Noteworthy News Articles on Mental Health Topics, August 14-20, 2001

OxyContin Abuse May Curb Progress in Pain Field
Linda Marsa, Los Angeles Times, 8/14/2001

Riddled with pain from rheumatoid arthritis and a degenerative bone disease for years, Diana Rose rarely left the house. Then in November, a doctor prescribed the painkiller OxyContin, dramatically changing her quality of life. "I can actually go shopping at the mall, play with my grandchildren and even swim in our pool," said Rose, a 57-year-old Kentucky woman. "This drug has enabled me to do things without being in pain."
    OxyContin, a powerful drug that is a chemical cousin to opiates such as morphine and heroin, has enabled thousands of people, such as Rose, to resume the normal activities of life. But now some doctors fear that a backlash triggered by rampant street use of the drug dubbed "hillbilly heroin" will derail significant advances in the field of pain management. They worry that U.S. drug officials may respond to rising illicit use of OxyContin by yanking it from the market, place stricter limits on the use of all opiates, commonly used to treat cancer patients, severe back pain and other chronic pain conditions. "This is not just about OxyContin," said John D. Giglio, executive director of the American Pain Foundation, a nonprofit consumer group in Baltimore. "This is about the potential for rolling back progress made in pain management. It's been an extremely hard uphill climb to get physicians to become more comfortable prescribing opiates and overcoming the stigma among patients about potential addiction and abuse." OxyContin is a synthetic opiate that has fewer side effects than other potent pain medications, including morphine or codeine, which can cause nausea, constipation or drowsiness. What's more, OxyContin is formulated to keep steady levels of the drug circulating in the blood for as long as 12 hours. Patients don't experience the intense peaks and valleys of taking other narcotics, like Vicodin or Lortab, which can take an hour to provide pain relief and whose effects wear off in four hours.
    Soon after OxyContin was approved in 1995, recreational drug users discovered that chewing the pill, rather than letting it dissolve in the gastrointestinal tract, crushing it into a power that can be snorted or intravenously injected, produced an intense high. Within a few years, Appalachian communities in Virginia, West Virginia and Kentucky, and rural Maine reported a wave of users who had become addicted to the drug. Since then, illicit use of the drug has spread throughout the country. It is estimated that more than 200,000 Americans have abused the drug, which also has been implicated in more than 100 deaths from suspected overdoses. Several doctors have been convicted of illegally dispensing the drug, while "Oxy" addicts increasingly turn to crime to feed their habits.
    The growing alarm about illicit use is having a chilling effect on legitimate use of the drug. Six states--Florida, Maine, Ohio, South Carolina, Vermont and West Virginia--have set strict limits on the number of pills that can be prescribed for people on Medicaid, the state-federal health program for the poor. That means that doctors may not be able to increase dosages for patients who need stronger pain relief. In the wake of several robberies at drugstores across the country, many pharmacies now refuse to stock it, and physicians are reluctant to prescribe it. "Since all this hysteria began, some patients have been abandoned by their doctors," said Dr. J.S. Hochman, executive director of the National Foundation for Treatment of Pain in Houston. "I had two patients, a mother and daughter with severe rheumatoid arthritis who had to fly from Boston to Houston to find a doctor--and were willing to do so because they were so desperate. It's pathetic."
    Some patients are so concerned about the negative publicity, especially fears of addiction, that they've asked their doctors to take them off the drug. "The day after an OxyContin story aired on one of the TV newsmagazines, I had two cancer patients come in the next day, telling me they wanted off the drug," said Dr. Neal Slatkin, director of supportive and palliative medicine at City of Hope National Medical Center in Duarte. "Their pain was well-controlled, and they weren't having side effects," he said. "So I spent a lot of time reassuring them that this drug was OK. But the whole incident was very distressing."
    Patients who continue taking the drug often face serious obstacles in getting their prescriptions. In Pulaski, Va., for example, a small town in Appalachia, police began fingerprinting patients who had OxyContin prescriptions. Under threat of a lawsuit by the American Civil Liberties Union, authorities later backed down. "I've been refused treatment in the ER because they think I'm a drug seeker," said Jeannette Murray. The 31-year-old nurse, who lives in an area of southwestern Virginia that is a hotbed of OxyContin addiction, takes the drug to relieve chronic pain from an injury to her right arm. "It's been difficult finding a pharmacy to get my prescription filled," Murray said. "I've been cautioned not to carry my prescription on my person, which just adds more stress to an already stressful situation."
    In response to reports of OxyContin abuse, Purdue Pharma, a Stamford, Conn., pharmaceutical firm, in May stopped marketing the 160-mg version of the drug, then the strongest dosage available. The company also recently announced plans to introduce a "smart" version of the pills, which lose their potency if they're crushed or snorted; however, the new formulation won't be available for a few years. And beginning in July, the FDA required that OxyContin boxes carry the agency's strongest warning: a black box label that calls attention to the drug's potential for abuse and diversion. "But all this hoopla just exacerbates patients' underlying anxiety about taking opiates, which we know are really quite effective," said Dr. Richard Payne, chief of pain and palliative care service at Memorial Sloan-Kettering Cancer Center in New York. "There is still a pervasive undertreatment of pain," he said, "and thousands of people are suffering needlessly."

