Noteworthy News Articles on Mental Health Topics, July 17-24, 2000

Meditation Helps to Lower Blood Pressure
Penny Stern, MD, Reuters- 7/17/2000

NEW YORK—Taking part in programs designed to modify behavior, such as anger management training and transcendental meditation sessions, seems to have a measurable impact on blood pressure in African Americans, according to preliminary results of the Health Education and Diet, Stress Management and Anger Reduction Therapy (HEAD SMART) study. The findings were presented Sunday at the 15th International Interdisciplinary Conference on Hypertension and Related Risk Factors Among Ethnic Populations, currently being held in Las Croabas, Puerto Rico.
    "We're finding, at least with the first 84 people who have gone through the trial, that our behavioral and lifestyle modification interventions are having a significant effect on blood pressure," lead investigator Dr. Charlie Lollis told Reuters Health. "Blood pressure, at least from the anger management and transcendental meditation (groups), is being reduced on average by 12 millimeters mercury (mm Hg) systolic and 7 to 8 millimeters mercury diastolic," said Lollis, a professor at the Morehouse School of Medicine in Atlanta, Georgia.
    In this study, the researchers had specially trained certified health educators, a mental health therapist, and a certified transcendental meditation (TM) instructor, study co-author Dr. Kofi Kondwani, administer the various interventions. Study participants spent 13 weekly sessions learning anger management skills, or health behavior modifications, or TM. Lollis pointed out that even in the lifestyle modification group, which was taught about diet and nutrition and other health behaviors but did not receive anger management or training, blood pressure was reduced by 8 mm Hg systolic and 6 mm Hg diastolic. Blood pressure levels are recorded by two numbers, the upper or systolic and the lower, or diastolic. The upper number measures the pressure of the heart during a contraction while the lower number is a reflection of the heart at rest, between beats.
    There are misconceptions about TM, Lollis said. And one of them is that TM is some sort of religion. It is not, nor does it require any religious involvement, she emphasized. "It's a simple mental technique...to achieve a restful state of alertness, kind of the art of doing nothing," she noted wryly. Lollis believes that stress reduction techniques and TM are "really cost effective" and may soon represent adjunct therapeutic options for people with high blood pressure, as the evidence accumulates for the effectiveness of the interventions. She and her colleagues plan to look at the long-term effects of these techniques, as well. "After 3 months (of the study), we showed significant effects, but what happens when you don't have the formal meetings...with the instructor?" she speculated. "Will the individuals continue to participate in the intervention on their own or will we start to find compliance drop?"
    The researchers also will be investigating the effects of combining therapies, such as TM with lifestyle modification to see if the effects are additive, in terms of blood pressure reductions. As to whether other diseases may also be affected by these interventions, Lollis said her team is about "to embark upon (a study) looking at the effects of TM for reducing atherosclerosis," that is, fatty plaque formation on artery walls. "If we can take these interventions and use them (to prevent disease)," she commented, "then we can reduce some of the excess burden of healthcare costs and illness...particularly in African Americans who are so disproportionately represented among the leading causes of death."

Drug Czar Says High-Purity Heroin a Threat to New England
Lisa Lipman, Associated Press- 7/18/2000

BOSTON--New England faces the threat of an influx of heroin so pure that users can inhale, snort or eat it instead of injecting it with needles, White House drug czar Barry McCaffrey warned Tuesday. McCaffrey will meet Wednesday with law enforcement leaders from the six New England states to discuss how to combat the problem.  McCaffrey said the high-purity heroin comes to the area primarily from New York City, but the Canadian border also remains vulnerable to drug smugglers. ''It's essentially unguarded,'' McCaffrey said. ''The northern border is a frontier. ... Cooperation between the Royal Canadian Mounted Police has been superb. But there's very little manpower up there. It's a question mark that has to be closely considered in the following years.''
    Last year, McCaffrey established the New England High-Intensity Drug Trafficking Area with $1 million in federal funding. The funding has allowed local law enforcement officials to link up with FBI agents, federal drug enforcement agents, and other agencies that could assist in the arrest of drug smugglers. There are 30 other such zones across the country. McCaffrey said the goal was to ''target these people (smugglers) for prosecution, to focus on the pipeline, and not just take small-scale criminals off the streets.''
    The New England effort only covers 12 counties in the six states. That means that the program still hasn't arrived in some counties that have heroin problems, such as Middlesex County, which has a substantial heroin trade based in Lowell. McCaffrey said he would ask New England law enforcement officials which counties should be added to the program and he thought Middlesex would be among those suggested. The program's budget this year has increased to over $1.85 million. McCaffrey said more funding would be needed to add new counties and he promised to seek it. McCaffrey said it was too early to tell how well the program was working. ''I think the payoff will happen in the coming years,'' McCaffrey said.
    Col. Edmund Culhane, head of the Rhode Island State Police, said that in his state, more large drug seizures have been made since the HIDTA program began. He also said that working with other states would enable him to dismantle much larger drug operations. The theory behind the HIDTA program is that local police in drug-riddled areas need help to fight criminal organizations that can easily spill over jurisdictional boundaries. McCaffrey said that Connecticut's Bradley International Airport, as well as airports in Manchester, N.H.; Burlington, Vt.; and Warwick, R.I. were vulnerable to drug traffickers. John Gartland, special agent in charge at the U.S. Drug Enforcement Administration in New England, agreed with McCaffrey. ''(High-purity heroin) is everywhere,'' Gartland said. ''We're seeing it in Bangor, Maine; we're seeing it in Cape Cod.''
    But cracking down on high-purity heroin isn't going to solve all the problems, Gartland cautioned. Gartland said that reducing the amount of very pure heroin could simply lead dealers to dilute their mixtures and could lead addicts to return to injecting heroin. In another indication of the threat posed by heroin, the Massachusetts Department of Public Health said Tuesday that, in 1992, 15 percent of people admitted into state-run rehabilitation programs listed heroin as their primary drug. By 1999, the number of people claiming heroin addiction had more than doubled to 32 percent, while the numbers claiming addiction to cocaine, marijuana and alcohol declined.

Stress, Multi-Tasking, High Expectations. Now Anger -- Sometimes Deadly Anger.
Karen S. Peterson, USA TODAY- 7/18/2000

Two shoppers in a Westport, Conn., supermarket get in a fistfight over who should be first in a newly opened checkout lane. A Continental Airlines flight returns to Anchorage after a passenger allegedly throws a can of beer at a flight attendant and bites a pilot. A Reading, Mass., father beats another father to death in an argument over rough play at their sons' hockey practice. And a high school baseball coach in Hollywood, Fla., turns himself in to face charges that he broke an umpire's jaw after a disputed call.
    Bad tempers are on display everywhere. The media report incidents of road rage, airplane rage, biker rage, surfer rage, grocery store rage, rage at youth sports activities. Leading social scientists say the nation is in the middle of an anger epidemic that, in its mildest forms, is unsettling and, at its worst, turns deadly. The epidemic rattles both those who study social trends and parents who fear the country is at a cultural precipice. ''We have lost some of the glue holding our society,'' says parent Frank Smist Jr., 48, of Kansas City, Mo. ''We have lost our respect for others. The example we are setting for our kids is terrible.''
    Experts searching for causes blame an increasing sense of self-importance, the widespread feeling that things should happen my way. Other factors, they say, include too little time, overcrowding, intrusive technology and too many demands for change in a society hurtling forward in the 21st century. ''Rage is the rage today,'' says C. Leslie Charles, author of Why Is Everyone So Cranky? ''I'm describing a fuming, unrelenting sense of anger, hostility and alienation that simmers for months, even years, without relief. Eventually, all it takes is a triggering incident, usually minor, for the hostile person to go ballistic. We even have a phrase for it, ''going postal,'' coined after scattered incidents of violence were committed by postal workers who succumbed to office rage.
    Hard data are tough to come by, but the phenomenon is building. A new USA TODAY/CNN/Gallup Poll finds that more than three-fourths (78%) of Americans believe rude and selfish behavior has increased at highways and airports. And 79% say the number of people who get angry at the bad behavior of others has grown. There are other signs of angry times. Airline employees handed out leaflets in 100 cities worldwide July 6 declaring ''a day of action'' to protest increasing abuse by violent passengers. The International Transport Workers' Federation says American air crews report a large increase in difficult passengers: 534 incidents cited in 1999, up from 66 in 1997.

'A matter of time'
Unruly passengers can actually affect airline safety. A NASA study found that in 40% of 152 cases studied, pilots either left the cockpit to deal with a disturbance or were interrupted by flight attendants who needed help. In one-quarter of those cases, the pilots subsequently reported committing errors such as flying too fast or going to the wrong altitude. ''It's only a matter of time before a serious accident is caused by one of these instances,'' says transport union spokesman Sarah Finke. The union favors prosecution, ''especially in the more serious cases. We think it would be a deterrent.'' Parental attacks at sporting events for children have been rising for a decade, says Richard Lapchick, director of Northeastern University's Center for the Study of Sport in Society. ''There is no question that the number of violent incidents has increased.'' The rising number of incidents has prompted the National Association of Sports Officials to offer assault insurance to its 19,000 members. ''The tenor at the events has changed from even five or six years ago,'' spokesman Bob Still says. ''There is absolutely more violence. Sports has become life with the volume turned up.''
    Competition at children's athletic events grows more intense as adults see possible college athletic scholarships ahead. In general, ''there has been a tremendous increase in parents' emotional investment in their children's extracurricular activities,'' says William Doherty, a professor of family social science at the University of Minnesota. ''Some individuals who don't have very much emotional impulse control go over the edge.'' And as the numbers of kids in sports increases, ''you've got thousands of hothead parents along for the ride.''

