilities, mental
health facilities or medical offices or clinics. TIP 42, created by a panel of experts and reviewed in the field, also emphasizes that 
outcomes forpatients are enhanced when both illnesses are addressed using an integrated approach.
"All too often individuals are treated only for one of the two disorders - if they receive treatment at all," SAMHSA Administrator 
Charles Curie
said. "If one of the co-occurring disorders remains untreated, both usually get worse. Additional complications often arise, including 
the risk for other medical problems, suicide, unemployment, homelessness, incarceration, and separation from families and friends."
"Since people with co-occurring disorders cannot separate their addiction from their mental disorder, they should not have to 
negotiate separate service delivery systems," Curie said. "We know that with appropriate treatment and supportive services people 
with co-occurring disorders can and do recover. This is the premise of TIP 42."
SAMHSA's 2003 National Survey on Drug Use and Health shows that 27.3 percent of persons 18 and older in the past year with 
serious mental illness used an illicit drug. In 2003, the survey also found that 5.7 million persons ages 18 and over with serious 
mental illness engaged in binge alcohol use and 1.9 million were heavy drinkers. Overall, the survey showed that about 4.2 million 
adults aged 18 and older met the medicalcriteria for both substance abuse and mental illness.
The consensus panel that created the document is encouraging development of a unified substance abuse and mental health 
approach. Emphasis is placed on assisting substance abuse treatment systems to develop the capacity to treat individuals with 
co-occurring disorders while mental health systems develop similar capacities.
This Treatment Improvement Protocol is part of SAMHSA's promise to Congress following the November 2002 Report to Congress 
on thePrevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders to document state-of-the-art 
treatment for individuals with co-occurring mental and substance abuse disorders.
Along with the TIP, SAMHSA has created a State Incentive Grant for Co-Occurring Disorders to help states enhance their 
infrastructure and treatment systems; established a national co-occurring disorders prevention and treatment technical assistance 
and cross-training center, the Co-Occurring Center for Excellence, to provide a broad array of information on co-occurring disorders 
to states and community providers in the substance abuse, mental health and related public health fields; and increased federal 
agency collaboration within HHS to enhance research attention to co-occurring disorders.
SAMHSA has also broadened the agency's efforts to identify and disseminate known effective programs for prevention and treatment 
of co-occurring disorders, including the development of a new tool kit on treating co-occurring disorders; increased collaboration 
between SAMHSA and the Centers for Medicare and Medicaid to explore waysto use existing reimbursement mechanisms for services
to people with co-occurring disorders; and convened two National Policy Academies on Co-Occurring Disorders to help states and 
communities enhance service capacity.
The TIP panel was chaired by Stanley Sacks, Ph.D., of the National Development and Research Institutes, Inc., New York and 
co-chaired by Richard Ries, M.D., Professor of Psychiatry, University of Washington.
TIP 42, inventory number BKD515, can be ordered through SAMHSA's National Clearinghouse for Alcohol and Drug Information.