Memory Loss Begins Early and Keeps On Going
Rose Palazzolo, ABC News- 8/14/2001

Forgetting why you walked into a room, put your car keys or blanking on someone's name may sound like a list of the early signs of Alzheimer's disease. But the common lapses in memory are what many twentysomethings experience and blow off. Research tracing the gradual decline of memory says that the process begins at the ripe age of 20 and as brain cells slip away, gone forever, the chemicals that help the brain work efficiently are also not being produced in the same quantities as when you were a fast-thinking teen.
    In studies of more than 350 men and women between the ages of 20 and 90, psychologist Denise Park found that normal memory loss in adults in their 20s and 30s affects their everyday lives in minor ways, such as forgetting a commonly used phone number or a person's name. "Younger adults in their 20s and 30s notice no losses at all, even though they are declining at the same rate as people in their 60s and 70s, because they have more capital than they need," says Park, who directs the Center for Aging and Cognition at the University of Michigan Institute for Social Research (ISR) and who appears in The Secret Life of the Brain, a new PBS series funded by the National Science Foundation.

Using Computer Memory and Not Your Own?
But other recent research suggest that sections of the brain that strengthen memory are becoming flimsy and weak in a generation reliant on computers. With an increasing reliance on computers for research and guidance, as well as Palm pilots and navigation devices, instead of exercising these parts of the brain, young adults just search the Web or punch some words into a gadget, say researchers.
    A preliminary study released earlier in the year looked at 150 20- to 35-year-olds in Japan and found that more than one in 10 were suffering from severe memory problems. Researchers from Hokkaido University's in Japan said the memory dysfunction was enough to further study the possible connection between reliance on computer gadgets, organizers and automatic car navigation systems.  "They're losing the ability to remember new things, to pull out old data or to distinguish between important and unimportant information. It's a type of brain dysfunction," said Toshiyuki Sawaguchi, the university's professor of neurobiology. "Young people today are becoming stupid."
    Park agrees that an increase in experience and general knowledge, as measured by vocabulary, compensate for memory loss.  But when people use the computer as a kind of external memory device, vocabulary, general knowledge and experience are not stored in the body's own "hard drive," instead they reside on the World Wide Web. "Cognitive performance is a direct result of brain activity and brain structure much like cardiovascular fitness relates to our ability to exercise and perform physical tasks," Park said

Exercising the Brain Like a Bicep
By the time people are in their mid-60s, according to Park, the continuous decreases in cognitive abilities may become noticeable.  Park is now embarking on a grand study of the brains of younger and older minds at work. By linking behavioral testing and neuroscience, she is studying what parts of the brain older adults use for different types of mental tasks compared to younger adults, and what patterns of brain activation high-performing older adults show compared to their lower-performing peers. "Only 40 years ago, we had little understanding of how smoking and cholesterol levels were related to cardiovascular health," Park said. "It's likely that just as diet and exercise help to keep our bodies fit and healthy, we'll find ways to improve the functioning of our aging minds."