Stress and technology
Stress is a hallmark of the anger epidemic, and the major contributing factors are time and technology, experts say. There is not enough of the first, and there is a strong fallout from the second. ''Cellphones, pagers and high-tech devices allow us to be interrupted anywhere, at any time,'' Charles says. ''This constant accessibility, and compulsive use of technology, fragments what little time we do have, adding to our sense of urgency, emergency and overload.''
    Office workers arrive to find dozens of e-mails that must be processed before they can start their business day. People feel the need to constantly ''multi-task,'' says Frank Farley of Temple University, former president of the American Psychological Association. ''I'm on my cellphone now talking to you while I'm driving. I'm at a stop light and I see three other people on cellphones. We are carrying the pressures of the workplace out onto the road.''
    To many, rage might seem a reasonable response, says Pamela Boyd, 52, an elementary school teacher in Olympia, Wash. ''If you have been sitting in traffic on freeways that have been clogged year after year, rage might seem rational. ''There are what, more than 260 million of us now? Our roads were not built to accommodate that. The grocery store parking lots are filled. It is hard to get into the bank. The airport tells you to come 90 minutes before your flight. Parking is at a premium. Overcrowding has become part of society at large'' and that contributes to a sense ''that anything goes,'' Boyd says. Most people feel impatient while waiting in lines, Charles says. ''Who among us has not stood in the express lane in the grocery store and counted the number of items in the cart somebody has ahead of us? Does he have 12 items or less?''
    The growing list of types of rage, from airplane to road rage, are all part of the same phenomenon, says Barton Sparagon, medical director of the Meyer Friedman Institute in San Francisco, which studies the relationship between stress and heart disease. Sparagon refers to ''the hurry sickness,'' the disease of an impatient society moving ever faster. ''When somebody is in a rush, and another person slows him down, the person in a state of hurry sickness can get extremely angry.'' Reactions vary across a wide range, ''from people who rarely exhibit their hostility to those on the other extreme, who have serious impulse control problems,'' he says. Experts have long known some of the roots of adult rage, including personality factors, difficult childhood environments, poor mental health and inadequate social support. New research is pinpointing possible genetic links, as well as a role played by brain chemicals such as serotonin, Sparagon says.
    James Garbarino, human development professor at Cornell University, says such factors are interacting with a societal shift. ''There is a general breakdown of social conventions, of manners, of social controls. This gives a validation, a permission, to be aggressive.'' Kids used to be ''guided by a social convention that said 'keep the lid on.' Today they are guided more in the direction of taking it off.'' Garbarino points to a growing ''culture of vulgarity'' as seen by the growing use of the f-word on cable TV and the glorification of violence in music. Psychologist Frank Farley cites a loosening of inhibitions promoted on TV talk shows such as Jerry Springer's. ''It is OK to say whatever is on your mind.''

Experts point to many other social factors that are creating pressures in the new age of anger:
* Accelerating change.
Farley calls an ability to deal with change ''one of the survival skills of the 21st century.'' ''We are going through one of the greatest periods of change in the history of this country,'' he says. ''There is a creative ferment in technology. But at the same time, people have been downsized to accommodate that. Even good change is stressful. People don't know how to deal with it all.''
* Loss of privacy.
Computer records make it possible for bosses to ''monitor and record everything you do at work,'' Farley says. E-mails can be retrieved, Web sites visited can be tracked, and the volume of work can be documented.
* Lack of responsibility.
''I think people have no sense of personal responsibility about anything anymore,'' says Dale Hartley, who runs the consumerama.org Web site, which tracks consumer complaints and various forms of rage. He includes ''funeral rage,'' funeral-goers who report ''other drivers so impatient to get on with their lives that they can't show a moment's respect for the dead.'' He notes reports of ''bird-flipping, weaving in and out, and cutting off the processions at intersections.'' Hartley thinks the media tend to over-dramatize the incidents of rage, but he notes, ''People do seem to have shorter fuses today.''
* An increasing sense of entitlement.
Charles, author of Why Is Everyone So Cranky?, says that materialism, consumerism and advertising have joined to create a nation of people with very high expectations for living the good life. Although those expectations can't be met for many, there is still a sense that they are entitled to fulfillment. That leads to '' a belief that life should be easy. People should get out of my way. My child should win this game,'' she says.
* Lack of connection.
''Families are just not doing things together the way they used to,'' Farley says. ''Instead, parents are getting kids involved with activities that have rules and structures. The family is no longer the private place where people spend time relating.'' Put all the ingredients together and you have a recipe for rage. ''The American scene is changing,'' Farley says. ''We have a nation of overstressed people.''

Once Again, Prozac Takes Center Stage, In Furor
Erica Goode, New York Times- 7/18/2000

Prozac has never been just any drug.  Soon after arriving on drugstore shelves 12 years ago, Eli Lilly's antidepressant transcended simple pilldom, becoming instead a cultural icon.  Hailed as a wonder drug one minute, cast as evil incarnate the next,  the green and white capsule has generated multitudes of lawsuits and garnered more attention than some presidential candidates.  Perhaps because Prozac treats the ills of the mind, not the complaints of the body, it has also served as a kind of public Rorschach test, a screen upon which Americans project deeply rooted attitudes about illness, character, biology and free will.  So, perhaps predictably, as the drug edges into adolescence and Lilly's exclusive patent on the medication nears expiration, Prozac is once more causing a stir.
    More or less at the center of the newest squall are two psychiatrists, Dr. Joseph Glenmullen, the author of a recently published book, "Prozac Backlash" (Simon & Schuster), and Dr. David Healy, author of "The Anti-Depressant Era" (Harvard University Press, 1998).  They claim that Prozac and its chemical cousins are often indiscriminately prescribed and have more serious and more frequent side effects than the public is aware of or than the package labeling indicates.  Many of their assertions are old ones, in particular the notion that the drugs cause some people to become suicidal or violent, an accusation that Lilly and other antidepressant manufacturer deny and that has so far failed to persuade juries in product liability lawsuits.   But Dr. Glenmullen, who is on the staff of the Harvard University Health Services, and Dr. Healy, a lecturer in psychological medicine at the University of Wales College of Medicine, raise new fears.  They suggest that Prozac and similar drugs, like the antipsychotic medications of the 1950's and 1960's, might pose a significant risk of neurological side effects, that long term use of the drugs might cause brain damage and that future generations might look back on the antidepressants and other psychiatric drugs, in Dr. Glenmullen's words, "as a frightening human experiment."   "Too many people have been lulled into thinking that they have no side effects and no risk," he said.
    The contentions of Dr. Glenmullen, Dr. Healy and other critics, however, have themselves drawn harsh criticism from scientists, psychiatric clinicians and mental health groups, who view them as alarmist and overblown.  Some scientists whose studies are cited in "Prozac Backlash" to support its thesis state that the author never contacted them about their work and they strongly disagreed with his conclusions.  And many psychiatrists said they worried that the new dispute would discourage people with depression from seeking needed treatment.  "Some of the statements that Glenmullen makes are simply outrageous," said Dr. Frederick Jacobsen, a psychopharmacologist in Washington.  "He trashes any benefit of the drugs and selectively quotes studies in a very biased way."
    The idea that Prozac and its later-arriving relatives are dangerous drugs runs counter to the experience of most psychiatrists and researchers.  They see the medications--which enhance the availability in the brain of serotonin, a neurotransmitter believed to be involved in depression--as useful, and sometimes lifesaving, tools for treating a variety of psychiatric disorders.  In their view, the antidepressants have both advantages and limitations.  The drugs, called selective serotonin reuptake inhibitors or SSRI's, are far less lethal in overdose than the older generation of so-called tricyclic antidepressants, making them more difficult for depressed patients to use in suicide attempts.  And they lack some annoying side effects of the earlier drugs, like dry mouth, constipation and weight gain.  Yet 30 percent to 40 percent of patients given the newer antidepressants receive no benefit from them;  a weakness they share with earlier medications.  Studies indicate the drugs may be less effective than tricyclics for severe depression.  And the medications, like all drugs, have side effects of their own, including loss of libido and other sexual difficulties, which occur in anywhere from 36 percent to 75 percent of patients, and a host of other, mostly mild, adverse reactions. 
    Their long-term side effects, if any, are less clear.  No scientist can offer an ironclad guarantee that Prozac and its counterparts--or for that matter, any other potent drug--are absolutely safe when taken continuously for long periods.  Yet what is known, scientists say, suggests that the medications are more benign in their long-term effect on the brain than many other psychoactive drugs.  And 12 years of wide-spread use have convinced most researchers and clinicians of the antidepressants' basic safety.   "The SSRI's are not innocuous," said Dr. Matthew Rudorfer, associate director for treatment research at the National Institute of Mental Health's Division of Services and Intervention Research, "and they should not be used casually.  But it's a vast over interpretation to say that they are dangerous and should be avoided."

A Calm Critique Amid Strong Claims:
Dr. Glenmullen and Dr. Healy said they were not opposed to the use of Prozac or similar drugs, and that they prescribed them regularly in their own practices.  But they deplore their use for people whose complaints are very mild and they criticize physicians who place patients on the drugs for long periods with little or no supervision, a trend that has increased under managed care.  Lilly estimates that 38 million people worldwide have taken Prozac since it was introduced in 1988.  And 10.3 million new prescriptions for the drug were written in 1999, says IMS Health, a market research firm.  "For people with only mild to moderate symptoms whose functioning is not compromised," Dr. Glenmullen said, alternative approaches, like psychotherapy and exercise, "are preferable forms of treatment."  Dr. Glenmullen also educates readers of his book about the withdrawal effects--including nausea, vertigo, flu-like symptoms, mood swings and irritability--that can result if newer antidepressants are stopped too abruptly.  (Prozac, which leaves the body more slowly than other SSRI's, is an exception).  And both he and Dr. Healy criticize the pharmaceutical companies, which they say influence medical research and often minimize adverse side effects in an effort to make their products look good. 
    Yet it is difficult to find scientists or clinicians who support the more extreme suppositions of Prozac's critics.  Dr. Glenmullen and Dr. Healy, for example, argue that neurological side effects--including muscle spasms, facial tics, Parkinson's disease-like symptoms, extreme agitation and even tardive dyskinesia, are more common in patients taking newer antidepressants than the labeling on the drug packaging indicates, and that their occurrence augurs serious problems to come.  Such side effects are frequently produced by older medications used to treat psychosis.  But Dr. Glenmullen said it took decades for doctors to recognize the extent or severity of the reactions.   "Do we this time want to ignore the early warning signs of these effects with serotonin boosters?" he asks in "Prozac Backlash."  "Even if disfiguring tic disorders turn out to be infrequent, with tens of millions of people having been on serotonin boosters, hundreds of thousands could be affected."
    But other scientists say it is misleading to compare antipsychotic drugs, which directly act on the neurotransmitter dopamine, with the antidepressants, which affect dopamine only indirectly.  "If SSRI's do in fact cause tardive dyskinesia-like syndromes, and that's far from proven," said Dr. William Wirshing, a professor of psychiatry at the University of California at Los Angeles and an expert on neurological problems caused by antipsychotic drugs, "they do at a rate so low that it's indistinguishable from background noise in the untreated general population."  Although some neurological side effects are reported in patients taking Prozac and similar antidepressants, researchers and clinicians say that in their experience the reactions are infrequent; some are so rare that many psychiatrists never see them in years of practice.   In many reported cases patients have used other medications, making cause and effect difficult to determine.

Cause for Concern or Reassurance?
Many scientists said that in their views "Prozac Backlash" also blurred distinctions between newer antidepressants and many other types of drugs.  In a discussion of possible long-term effects of Prozac and similar drugs, for example, Dr. Genmullen drew analogies to cocaine and MDMA (the recreational drug known as ecstasy), which are known to cause brain damage, and diet drugs like Redux, which was pulled off the market in 1997.  Dr. Genmullen said research was scant on how Prozac and other SSRI's affected nerve cells in the brain with long-term use, but he argued that findings on the effects of ecstasy and other drugs offered reason for concern about the antidepressants.   "Surely we already know enough to indicate these drugs should be prescribed far more cautiously than they typically are today," he wrote. 
    But Dr. George Ricaurte, an associate professor of psychiatry at Johns Hopkins University and a leading expert on ecstasy's effects on the brain, said that MDMA and newer antidepressants "are two entirely different classes of drugs."  Dr. Efrain Azmitia, a professor of biology and psychiatry at New York University and an authority on serotonin, said he regarded the newer antidepressants as "remarkably effective and in a way, remarkably safe," because unlike many drugs their mechanism of action had "a more psychological flavor, more in harmony with the body's natural rhythms," offering the possibility that "you're not going to all of a sudden see something appear that you didn't see at two years."  Dr. Glenmullen, asked about other scientists' disparate views, said that in his book, "I'm very careful to be really clear about when I'm talking about SSRI's versus other classes of drugs" and his point was that "we badly need more research."

The Suicide Question
Of all the issues raised by Prozac skeptics, the most difficult for many people to sort out is the accusation that the drug is linked to suicide, an association that began in 1990 when a Harvard University researcher, Dr. Martin Teicher, reported on six patients who "developed intense, violent suicidal preoccupation" shortly after starting Prozac.  Dr. Teicher's report was followed by a few other case descriptions from other researchers.  Some scientists offered hypotheses about how such an effect, if it existed, might occur.  One theory centered on an infrequent reaction to Prozac and other medications, a state of agitation and restlessness know as akathisia.  In some cases, researchers suggested, akathisia may be so uncomfortable that it sets off suicidal thoughts, or intensifies existing suicidal impulses.  Other investigators proposed that in rare cases the drugs might paradoxically produce a drop in serotonin levels.   Lowered serotonin levels have been associated in some studies with suicide and other forms of violence.
    In the public arena, the suicide question also created a commotion.  Of the more than 100 lawsuits filed against Lilly, many have been dismissed, and some--the drug company will not say how many--have been settled out of court.  Two have come to trial, with both resulting in jury verdicts in favor of the pharmaceutical company.  In one case Lilly paid the plaintiffs an undisclosed amount.  By the mid-1990's, however, most scientists had lost interest in the issue.  Several larger studies--which compared Prozac to other antidepressants or to dummy pills, including a reanalysis of Lilly's clinical trial data--concluded that subjects on Prozac showed no increase in suicidal acts or feelings; some reported that the drug reduced suicide risk.  In 1991, a Food and Drug Administration advisory committee concluded that there was no persuasive evidence for a suicide link, allaying many people's fears.  The consensus of most researchers was that, in any case, disentangling the effects of the antidepressants from the effects of depression itself, a disease that has a high rate of suicide, was difficult or impossible.   "It would be a needle in a haystack," said Dr. Rudorfer, of the National Institute of Mental Health.  For its part, Lilly said there was no data supporting the idea that Prozac increased suicidal risk.  "On the contrary," said Dr. Steven Paul, a psychiatrist who is a vice president at Lilly Research Laboratories, "all the available data supports the fact that Prozac reduces suicidal risk in depressed patients.
    In reviving the issue, Dr. Glenmullen and Dr. Healy, like earlier critics, focus on Lilly's role in lawsuits and research.  They reprise, for instance, accusations that the F.D.A.'s inquiry was tainted by some scientists' drug company ties.  And they criticize the larger studies of Prozac and suicide, citing problems in methodology, and pointing out that they were carried out by scientists financed by Lilly or working for the company.  They also recycle excerpts from internal Lilly memos, retrieved by lawyers for plaintiffs in earlier lawsuits.  Dr. Healy recently published a study in which 20 normal volunteers, who told researchers they had no history of depression or other psychiatric problems, were alternately given Zoloft, an SSRI and reboxetene, another antidepressant that has not been approved for use in the United States.  Two of the volunteers, Dr. Healy reported, became acutely suicidal while taking Zoloft.  Dr. Healy said that compared with the normal suicide rate in Great Britain, the healthy volunteers on Zoloft showed a 2,000-fold increase in suicide risk.  He believes the same is true for other SSRI's.  "My estimates are that Prozac alone has led to 25,000 people committing suicide" who would not have otherwise, Dr. Healy said.
    But the Zoloft study, published in a British journal, Primary Care Psychiatry, is controversial.  Critics said its methodology was flawed--for example, they said, the study included no placebo control, the subjects were employees of the hospital where Dr. Healy practiced, and no medical records or other independent sources were evaluated to confirm the subjects' reports about their psychiatric histories.  To conclude that Zoloft made subjects suicidal, said Dr. Wirshing of UCLA, "is ludicrous."   Celeste Torello, a spokeswoman for Pfizer Inc., which manufacturers Zoloft, Prozac's closest competitor, said the drug's "safety and efficacy has been proven time and again, in more than 180 clinical trials involving more than 10.000 patients worldwide."  Meanwhile, some researchers whose early reports on the suicide issue were cited in "Prozac Backlash" said they did not agree with the way the issue was characterized in the book.  One is Dr. Anthony Rothschild, a professor of psychiatry at the University of Massachusetts in Worcherster and the author of a 1991 report of three patients who developed akathisia and became more suicidal on Prozac.   "Akathisia can occur," Dr. Rothschild said, "and in some people, who have a previous propensity to feel suicidal and are still suffering from depression, this can sometimes push them over the edge.  But is it common? No. Can it be easily recognized and treated? Yes."   Even Dr. Teicher, author of the original suicide report, said he viewed the risk for suicide as something "that clinicians need to be aware of but it's generally not a huge problem."  Dr. Teicher, who along with others holds the patent on R-fluoxetene, a refined version of Prozac that Lilly has licensed and is testing in clinical trials as a potential successor to the drug, speculated that patients who became suicidal on Prozac and other drugs in the early 1990's might have done so as a result of the higher doses prescribed by physicians.  Lilly's exclusive patent on Prozac expires in December 2003.
    Dr. Glenmullen has written to the F.D.A. requesting that stronger warnings about akathisia and suicides be added to labels for antidepressants.  But the federal agency, a spokesman said, is satisfied that current warning labels, which mention both akathisia and suicidal thoughts as having been reported since the drugs reached the market, are sufficient.  The agency said it had no plans to begin another official investigation into the issue, although it would review any new data that emerged, as it does routinely on topics of public concern.  In the end, the message for anyone contemplating taking Prozac, Zoloft, Paxil, Luvox or other antidepressants, scientists said, may be simply that drugs have side effects, and the decision to take medication always involves the weighing of benefit against risk.  "No one should really be on any type of medication for long periods of time unless they have to," said Dr. Azmitia, of N.Y.U.   "But some people really can't function unless they are on these drugs."