Child Molester's Victims Describe Monster, Psychologists Say He Could Be Rehabilitated
Associated Press- 8/15/2001

SALEM, Mass. -- Attorneys for a former church youth leader who admitted molesting two dozen children are counting on psychologists to convince a judge that he can be rehabilitated. Following hours of emotional testimony Tuesday from several of Christopher Reardon's young victims, defense attorneys began making their case.
    "This is a very anxious, confused man. ... He's not somebody who's going to be sexually aggressive," psychologist Kenneth A. Chase testified. Chase said he gave Reardon a battery of tests that indicated Reardon had several psychological disorders but could be treated. "Mr. Reardon presents as someone who's intelligent, who's conforming, who engages with treatment," he said. Prosecutor Robert A. Brennan challenged Chase, at one point piling Reardon's sex toys in front of the psychologist and asking whether he had considered the totality of Reardon's crimes. Chase replied: "I had some knowledge, but not an exhaustive knowledge" of the crimes. Raymond McGuiggan, testified for the defense that the Reardon he knew at St. Agnes parish was "always prepared to help others" and that he was part of an "exemplary, loving and Catholic family."  Reardon, a 29-year-old former youth ministry coordinator, Boy Scout leader and YMCA instructor, pleaded guilty last month to 75 counts, including rape, indecent assault and battery on a child and disseminating pornography. The charges involved 24 boys, ages 7 to 14. Testimony was to resume Wednesday in his sentencing hearing.
    The victims and their parents who testified Tuesday talked about nightmares, violent outbursts and falling grades. One boy obsessively locked doors and windows, others flew into rages and shied away from adults. One boy wrote that he is plagued with depression and anger, has lost his trust in other people and has problems at school. "No one should go through what I and the other children had to suffer," he said. Another boy's mother said her son, a 6th-grader, at first thought Reardon was "awesome." But later, she said, the boy lost weight, his grades fell and he began having violent outbursts and breaking into tears. "The most lovable little boy was gone," she said. "It's like he had a huge cloud over his heart. We're working hard to clear that cloud."
    Reardon watched impassively, even as other parents called him a monster. If sentenced to 50- to 75-years in prison as prosecutors have asked, he would not be eligible for parole until he completed the first 50 years. If he receives life in prison, he would be eligible for parole after 15 years. Sentencing was scheduled for Friday.

Michigan Doctors, Nurses Getting Advice on Domestic Abuse
Chicago Tribune- 8/15/2001

LANSING, MI -- A new campaign got under way Tuesday to help Michigan doctors and nurses recognize domestic violence and guide victims toward help. The campaign will provide health-care professionals with a manual explaining how to recognize and record signs of domestic violence; posters encouraging patients to speak to doctors or nurses about abuse; and an explanation of the law requiring health-care professionals to report domestic abuse.
    "Physicians are uniquely situated to notice signs of domestic abuse," Diana Jones, vice president of community affairs for Blue Cross Blue Shield of Michigan, said at a news conference. A doctor's visit "may be the only chance for an abuse victim to share" her experiences with someone who can help her stop the abuse, Jones said.
    In 1998, more than 47,000 cases of domestic violence were reported in Michigan. Yet many cases go unreported, Blue Cross officials said. The kits were developed by Blue Cross Blue Shield and Blue Care Network with help from the Michigan Nurses Association, Michigan Osteopathic Association, Michigan State Medical Society and the Michigan Coalition Against Domestic and Sexual Violence. The kits are going out this week to physicians, obstetricians/gynecologists and nurses in seven counties. Blue Cross also is mailing the free kits to any health-care professional who orders one, company spokeswoman Cheryl McDonald said. Kits will be mailed to health-care professionals in other counties in the months ahead.
    The state has 32,000 licensed physicians and about 100,000 registered nurses, so getting the word out to them on how to recognize domestic abuse and direct victims toward assistance should increase the number of victims helped, said Michigan State Medical Society spokesman David Fox.

Group Homes On the Rise In D.C. Area
D'Vera Cohn and Dan Keating, Washington Post- 8/15/2001