Hospitals Aim to Ease Crisis in Youth's Psychiatric Care
Liz Kowalczyk, Boston Globe- 7/19/2000

Two Boston hospitals have decided to open child psychiatric units after the state, faced with a growing treatment crisis for disturbed youths, agreed to guarantee the cost of treatment. New England Medical Center's Floating Hospital for Children, which closed a similar unit eight years ago, will reopen for inpatient child psychiatry on Aug. 15. Dr. Marshal Folstein, psychiatrist in chief, said children have lived in the hospital's emergency room for as long as two weeks recently because all the programs in the city were full. Carney Hospital in Dorchester is opening a 14-bed psychiatric unit for teenagers gradually over the summer. The two units are intended as temporary stops, usually a couple of weeks, for disturbed children until they are stable and have a long-term treatment plan. Folstein said he expects New England Medical Center's 14-bed unit for children under age 12 to be full within days of its ribbon-cutting.
    ''The kids have been lining up in the emergency room,'' he said. ''We've had to supply 24-hour-a-day sitters and move in video cameras. People were coming in with heart attacks and there'd be no place to put them.'' Because the teenage population has been growing at the same time hospitals have closed psychiatric units, disturbed children needing treatment are being turned away, doctors say. The children are sleeping in emergency rooms or in pediatric surgical units because they can't get into overnight treatment programs. They are stuck in locked psychiatric wards because long-term residential programs are full. And they are being sent home before they are stable - only to have frustrated parents bring them back hours later. In May, Massachusetts hospitals had to board 99 mentally ill poor children in emergency rooms or on surgical floors, said Angelo McClain, vice president for regional operations for the Massachusetts Behavioral Health Partnership. The partnership is a private company that manages mental health care for Medicaid, the government-run health insurance program for the poor.
    State officials, however, said they realized in the spring of 1999 that a crisis was developing, so they began asking hospitals to open inpatient psychiatric units. New England Medical Center ''was very reluctant initially because the reason we closed the unit in the first place was that the rates were so low we were losing money,'' Folstein said.  The medical center closed its unit in 1992 when it did not win a Medicaid contract under the new managed-care plan fashioned by the administration of former governor William F. Weld. The plan was to control costs in Medicaid by granting contracts to hospitals and doctors who offered the lowest rates. This time around, Medicaid officials and the health partnership essentially agreed to meet the hospitals' costs, hospital executives said. ''For a long time people were saying that these kids do not really need to be admitted to the hospital,'' Folstein said. ''I think we have demonstrated to everyone's satisfaction that it wasn't excessive use of resources. The system cut it a little too close.''
    The hospitals do not expect to make money on the psychiatry units but hope to break even, said Mitch Creem, chief financial officer at New England Medical Center. He expects the state Medicaid program to just about meet the unit's $3 million annual budget. Private insurance companies may also end up paying for children to stay in the unit.   ''There's a real crisis out there, and we have a significant children's hospital presence in the city,'' Creem said. ''We felt we really needed to step forward and help solve the crisis. This is not a money-making venture.'' With New England Medical Center and Carney Hospital each adding 14 beds, the total number of inpatient pediatric psychiatric beds will climb to 110 in Boston, McClain said, and 533 statewide. Children's Hospital is the only acute-care hospital in the city with a psychiatric unit for children.
    John Ford, undersecretary of the Executive Office of Health and Human Services, said the outreach to hospitals and the subsequent negotiations were unusual and driven by the growing crisis - and by the fear that it would get worse.  The number of teenagers in Massachusetts is expected to grow by 25 percent between 1995 and 2005, he said.   Executives at New England Medical Center and Carney and state officials would not divulge the rate they've negotiated. But Carney Hospital president Joyce Murphy said that insurers are agreeing to pay between $700 and $800 per child per day, just enough to allow the unit to break even. When Carney made available the first five beds in its new unit last month, the hospital received 130 calls from families and doctors during the first week alone. ''We know kids who live in our neighboring communities who are in trouble, and a lot of them have been going out of state for placement,'' Murphy said. ''But this is a far cry from being able to serve 130.'' Folstein agreed that the new units are only a beginning. ''We still can't provide what we ought to provide,'' he said. ''Things like playgrounds and some sort of facility so parents can stay near their children. But the ER is one of the worst places to keep these children.''

Adoption Saga May Have Wide Impact
Adam Pertman, Boston Globe- 7/19/2000

BURLINGTON, Vt. - Michael Stamatis spent his formative years being tormented in one of the world's cruelest institutions. Then, two years ago, everything changed: He was removed from an orphanage in Romania, adopted by a couple in Vermont, and began to recover from the psychic wounds any child would incur if subjected to sustained emotional and sexual abuse. But the 17-year-old's journey from nightmare to dream didn't last long. The people who took Michael in have dissolved the adoption, relinquished their erstwhile son into state custody, and accused him of sexual assault - a felony charge for which the state plans to prosecute him as an adult.
    Michael's saga is about to spark an international incident. Outraged Romanian Embassy officials in Washington already have drafted a letter to legal and social-service authorities in Vermont warning their treatment of Michael could determine the future of all adoptions by Americans from his country. Moreover, some adoption specialists worry this case could have even wider repercussions, inducing more governments to reconsider their policies on placing children with US families. ''When other countries see Americans adopting their children, then dissolving the adoptions and prosecuting the children, they wonder whether to get involved with us at all,'' said Maureen Hogan, who as president of Adopt America has been working to improve conditions in Romanian orphanages. Vermont officials say they understand that Michael went through hell in Romania, but insist that they are doing everything possible to help him. ''Our recommendations have to be based on the standard of `best interests of the child' ... and not on international relations, on any effect on adoptions generally ... or on any other political considerations,'' said William Young, the state's commissioner of Social and Rehabilitation Services.
    Constantine, as Michael was named in his native country, spent his first 15 years at the Siret Neuropsychiatric Institution in the northeast corner of Romania. The facility is widely known as one of the worst legacies of Nicolae Ceausescu, the longtime dictator who was deposed in late 1989. As many as 200,000 boys and girls were institutionalized during Ceausescu's regime, the majority because their parents were too poor to care for them. Most were abused and deprived of the affection or personal contact necessary to develop normally. While the current Romanian government has markedly improved conditions, and has begun deinstitutionalization programs, its orphanages generally remain damaging places for children to grow up. The one in Siret, where about 500 children now live, by all accounts is among the most horrific.
    Before children from Siret are deemed ready for adoption by Americans, they undergo years of therapy and behavioral training by a team of US physicians and mental-health professionals who travel to Romania. The team is led by Ron Federici, a Virginia psychiatrist who is an authority on institutionalization and has adopted four children from Siret himself. In the case of Constantine and two Romanian girls adopted with him, Federici also intensively screened the parental applicants to assess whether they could cope with the difficulties inherent in raising such challenging children. He approved Lisa and Tim Stamatis of Burlington, who had received high marks for their rearing of five special-needs children they had already adopted.
    For the first year, by all accounts, the three Romanian children made substantial progress and everyone seemed happy with the new family arrangement. But then, for reasons that haven't been explained publicly, something changed dramatically. Michael, the name the Stamatises gave their son, began to slip. The boy had a less-than-normal intelligence level and spoke no English, so he'd always had a hard time communicating. Now he was growing unresponsive to educational efforts, and the sexual acting out that he had done initially - a frequent behavior for sexually abused children who haven't learned other ways of making physical connections - began to recur, according to a detective's report filed in the case.
    At the same time, the Stamatises' willingness or ability to deal with their children's problems changed, too. In the last several months, they have moved to legally dissolve their adoptions of Michael, one of his Romanian sisters, and a severely disabled child they had adopted years earlier. The couple, whose lawyer did not respond to requests for interviews, also filed a complaint alleging Michael had inappropriately fondled the genitalia of both Romanian girls adopted with him. Federici and others described the parents' decision to initiate criminal proceedings, rather than to seek treatment, as unusual. They say it might have been at least partly a financial move by the Stamatises, who would have been responsible for some child-support payments since they voluntarily relinquished their son into state custody. When the minor involved is the object of criminal charges, such costs are absorbed by the state.
    Michael is currently being treated at a facility in southern Vermont, and no court dates have been set for him. Vermont officials declined to discuss why they decided to prosecute him as an adult as well as a juvenile.  Federici, Hogan, and the Romanian government insist the boy's language, cultural, and institutional problems are not being taken sufficiently into account. ''Imagine how lonely he feels, whatever they are trying to do for him; he doesn't speak the language and he knows nobody around him,'' said Federici, who is fluent in Romanian and has tried to become a party to the court cases involving Michael. He has been rebuffed by the judge and by other state officials. They have not said why they have excluded the psychiatrist's participation as an expert witness or as a therapist, though he has volunteered to play either role at his own expense. Federici said he is so concerned about Michael's welfare he has offered to take the boy and his adoptive sisters off of Vermont's hands altogether, again at his own expense. He wants to find other homes for the girls and to place Michael in a specialized treatment facility in Baltimore, where there are other onetime Romanian orphans with whom Michael is friends and whom he has seen during reunions arranged by Federici.
    The press and science attache at the Romanian Embassy, Stefan Maier, has drafted a letter, which the ambassador is now reviewing, praising Federici's efforts and asking Vermont officials to reconsider the psychiatrist's participation.  Michael's prosecution, Maier added in a telephone interview, could hurt future adoptions from Romania. ''This way of dealing with this boy doesn't serve anyone,'' Maier said. ''Not the children who need families ... or the Americans who want children. This way, there are only losers.''