Group homes for the mentally ill, mentally retarded and others needing care have multiplied in the Washington region, with the number of residents more than doubling in the past decade, according to new census figures. The rapid growth -- aimed at closing large institutions and moving residents into communities -- is the result of a social movement that began three decades ago but took hold only recently. Nearly 8,000 people now live in such homes in the District, suburban Maryland and Northern Virginia, up from 3,735 a decade earlier, according to the 2000 Census. That surge has been accompanied by battles over where to locate homes for people with mental illness, mental retardation, physical disabilities, substance abuse problems and other needs. Similar controversies are playing out over new homes in Northwest Washington and Fairfax County.
    The group home growth flows from a campaign to move people from warehouselike mental hospitals and other institutions into less restrictive settings where they can rejoin society. Stalled by local opposition and lack of money, the campaign revived after Congress passed a fair housing law in 1988 that made it harder for localities or neighbors to block group homes. "It has opened opportunities right and left for people," said Michael Allen, senior staff attorney for the Bazelon Center for Mental Health Law. "There still is incredible resistance. But the Fair Housing Act is the primary cause of there being more residential opportunities."
    The new statistics show that the largest number of group home residents are people with mental retardation, the category that tends to face the least opposition. The next-largest category is recovering substance abusers, followed by the mentally ill and physically disabled. The growth of group homes is also fed by a trend toward smaller ones, with two or three people instead of eight or 12, sometimes without live-in staff. It is easier to find a two- or three-bedroom apartment than a house, said Charles Short, Montgomery County's human services director. "Secondly, it has much less community impact when we do a smaller living arrangement like that."
    As group homes grew in the 1990s, institutions shrank. The number of patients at St. Elizabeths Hospital for the mentally ill in the District dropped by more than 50 percent in 10 years. Several District institutions closed over the decade, including the Forest Haven home for the mentally retarded in Laurel. In 1996, Maryland closed the Great Oaks Center, on the Montgomery-Prince George's County border, sending most of the last 50 disabled residents to suburban Washington group homes.
    Although the census showed that group home growth soared in the District and Maryland, local officials say the data might understate the true number. In the District, for example, the city says 1,000 people live in group homes for the mentally retarded, compared with 877 in the census. And the census reported a decline in Northern Virginia group home populations, which local officials disputed. In Prince William County, where the census reported no group home residents, county officials say they know of several group homes. "We need to take a closer look to see what is going on," said county demographer Laurie Gill.
    In Virginia, state law now allows a group home for eight or fewer people without zoning approval. In the District, the number is six or fewer. Laws vary in Maryland, but they also have grown more flexible. The 1988 housing law wiped out many local ordinances that worked against group homes -- requiring special-use permits, for example, or prohibiting unrelated groups of people from sharing a dwelling. Now, many group homes, even those requiring a state license, may open without a zoning permit.
    Neighbors sometimes learn of a group home after it has arrived. "The community integration occurs a lot more easily if they move in like everyone else does," said Pam Gannon, residential development manager for the Fairfax-Falls Church Community Services Board. "The neighbors know when they move in. But they are getting to know each other in a much more civilized way." Still, Gannon said, some people "call our office and say, 'Why were we not notified?' We say it's a civil rights issue and a right of privacy."
    Residents in the District's Chevy Chase neighborhood are fighting a home for five formerly homeless men with mental illness. Neighbors of a new group home for Hispanic substance abusers in Fairfax County recently succeeded in getting the Board of Zoning Appeals to order it closed, which the county is fighting in court. In the District, reports of poor oversight of group homes have fed opposition to new ones.

First Maine Lawsuit over OxyContin Filed on Behalf of Prison Guard
David Sharp, Associated Press- 8/15/2001

PORTLAND, Maine -- A lawsuit that blames the manufacturer of OxyContin for a prison guard's drug addiction is believed to be the first in Maine and the latest in a string of similar suits across the country. The lawsuit in federal court accuses Purdue Pharma LP, based in Stamford, Conn., and Abbott Laboratories, based primarily in Chicago, of marketing the drug aggressively even when they knew people were abusing the drug and becoming addicted in the late 1990s. The plaintiff, William E. Bushey, 33, of Gorham, contends he became addicted to OxyContin after it was prescribed three years ago for back pain.
    ''This case is largely about promotion. Assuming there is a role for OxyContin in the arsenal of pain relief, the problems have arisen because of overmarketing, overpromotion and oversale,'' said Bushey's lawyer, Jon Hinck. Nationwide, more than a dozen lawsuits have been filed against those who make and market OxyContin. Among those suing is the state of West Virginia, which alleges Purdue Pharma violated state consumer law. Some plaintiffs, like Bushey, contend they became addicted while using it as the doctor prescribed. Others seek to hold the company responsible for illegal abuse of the drug. OxyContin, the nation's best-selling narcotic painkiller, is a slow-release narcotic that is prescribed for victims of chronic pain. Those who abuse OxyContin usually crush it and then snort or inject it.
    Bushey always used a legitimate prescription for OxyContin but he eventually resorted to chewing them to get a quick high once he had become addicted. He never snorted or injected the drug, Hinck said. During a detoxification program, he was unable to carry out his responsibilities to his family and employer, according to the suit. Eventually, he filed for personal bankruptcy. Bushey is now being treated with methadone and he has been able to return to his job at the Maine Correctional Center, Hinck said. The lawsuit filed Tuesday in U.S. District Court names Purdue Pharma LP along with several subsidiaries and Abbott Laboratories. It seeks compensatory damages, punitive damages and legal fees.
    OxyContin abuse first became widespread in Maine and in mountainous areas of Kentucky, West Virginia, Virginia and Tennessee. It has since spread to urban centers, including Boston, Philadelphia and South Florida. OxyContin abuse has been blamed for more than 100 deaths nationwide. Purdue Pharma said that those estimates are unreliable. Representatives of Purdue Pharma and Abbott Laboratories could not immediately be reached for comment. Hinck said his law firm, Lewis Saul & Associates, may bring additional lawsuits in Maine. His law firm, which took out advertisements seeking people who abused OxyContin, was contacted 140 people, he said.