Drug Abuse Treatment Lauded
Megan Scott, Boston Globe- 7/19/2000

Nine out of 10 drug and alcohol abusers who entered treatment programs stayed out of jail last year, and a third of them found jobs, according to the state's most comprehensive study of the effectiveness of substance-abuse treatment. Its conclusion: treatment works. The Massachusetts Department of Public Health's Bureau of Substance Abuse Services found that substance abusers in residential treatment programs were less likely to be involved in criminal activity, to require hospital care, or to experience psychological and social problems. They also were more likely to abstain from drinking alcohol and using drugs.
    ''Every family in the Commonwealth is affected in some way by substance abuse,'' said Massachusetts Public Health Commissioner Howard Koh. ''We are presenting treatment outcomes, and our results indicate that treatment intervention leads to more sobriety, more employment, fewer arrests, and improved health.'' In the United States, substance abuse is estimated to cost $246 billion a year in health care services, crime, auto accidents, and lost productivity. A University of California study indicated that for every dollar spent on substance-abuse treatment, the average taxpayer saves $7 in future costs tied to alcohol and drug abuse. Yet, until now, researchers had not attempted to measure the effectiveness of substance-abuse treatment in Massachusetts in such detail.
    This report has ''national significance in demonstrating how effective substance-abuse treatment programs can be,'' said John Auerbach, executive director of the Boston Public Health Commission. ''I have never seen a report that is as thorough as this. Massachusetts has a particularly well-developed system of data collection and analysis.''  The report indicates that Massachusetts avoided $3.4 million in potential intensive-care treatment costs for newborns in the 1999 fiscal year. Of the 54 babies born to patients in residential substance-abuse programs, 52 were born at full term, had no medical complications, and were of normal birth weight. Massachusetts saved $66,000 per child in neonatal care treatment, according to the report.  Substance abusers getting residential treatment also were more likely to find jobs. The study found that at the time of admission, 4 percent had full-time jobs. Of those that completed the program, 33 percent worked full-time.
    ''There are many positive outcomes of treatment,'' said Teresa Anderson, research and coordination unit manager for the Bureau of Substance Abuse Services. About $90 million a year is invested in the state's 400 substance-abuse treatment programs. Almost half comes from the state. Total admissions to substance-abuse treatment programs was 115,491. Of those, 24 percent were female, 13 percent black, and 13 percent Latino. About 70 percent were unemployed and 16 percent were homeless. They were 35 years old on average, and two out of three graduated from high school. Alcohol was the most abused substance, followed by heroin, cocaine, and marijuana, according to the report.

Dramatic Use in Drugs Reported in the Northwest Cities
David Pitt, Associated Press, 7/20/2000

Heroin use has risen dramatically in the Pacific Northwest, with overdoses in the Portland, Ore., area accounting for nearly as many deaths among young and middle-aged men as cancer or heart disease, the government said Thursday. The drug, at about $20 a dose, is cheap on the West Coast, and black tar heroin from Mexico or South America is readily available there, the Centers for Disease Control and Prevention said. Other studies have indicated heroin overdoses increasing in most U.S. cities in the 1990s, but not as dramatically as in Seattle and Portland.
    Multnomah County, Ore., which includes Portland, analyzed medical examiner reports and found that heroin overdose deaths climbed steadily from 46 in 1993 to 111 in 1999, a 141 percent increase. Eighty-seven percent of the overdoses were among men. In 1997, 67 men ages 25 to 54 died of heroin overdoses in the county, compared with 88 from cancer, 73 from heart disease and 44 from AIDS. The CDC said the report probably underestimated heroin overdoses. Many deaths were excluded because they may have been suicides, and 52 were excluded because the victims were not residents of Multnomah County.
    The Seattle area saw a similar increase, as the number of heroin overdose deaths climbed from 47 in 1990 to 110 in 1999, a 134 percent rise. The population of King County increased 11.3 percent during the same period. Deaths from overdoses of heroin and other opiates peaked in 1998 with 140 deaths. As in Portland, more than 84 percent of the victims were male and many overdoses were not included in the statistics because they were believed to be suicides or because the victims were not residents.
    The CDC has not tracked heroin overdoses nationally, but statistics from the Drug Abuse Warning Network indicate that use of the drug is increasing in most large cities. During 1994 to 1998, DAWN received reports of 20,140 drug-induced deaths in the United States where heroin or related opiates were detected. During that four-year span, heroin overdose deaths increased 25.7 percent. Injection increases the risk of death because of the rapid rise of opiate levels in the blood, the CDC said. Black tar heroin is usually injected because it is too impure to snort. In most opiate overdose deaths, alcohol and other drugs were also involved, the CDC reported.
    Dr. Gary Oxman, director of the Multnomah County health department, said price, availability and a glamorization of the drug in movies and music have contributed to the rapid growth. ''In today's economy you can work a minimum-wage job and scrape up enough for housing and food and be a heroin addict. It used to be a lot more expensive,'' he said. ''We've also seen that heroin at various times has been seen as a fashionable drug.'' Oxman said heroin users develop a tolerance to higher doses and most users eventually stop injecting for periods of time, usually when they are jailed, run out of money or seek rehabilitation. When they resume, they often inject the same dose, and since the body's tolerance has declined, they often overdose.
    Three fourths of the users in Seattle interviewed said they hesitate to call for emergency assistance for fear of being arrested. ''We need enhanced prevention and treatment for opiate addiction and we're going to need a better balance of resources,'' said Dr. Alonzo Plough, director of the Seattle-area public health office. He said federal dollars should be diverted from drug-trafficking programs and placed into treatment, which has proved to be more successful. ''These death rates can be brought down with aggressive prevention and more treatment capacity,'' he said.

Teen Accused of Beating Counselor to Death
Rochelle Hines, Associated Press, 7/20/2000

OKLAHOMA CITY--Kristie LeGrange hoped she could help the 17-year-old boy who had battled psychotic episodes, sleeplessness and learning disorders. The 26-year-old counselor specialized in working with troubled youngsters. But authorities say the teen-ager killed LaGrange this week, bashing her head in with a brick during a counseling session at his trailer home. ''She could have chosen any profession, many would have paid better with better benefits,'' her brother Chris said Tuesday, a day after the slaying. ''But the benefits she was looking for were eternal.'' Jack Chance was arrested on suspicion of murder after police found him driving LeGrange's car with her body in the trunk.
    ''She was a person who truly died doing what she loved to do,'' said Mark Hayes, chief executive of North Care, the counseling center where LeGrange worked. Psychologists from North Care visit clients at their homes. Teams go out on initial visits but after that, counselors go alone. ''She was never concerned about that, I don't believe,'' sister-in-law Kim LeGrange said Wednesday. ''She really cared about those kids she was seeing.'' LeGrange had gone to the trailer home Monday for an appointment with Chance. He lived there with his grandmother, her common-law husband and another child, the manager of the park said. Police believe Chance was alone when he allegedly killed LeGrange, then dragged the body to her car. Chance's grandmother told police that her grandson said he had harmed his counselor. A short time later, police said they found him driving the car.
    Kathy Chance said her son had suffered from mental illness all his life and had the educational level of a second- or third-grader. ''He really liked her,'' she said about LeGrange. ''I had told her that he needed help, more help than he had been getting.'' The victim's family has released what they called a ''Letter to a Killer,'' written primarily by LeGrange's brother. In it, LeGrange's mother, Betty, wrote that Chance had destroyed her life. ''Dare I say I despise you with every bone in my body. She would probably say `forgive him.'''