Women in Abuse Counseling Get Assertive with Tow Truck Driver
Edward Hegstrom, Houston Chronicle- 8/15/2001

A dozen battered spouses were in a class learning the importance of empowerment and assertiveness Wednesday when a tow truck driver gave them a chance to put their new skills to the test. He threatened to tow one woman's car from an unmarked parking spot outside La Rosa counseling center, so the women streamed outside and formed a human chain to block him in. The driver radioed about 10 tow truck buddies, resulting in a face-off between the Spanish-speaking women and burly tow truckers. Police arrived to resolve the dispute, and the driver left without the car in tow. No charges were filed. "These women did learn a lesson today," said Candelaria "Candy" Perez, executive director of La Rosa, located in an office building near Northline Mall. "They learned that you have to know your rights and stand up for your convictions."
    The tow truck driver, William Kashbohm, said he thought the car belonged to a body shop across the street. He said the office building's owner had ordered him to send a message to the body shop by acting as if he was going to tow cars, without actually doing so. "I thought she (the woman whose car he had threatened to tow) walked over to the mechanic shop," Kashbohm said. "I lowered my sling" but never hooked the car to the truck. Two parking spaces in front of the office building are marked tow-away zones. The others have no markings. By law, tow trucks can only tow from spots with a warning sign. Wednesday's incident took place in an unmarked lot out back, where the women formed their chain.
    "Evidently, (Kashbohm) was towing a car not parked in one of those marked spots," said police spokesman John Leggio. The women at La Rosa say Kashbohm has previously hitched their cars up to be towed, demanding cash to let them go and not offering a receipt.  "He charged me $50, all the money I had to feed my children for the week," said Sandra Luz Rodriguez, one of the women in the group who said her van was nearly towed recently even though it was parked in an unmarked spot. But Kashbohm said he only tows cars from the two marked spots, which belong to an optical shop owner who complains that they are often not available to customers. And he calls his offers to accept cash on the spot a lucky break for the women. He lets them off for "half-price," he said. "And there were three I just let go (for free) because they were crying," he added. But La Rosa's Perez said it is inexcusable to cause any problems for the women coming to her center. "We deal with domestic violence," she said. "Some of the women come here incognito, without their spouses' knowledge. Some are distressed."

Military Battling a Rise in the Use of Ecstasy
Lisa Hoffman, Scripps Howard News Service- 8/16/2001