Judge Throws Out Lawsuit by Repressed-Memory Murder Defendant
Christine Hanley, Associated Press, 7/20/2000

SAN FRANCISCO-- A federal judge Wednesday threw out a civil rights lawsuit filed against prosecutors and detectives by a man who spent 6½ years in prison after being convicted of murder based on repressed-memory testimony. In his ruling Wednesday, U.S. District Judge Charles R. Breyer also partially cleared George Franklin's daughter of liability in a case that fueled national debate about the legal reliability of repressed memory.
    Franklin, a former firefighter, was convicted in 1990 after his daughter, Eileen Franklin Lipsker, said she recalled witnessing her father crushing 8-year-old Susan Nason's skull with a rock in 1969. Franklin went to prison for 6½ years, but a federal judge overturned the conviction, saying jurors were improperly told that Franklin had admitted the crime by remaining silent in the face of his daughter's accusation during a jailhouse visit. The judge also said the defense should have had the chance to prove that details Lipsker claimed to remember firsthand were contained in newspaper articles.   Prosecutors decided against a retrial after learning that Lipsker had falsely accused her father of a second murder.
    After his release, Franklin sued his daughter, her therapist, prosecutors, detectives and expert witnesses, saying they ''trampled on my rights and the truth.'' He sought $1 from his daughter and unspecified damages from the other defendants. Breyer already has dismissed the claims against the therapist and witnesses. In his latest ruling, Breyer found that detectives and prosecutors who investigated the case did not arrest Franklin without probable cause or violate his right to an attorney.

Sex Offender's Past Was Marked by Abuse
Jordana Hart, Boston Globe- 7/20/2000

Convicted sex offender James Lee Pells, facing a new rape charge, had an early life filled with sexual and physical abuse that, while not excusing his crimes, exemplifies the complex, violent currents often converging in a sexual predator, officials say. Pells, 43, was arrested last week for allegedly raping a 19-year-old mentally disabled Hyannis man and ordered held without bail following a dangerousness hearing yesterday. Specialists said they consider him to have the classic history of a sex offender.
    At 8 months of age, Pells was assigned to a school for boys on Cape Cod and then bounced between foster homes and his parents, according to a report by two doctors and a correctional officer who reviewed his case in 1998. Pells saw his alcoholic father beat his mother and sisters. By the time he turned 16, had been repeatedly raped by his father, an uncle, and an older brother over a period of four years, his records show. With an IQ of 65, Pells was deemed mentally retarded and enrolled in special education in Osterville's public schools, but he quit in the eighth grade. He could barely read. He smoked marijuana, drank, and sniffed gasoline, the report said. As a teenager he beat his mother with a belt. He also admitted to clinicians that he had sex with a 17-year-old relative when he was 16.
    No matter how harsh an offender's past, clinicians refuse to let men like Pells lean on their trauma to explain away rapes and attacks, saying they must learn control and responsibility. But some specialists said these childhood histories should serve as a signal. ''It's not about saying `Poor, pitiful him' but about asking when will we stop the abuse of children,'' said Craig Latham, a forensic psychologist in Natick, who treats sexually abused children and children who are abusers. ''What will stop all this is protecting people like [Pells] when they are children, not punishing him after he has abused several other people.''
    Pells, who twice pleaded guilty as a teenager after trying to rape a 13-year-old girl and a 61-year-old woman, spent 20 years at the Massachusetts Treatment Center for Sexually Dangerous Persons in Bridgewater. A jury ordered him released in June 1998, even though three out of five state specialists on a review panel determined he was still a sexual predator. The other two doctors on the panel argued that Pells be released because he had shown empathy for some of his victims by letting them go without raping them and also that his borderline intelligence had hampered his ability to gain any more benefit after 20 years of treatment. At the hearing yesterday in Barnstable District Court, Pells was determined to be a threat to the public and ordered held without bail for at least 90 days. His pretrial conference is Aug. 1. His lawyer has argued that sex with the Hyannis man was consensual.
    In interviews, clinicians around Massachusetts who treat sex offenders said that between 65 percent and 95 percent of the offenders are believed to have suffered sexual and other types of abuse as youngsters. Increasingly, they are treating younger abusers, many of them under 18. Added to that, thousands of children have seen their father or a boyfriend rape or beat their mother, which studies show can cause as much psychological damage to children as being attacked themselves, Latham said. ''What we have learned from talking to kids is that many have seen their mothers hurt physically and sexually and so they get the idea that when you are mad, you do this,'' he said. ''There is a fusion of sex and violence.''
    Further complicating an already difficult treatment plan was the fact that Pells, who had been living in a Hyannis homeless shelter, is considered mentally retarded and was not considered to have greatly benefited from the standard programs at the center. But Thomas P. Keating, a clinical social worker from Fitchburg who was not involved in Pells's case, said he has developed a therapy that helps ease this group mostly made up of men back into society.  ''There's no cure for sex offending, but this is a system you can carry in your pocket, a card with the seven steps: Reality, empathy, self-esteem, plan, evaluation, choice, and trust,'' said Keating, adding that his method, known as Respect, is part of a comparative study this fall of sex-offender treatment programs.

Maine Asks for Dismissal of Lawsuit Over Services to Children
Associated Press, 7/20/2000

PORTLAND, Maine--Maine officials are asking a federal court to dismiss a class action lawsuit that accuses the state of failing to adequately care for children with serious mental and behavioral problems. Maine has launched a broad effort to improve services for children, and the claims filed last month were resolved in 1997 by a previous lawsuit, according to attorneys for the state.  Advocacy groups that filed the class action suit were angered by the motion, filed Monday in U.S. District Court in Bangor. William Kayatta Jr., a Portland attorney representing the children, said the services the state is asking for more time to provide should have been provided years ago. He also said the state's five-year plan for improving the services, which is in its second year, is not moving fast enough. He said the delays are hurting one of the state's most vulnerable populations.
    Assistant Attorney General Christopher Leighton defended the state's response to the lawsuit. ''The common sense view here is that we were sued, and we responded and greatly expanded the programs,'' he said. ''That we are even involved in litigation is very frustrating, because so much effort and so much money has gone toward helping these children.'' The lawsuit claims that hundreds of children with behavioral and mental health problems are not receiving the state services that Medicaid entitles them to. A state survey in March found that more than 500 children are not getting the in-home care they need, since the state doesn't have enough in-home care providers.
    The suit names the Department of Human Services and the Department of Mental Health, Mental Retardation and Substance Abuse Services as defendants. Kayatta is lead attorney for the plaintiffs, working with the Maine Equal Justice Project and the Disability Rights Center of Maine. The state says it has dramatically increased services since the previous lawsuit, with the number of children receiving behavioral services jumping from 65 in fiscal 1997 to 1,164 in fiscal 1999. The services cost the state just $236,127 in 1997, compared to $9.3 million in 1999. But Kayatta said that the programs the state has put in place are not working. ''That state is planning to take more time to get these kids the care they need than it will take to widen the Maine Turnpike,'' he said. ''These kids can't wait.''

Judge Blasts Drug Courts
Howard Pankratz, Denver Post- 7/21/2000

Denver's drug court and drug courts around the nation came under fire Thursday when a veteran Denver judge wrote in a law review article that the courts are ineffective gimmicks meant to appease voters, law enforcement and medical experts. "The scandal of America's drug courts is that we have rushed headlong into them - driven by politics . . .fuzzyheaded notions about "restorative' justice . . . and by the bureaucrats' universal fear of being the last on the block to have the latest administrative gimmick," Denver District Judge Morris Hoffman said in a North Carolina Law Review article released Thursday.  Though he never presided over the drug court, Hoffman was particularly critical of Denver's drug court, claiming it was approved at a single meeting of the Denver judges with the entire discussion lasting less than 30 minutes.
    Drug courts typically let certain people charged with drug offenses avoid jail time in exchange for their continuing, successful participation in a treatment program. Supporters say that is an effective way of reducing crowded court dockets and getting drug users help. But Hoffman, who began serving on the Denver bench in 1990, said drug courts are just "the latest Band-Aid we have tried to apply over the deep wound of our schizophrenia about drugs." He questions how drug use can be punished when "our self-described experts have been telling us for so long that addiction is a disease." Hoffman, said the proponent of the Denver drug court, Judge William G. Meyer, presented it as a "sort of a functional fait accompli." "In this atmosphere it was understandably difficult for most of us to analyze the proposal critically, for fear that any criticism would be interpreted as a criticism of a very talented, hardworking, committed colleague," Hoffman said. Hoffman said there is no reliable data that drug courts work. Without such proof, "we should consider abandoning the experiment," Hoffman said.
    But Hoffman's contentions were challenged Thursday by Meyer; Adam Brickner, recently named drug coordinator for the city of Denver; and Denver District Attorney Bill Ritter. Meyer, in particular, took exception to Hoffman's claim that the drug court in Denver is not working. Meyer listed 10 ways the court has - in his opinion - been successful. Those include cutting case processing time, enabling those who need treatment to be appropriately placed as quickly as possible; helping reduce overcrowded dockets in the criminal courtrooms; and by allowing defendants the opportunity to participate in treatment by placing them in a less-restrictive setting. Meyer said local drug court data for 1996 suggests that 81 percent of the individuals sentenced stayed with treatment through the six month time frame measured and that the drug court offenders spend less time incarcerated, which saves the city and state between $1.8 and $2.5 million annually.
    A 1999 U.S. Justice Department sponsored study of a decade of drug court cases concluded that recidivism among participants was between 5 and 28 percent, and less than 4 percent for graduates. Ritter said he attributes Denver's declining crime rate, in part, to the drug court. "We've had this drug court now for seven years, and . . . in that seven-year period we've also seen our crime rates nose-dive," the district attorney said. "I think drug court plays an enormous role in that. "That's the thing we've changed most significantly in the criminal justice system," said Ritter. "We are putting 1,700 offenders a year through there. The tight supervision of their treatment is different than anything done prior to drug court."
    Brickner, who will assume his new job as Denver's drug czar in mid-August, and has worked as the drug court coordinator since 1998, said that Hoffman got his statistics wrong. The drug court has done a very important job, he said. "Drug courts hold substance abusing offenders accountable for their actions," Brickner said. "Drug court offenders are responsible for paying for their own treatment and their own drug testing. So it does not, really, cost the taxpayers more than what they were already paying for a district court judge. There is some more staff, but most of it is grant funded." Brickner said that national research shows that between 1986 and December 1999, 70 percent of drug court clients either graduate or are still active in the program. "I think that Judge Hoffman looked at some statistics incorrectly - certainly the one where he said that 80 percent of our clients recidivate," Brickner said. "That wasn't true."

Northwest Can't Kick Habit: CDC Reports Surge in Drug Use
Luis Cabrera, Associated Press, 7/21/2000

SEATTLE- Lisa Grenier extended her arms, palms up, to reveal deep track marks, the signature of heroin use.  ''This is what it does to you,'' she said, sobbing. ''It's the worst thing that you can ever, ever do. Don't do it. Don't even try it, not even once.'' Now 42, Grenier is a 20-year addict. She is also one of approximately 15,000 to 20,000 heroin users in Seattle and surrounding King County, where a new federal report says overdose deaths have increased 134 percent in 10 years.
    A similar rise was seen in Portland and surrounding Multnomah County, Ore., where nearly as many men ages 25-54 now die from heroin than cancer or heart disease, according to the study published Friday by the Centers for Disease Control in Atlanta. Other studies have shown heroin overdoses increasing in most U.S. cities, but not so dramatically. ''It's a very serious problem, and one that we're addressing very aggressively,'' said Dr. Alonzo Plough, director of the Seattle-King County Health Department.
    King County recently expanded its methadone treatment program, which allows addicts to function normally without agonizing heroin withdrawal. Yet the program still has a waiting list of 600 names, Plough said. Grenier said she has been waiting for more than a year for treatment. ''It shouldn't take that long to get somebody on. It shouldn't, because then people go out and start stealing and whatever else they need to do'' to pay for a fix, she said at the downtown Street Outreach Services, a drop-in center for injection drug users. ''We've got people who come in every single day asking where they are on the list. These are people who are desperate,'' said Kris Nyrop, executive director at the center, where about two dozen men and women sipped coffee and watched television Thursday. At least a dozen more stood outside.
    According to experts and recovered addicts, Seattle and Portland have both struggled to supply resources to treat addicts who are most seriously ill. Both cities are on the Interstate 5 corridor, which runs from Mexico to Canada. That, coupled with their role as international ports, makes the cities convenient for smugglers selling ''black tar'' heroin from Mexico and South America, said Capt. James Ferraris of the Portland police drug and vice division. ''Heroin is much more available now than it ever has been in the past, and the younger crowd is breaking into heroin use in particular,'' he said.
    Chris Harvey, a recovered addict and counselor from Portland, said many users aren't as cautious about the more potent heroin. ''If you know a hard-core addict and somebody down the street just bought some dope and overdosed and died, the first thing this guy's gonna say is, 'Where did he get that? I want some of that,''' Harvey said. ''That's the insanity of drugs.'' Heroin doses start at about $20.
    Dr. Gary Oxman, director of the Multnomah County health department, said price, availability and a glamorization of heroin in movies and music have contributed to the rapid growth in use. In Seattle, Nyrop said the city's reputation as a heroin hotspot was established during its ''grunge rock'' heyday of the mid-1990s. It was magnified by the 1994 suicide of Kurt Cobain, the lead singer for the group Nirvana who struggled with heroin addiction. Three months later, Kristen Pfaff, the bassist in the band of Cobain's widow, Courtney Love, was found dead of an overdose.
    The number of heroin overdose deaths in Seattle and King County climbed from 47 in 1990 to 110 in 1999. Overdose deaths peaked at 140 in 1998 topping the 137 who died in auto accidents the same year. Overdose deaths are expected to top 100 again this year. In Multnomah County, heroin overdose deaths climbed from 46 in 1993 to 111 in 1999. Three years ago, 67 men ages 25 to 54 died of heroin overdoses, compared with 88 from cancer and 73 from heart disease. The CDC has not tracked heroin overdoses nationally, but statistics from the Drug Abuse Warning Network indicate use of the drug is increasing nationwide. During 1994 to 1998, DAWN received reports of 20,140 drug-induced deaths in the United States where heroin or related opiates were detected. During that span, heroin overdose deaths increased 25.7 percent. Nyrop said those who overdose often had stopped temporarily because they were in jail or could not get the drug. They inject the same high dose after losing tolerance to the drug, with fatal results. Grenier said she had witnessed two recent overdoses. ''One was this guy I know. He made it. He was one of the lucky ones,'' she said. ''And I seen one down at the (Pike Place) public market. She didn't make it.''

Stalking Law is Last Hope for Victims
Maryanne George, Detroit Free Press- 7/21/2000

ANN ARBOR--Sandy Chumney lived in a shelter, moved five times, dropped out of school, filed for divorce, obtained a restraining order and finally bought a gun to keep her abusive husband from stalking her. But shortly after he was paroled in 1990, after spending slightly more than three years in prison for raping and kidnapping her, the stalking began again, Chumney recalled Tuesday.  Although her home and car were vandalized repeatedly and her ex-husband made death threats that were reported to the Ann Arbor police, there was little police could do except warn her.  "The police worked with me, but their hinds were tied," said Chumney, 52.  "They could never find him, and there was no law to hold him."
    Chumney is among the many stalking victims and law enforcement officials who are fearful of the effects of throwing out Michigan's stalking law.  A federal judge ruled last Friday that the law is unconstitutional.  The Free Press typically does not publish rape victims' names.  Chumney gave her permission to be identified.  In 1992 she testified about her ordeal before the state legislature during hearings on a proposed stalking law that was enacted in 1993.  The stalking law has helped a lot of women," said Chumney, who is a staff member of Washtenaw County's Domestic Violence Project.  "At least there are consequences now where there never used to be."  Chumney said her ex-husband stopped stalking her when he moved to California, but she still is afraid to go out alone at night and still owns a gun for protection.  "If he wants to find me, he will," she said.  "He had gone door-to-door looking for me and followed my friends."
    U.S. District Judge Richard Enslen ruled that the law was "unconstitutionally overbroad" and could criminalize behavior protected by the First Amendment, such as news reporting or telemarketing.  Enslen issued a 2-week stay of his ruling to allow the state Attorney General's Office to appeal his decision to the U.S. 5th Circuit Court of Appeals.  Attorney General Jennifer Granholm is seeking another stay while the case is appealed.  The parole eligibility dates of approximately 126 people who are serving time for aggravated stalking may be affected if Enslen'[s ruling is upheld.   But Matt Davis, spokesman for the Michigan Department of Corrections, said the majority of those people are serving multiple sentences and that each case must be reviewed individually.
    "It's really upsetting that the stalking law has been thrown out," Chumney said.   "So many people worked so hard to get this law in place."  Joan Zorza, a member of the board of directors of the National Coalition Against Domestic Violence, said that all 50 states have passed stalking laws within the last decade and that all but tow have successfully survived legal challenges.  After a Texas law was ruled unconstitutional in 1996, it was amended and has since withstood legal challenges, she said.  Parts of a Massachusetts stalking law were thrown out several years ago and later amended.  Zorza said she expects Enslen's ruling to be overturned on appeal.  "The Michigan case is surprising because there have been so many challenges tried in other states and they went nowhere," Zorza said.  "It's also disappointing because it trivializes some of the most damaging and terrorizing behavior."
    Stalking happens not only in cases of domestic violence but also to celebrities such as David Letterman and Madonna.  Cyberstalking has added a new dimension to the problem, Zorza said.  Every year, one million women and 400.000 men are plagued by unrelenting pursuers who harass, terrorize and kill victims or anyone else deemed in the way of a stalker's goal, according to a 1998 study by the Justice Department.  One in 20 women in the United States will be stalked at some point in her life, various studies have suggested.  "It's something people are doing in greater numbers," Zorza said.  "they move on to stalking when restraining orders have prevented assaults."
    Enslen's ruling came in the case of Jerry Lee Staley, a 39-year-old Barry County man convicted of aggravated staking of a former girlfriend in 1994.  Staley, who had been convicted of crimes as a juvenile and an adult, was sentences to life in prison on the 1994 stalking conviction as a habitual offender.  The state Court of Appeals later upheld the conviction but determined that Staley's sentence was excessive.  He was resentenced to 15 to 25 years in prison.  In 1997, the Michigan Supreme Court denied Staley's appeal of that sentence and he took the case to federal court, arguing the stalking law was unconstitutional. 
    Chumney's case is a good example of how a stalker can devastate a victim's life, said Jim Fink, chairman of the state's Domestic Violence Prevention and Treatment Board.  Fink worked as a lieutenant in the Washtenaw County Sheriff's Department when Chumney was being stalked, and also recounted her ordeal Tuesday."  "Stalking goes on and on," Fink said.  "It's not like other crimes where there is an event, a resolution and then people pick up the pieces and go on."