WASHINGTON -- After a two-decade decline in drug abuse, the U.S. military now is confronting a surge in use of the "club" drug Ecstasy, the nation's fastest-growing illegal intoxicant, by servicemen and women. While only a tiny portion of the 1.4 million-person active-duty force is believed to have used the amphetamine-related substance, a series of recent arrests has focused the Pentagon's attention on the matter.
    Among the Ecstasy cases surfacing in the armed services in recent months:
*Eleven soldiers in the Army's 16th Military Police Brigade at Fort Bragg, N.C., were busted for using Ecstasy, along with LSD and marijuana. Two were accused of dealing the drugs.
*Five Air Force Academy cadets were charged with possessing Ecstasy, with two of them drawing prison time.
*Four sailors on the Navy's aircraft carrier Stennis were arrested on charges of selling thousands of dollars' worth of Ecstasy and other club drugs to undercover agents. A lieutenant commander on the carrier Constellation was busted for Ecstasy dealing.
*Seventy Marines from California and Arizona bases have tested positive for Ecstasy in the past year and the brass recommended that all be booted from the service with less-than-honorable discharges.
    "Ecstasy is dangerous and the military is taking steps to" combat its use, an in-house Pentagon publication announced this month. Military leaders are quick to note that only a tiny minority of troops have been documented to have used or trafficked in the drug, which is both a stimulant and mild hallucinogen, and is popular at nightclubs, college campuses and all-night dance gatherings called "raves." In fiscal 2000, 2.3 million urinalysis drug tests taken by GIs turned up 1,070 positives for Ecstasy. That amounts to more than double the number detected in 1999, and a fourfold jump from 1998, according to Pentagon figures. Even with that increase, Ecstasy use still falls far behind that of marijuana and cocaine by troops. In 1999, for instance, drug tests registered 12,000 positive for marijuana use and 2,800 for cocaine, military statistics show. And drug use overall in the services is a shadow of what it was in the 1970s and 1980s, when as many as a third of the troops reported using illegal drugs in the previous month.
    To combat Ecstasy use, the Pentagon is attacking on several fronts:
*A new, improved test that is better at picking up traces of Ecstasy is being used.
*Random drug tests are being given on weekends, holidays, Mondays and the middle of the night to try to catch more recreational users.
*More anti-drug instruction and abuse prevention education programs are being established.
*Military dogs are being trained to detect Ecstasy in living and work spaces.

Counselors Say Drug Abused by Man Police Shot Is Trendy--and Dangerous
Lewis Kamb, Seattle Post-Intelligencer- 8/16/2001

It is referred to in rap lyrics. Area funeral directors are aware of the practice. And drug counselors are all too familiar with its intense, sometimes volatile high. "Fry," "wet," "sherm" -- whatever its preferred street name -- smoking marijuana or tobacco cigarettes dipped in mixtures of embalming fluid, formaldehyde or PCP is a growing fad among youth drug users in King County, drug counselors say. "To people using it, everything is moving fast. They hallucinate and feel their body warming up," said Leroy "LC" Canty, a Seattle drug counselor who treats about three out of every 10 patients he sees each week for sherm use. "But if someone is full-blasted shermed-out, their behavior is going to be bizarre, paranoid, maybe violent, because they can't think straight."
    Friends and relatives of 20-year-old Devon Jackson told police that he was on a 10-day sherm binge before he exploded into a rampage Monday evening in a Rainier Beach triplex. Police say three veteran officers shot Jackson after he pointed a gun at officers while trying to flee from the crime scene along 51st Avenue South. He died later at Harborview Medical Center. Police then stormed the triplex, finding Jackson's friend, Donte Coleman, 20, fatally shot in his upstairs apartment. In a neighboring unit, they discovered the body of 23-month-old TreVieon Spruel, bludgeoned to death. In a nearby bathroom, Jackson's niece, Samunique Wilson, was found alive with severe head wounds. Wilson turned 7 years old yesterday in Harborview, where she remained in serious condition after surgery, a hospital spokeswoman said. She has been taken off a respirator, and was awake and talking. Friends, relatives and the Seattle Police Officers Guild brought gifts and a cake to celebrate her birthday.
    Meanwhile, the bodies of the dead have yet to be released to relatives, the King County Medical Examiner's Office said yesterday. Investigators are still awaiting results from ballistics and toxicology tests. But they said preliminary evidence indicates markings found on the toddler's head match up with an unloaded and bloodstained .45-caliber pistol taken from Jackson. Bullet casings found in Coleman's apartment are the same caliber as the gun's. Witnesses have told detectives that Jackson, a former con with a violent past of drug and alcohol abuse, had been on a sherm binge when he came to party at Coleman's Monday evening. At times during the binge, his temper flared and he carried a gun, they said.
    Violent behavior is not unusual in those who regularly use sherm, experts say. They can experience feelings of euphoria with heightened emotions and sexual arousal. But they can also slip into a "toxic psychosis" of hallucinations, paranoia and intense anger, said Heather Reitmeier of Ruth Dykeman Children's Center in Burien. Chronic use can cause everything from bronchitis and open sores in the nose and esophagus to heart attacks and brain damage, she said.
    A 17-year-old Burien girl, who asked not to be identified, said she used to "do wet" before turning to counseling and sobriety about a year ago. "It kind of makes you feel like you're floating," she said. "But if you're feeling mad or whatever, it makes you feel extra mad." Smoking "blunts" dipped in sherm while using crank and other drugs landed the teen in hospitals on several occasions. "I almost died a couple of times," she said.
    Harborview reports that treatment for those on sherm has climbed in recent years, along with popular club drugs, such as Ecstasy. "It has really escalated in King County in the past five years," said Canty, who counsels at Central Youth and Family Services in the Central District. "It's a big seller now." A 2-ounce bottle of sherm can go for $50 on the street, while dipped joints and cigarettes garner $10. The chemicals can get to the street from people with access to medical facilities, or even from formaldehyde stolen from biology classes, counselors say. A 1994 newsletter of the Washington State Funeral Directors Association cautioned members to securely store embalming fluids and dispose of empty bottles after warnings of increased sherm use among area teens.