A Record 4.5 Million Americans on Probation or Parole
Ellen Nakashima Washington Post, 7/24/2000

WASHINGTON - The number of people on parole or probation reached a record 4.5 million in 1999, the Justice Department announced yesterday. The biggest increase is in probationers, reflecting a rise in drug arrests and a decline in the number of drug offenders sent to prison. Twenty-four percent of the people on probation were convicted of drug offenses and 18 percent were given probation for drunken driving. ''What we've seen is a 30 percent decline in the likelihood of going to prison for a drug arrest over the last decade,'' Justice Department statistician Allen J. Beck said. ''So even though we've had an increase in drug arrests, the flow into prisons has stabilized.''
    More than 1 million of the nation's probationers and parolees were in Texas, with 556,410, and California, with 446,460. States with the largest percentages of their adult population under community supervision were Georgia, with 5.8 percent, and Idaho, with 4.2 percent. The parolees and probationers are part of the burgeoning population that is under correctional supervision as a result of a national crackdown on crime, Justice Department officials said. States have built prisons, toughened sentencing standards, and increased options for community supervision. Overall, the number of people under correctional supervision stands at an all-time high of 6.3 million, with 1.86 million men and women behind bars as of June 1999. The number has climbed every year for a decade. New figures will be released next month.
    ''The scope of the criminal justice system has increased substantially over 20 years,'' Beck said. ''It went from a little over 1 percent of the adult population back in 1980 to now up over 3 percent of all adults. That's one out of every 32 adults.'' Despite a decline in violent crime, arrests for simple assaults were up by 28 percent between 1990 and 1999; arrests for forgery, fraud, and embezzlement increased 37 percent; and arrests for drug use and sale rose 34 percent. The three types of convictions disproportionately result in sentences of probation, which allow offenders to avoid prison or jail but remain under supervision in the community. After a steady increase in the 1980s, the parole population last decade stabilized at around 700,000, which Beck said reflects a drop in prison-release rates and an increase in lengths of stay.

The Prosecutor, the Investigation and the Suicide
Fawn Germer, Washington Post- 7/24/2000

TAMPA –– "Hangin' Harry" Coe had been scrutinized by the media before. So nobody expected Hillsborough County's top prosecutor to kill himself because of it. Especially when the attention focused on $12,000 in loans he'd paid back. What made Coe's July 13 suicide even more unbelievable was that the very reporter who uncovered the loans was the one who found Harry Lee Coe's body under an expressway overpass. Now, acting on orders from Gov. Jeb Bush (R), state investigators are sifting through whatever secrets the former semi-pro baseball player, circuit judge and state attorney left behind. As the public waits, it has been quick to lash out against the messenger. It's a peculiar legacy that ended three days after WFLA investigative reporter Steve Andrews reported Coe had borrowed $5,000 and $7,000 from two employees he had considered "lifelong friends." The press speculated on whether employees might have felt pressure to make loans to their boss, although Deanna Easterling, who had worked with Coe for 30 years, said she hadn't. As other reporters jumped on the story, they questioned why the 68-year-old Coe, who made $216,502 a year between his salary and judicial pension, would borrow money from anybody.
    Through much of his eight-year tenure as state attorney, tales of a gambling addiction hounded Coe, who got the nickname "Hangin' Harry" for some of the stunning 100-year-plus sentences he handed down as a circuit judge. After he ran and won as state attorney, Coe became the oddball of local politics when he reported two guns--and his underwear--had been stolen from his car. Then, when several other guns apparently vanished from the state attorney's office, he said that wherever they were, he was certain "they're where they ought to be." The loans were just the latest incident to come to light. "He has weathered darker days than this in the past, both in the media and in his life," said Coe's son, Harry Lee Coe IV. "You just never know. I think he was under a lot of stress and continued to internalize it. Obviously, he was feeling pressure financially, political pressure in the middle of a high-profile race in an election year, and he was probably experiencing emotions and forces and pressures that we don't know or understand." Coe had long held a reputation as a gambling man who made too-frequent trips to local dog tracks. When asked about it, he said he had already quit gambling, that it wasn't a problem and he hadn't broken the law. But he was continually seen at the races. Andrews's stories led to questions of whether Coe was borrowing money to feed his gambling habit.
    "I continue to regret that we didn't have it first," said Paul Tash, editor of the St. Petersburg Times of the loan story. "I am sorry it came to such a tragic result, but it is an absolutely fair question to be explored." "I think that the TV and the news I saw was balanced and restrained," said Gil Thelen, executive editor of the Tampa Tribune. "The only case you could possibly make is, because it was sweeps time, [Channel] 8 was promoting its investigative report Saturday and Sunday in Wimbledon heavily. That could smack of audience-building and ratings-chasing in some people's eyes, but it is certainly normal practice in broadcasting." Coe's former wife and close friend, Ida Felicione Coe, wondered what Coe, an avid tennis player, thought when he saw the promotions airing repeatedly.
    "I'm not saying the media caused him to go to his death, but they certainly were a part of it," she said. "I'll always believe that." WFLA news director Dan Bradley said the stories weren't timed to hit during the July sweeps period, but aired because that's when they were ready. Andrews stayed on it, trying to nail down a story that Coe had been using his state-issued laptop computer to bet online. When Andrews requested Coe's Internet records through the Florida Open Records Act, he was handed a list with just two Web sites, which had been visited only in 1998. The station contacted law enforcement to see whether Coe violated public records laws by purging records on his computer.
    On Wednesday morning, July 12, Gov. Bush ordered the Florida Department of Law Enforcement to investigate. "After that, it was the lead story on four of the five news stations. Everyone was looking for Harry," Bradley said. Coe left the office that afternoon and wouldn't return calls. By Thursday morning reporters and photographers from every newspaper and television outlet waited for Coe to show up for work. "That's what the media does," Bradley said. "A public official is in the center of a story and the media wants a comment." Coe's parking space was empty. Andrews called Coe's secretary and was told Coe wasn't there and she wasn't sure if he'd be coming in at all. Perplexed, Andrews and producer-photographer Gordon Dempsey drove to Coe's apartment complex. They didn't know which apartment Coe lived in, but they saw his car and a car belonging to one of the prosecutor's friends.
    They waited for about two hours, and saw one of Coe's former prosecutors drive up and look inside his car windows. "She looked nervous and upset," Andrews said. "I thought, 'I wonder if he's missing. I wonder if he's okay.' " As she left, Andrews and Dempsey drove around the nearby area. Andrews spotted a man sitting against a concrete pillar under the expressway, and assumed it was a homeless person. They decided to take a look after debating whether it might be Coe. "I noticed the gun. It was, 'Holy God, what is this?' " Andrews said. "A hundred things were going through my head. We had no idea what we were coming up on." Andrews realized he'd found Coe. Dempsey called 911, then the two called the station. Sometime between 9 p.m. and 6 a.m., Coe had held a .38-caliber revolver to his forehead and ended his life.
    The irony of Andrews finding the body was all the news, and the backlash was immediate and fierce. Andrews says he is still chilled by the bold-lettered e-mail that called him "MURDERER!!!!!" He has lost count of messages asking, "Are you happy now?" "You know, you can take a couple of 'you stinks, you're a rat, you're responsible,' but man, it was overwhelming," he said. "There were several very supportive notes from people who said 'Mr. Coe killed Mr. Coe, not Steve Andrews,' but it was hard working through that. As an investigative reporter, I've always felt good about sticking up for the little guy. Suddenly, there was this groundswell of hate mail that was directed at me."
    Two letters were discovered after Coe's death. One, in his apartment, said he wanted to be cremated and didn't want a funeral. It was signed by witnesses. The other, left in his office, was a one-sentence letter concerning Deanna Easterling, who had lent Coe $5,000. Their friendship had suffered when Coe, a Democrat, recently endorsed the Democratic county commission candidate who was running against Easterling's daughter, a Republican. The second letter said, "I hereby authorize the termination of Deanna Easterling effective immediately." Coe's death did not end the investigation into the prosecutor and his office. Many speculate that there is much more to come. "Apparently," said his former wife Ida, "he had more concerns than we knew."