Psychiatric Treatment Urged for Reardon
Farah Stockman, Boston Globe- 8/16/2001

SALEM, MA - A team of psychologists yesterday testified that Christopher Reardon's punishment should include treatment in a hospital as well as punishment in prison, drawing gasps from the former youth worker's victims and a blank stare from Reardon himself. ''Treatment works,'' Dr. Carol J. Ball told Superior Court Judge Isaac Borenstein, who will announce Reardon's sentence tomorrow. In a courtroom packed with police officers who investigated the case, Reardon's parents, and his teenage victims, Reardon took notes as psychologists dissected every facet of his psyche, from testimony that he never consummated his marriage to whether he is attracted to women. ''He believes there was no real harm committed,'' Ball said, looking at Reardon. ''That's the sickness.''
    The defense's portrait of Reardon as a sick man whose illness can be treated came one day after prosecutors and victims called him a ''predator'' who has shown no remorse, even after admitting to sexual crimes involving 24 boys, who ranged in age from 11 to 14 at the time they were abused. Prosecutors asked for a sentence of 50 to 70 years for the 28-year-old YMCA swim instructor and youth minister, who they say organized his life around gaining access to young boys.
    But yesterday, John Andrews, Reardon's lawyer, asked that Reardon's prison punishment be short enough so that he could one day benefit from treatment at the maximum-security treatment center for sex offenders in Bridgewater State Hospital. Asking for a sentence of 10 to 15 years, Andrews said only prosecutors have the power to push for Reardon's transfer to Bridgewater, where he ''truly belongs.'' ''What is justice in this case?'' Andrews asked in his closing remarks. ''In addition to punishment, you've got to consider the possibility of rehabilitation.''
    Yesterday, the psychologists portrayed Reardon as a nonviolent man with obsessive-compulsive disorders and a fear of humiliation, who fashioned a fantasy world in which he was the older teenager teaching younger ones about sex. He was a good candidate for rehabilitation, they said, because he had never shown sadistic tendencies, he'd shown an interest in adult women, and he was not a ''sociopath'' isolated from society. ''There's a good part to him,'' Ball said. ''There's a healthy part.'' Dr. Murray Cohen, a former Boston University professor, said Reardon might be a hebephile - someone who liked pubescent boys rather than very young children - and stressed that the ''phile'' in the word means that those who suffer from the illness feel affection for their victims.   ''I would not want to see him around the community at this time,'' Cohen said, but later added: ''It was not as if it was a plan to go out and kidnap boys after observing them.''
    But prosecutors said it was the way that Reardon lured his victims into a secret club of sexual activity, using his relationship as a mentor, rather than violence, that made him so dangerous. ''It is almost more insidious,'' Essex Assistant District Attorney Robert Brennan said in his closing arguments Tueday. In a presentencing report, Essex County probation officer Alba Nunez said Reardon could not be treated because he did not take responsibility for his crimes. He blamed his victims and ''his wife's refusal to consummate the marriage'' for his sexual involvement with the boys, she wrote in the report. On the stand yesterday, Nunez acknowledged that she had no training in the treatment of sex offenders and learned about pedophilia from a police officer's article on the Internet. Still, she said, she remained convinced that he should spend ''the rest of his human life in prison.''
    During a stinging cross-examination of the doctors, Brennan sought to show that they knew little about the crimes of the man they had assessed. During the cross-examination of Cohen, Brennan discovered that the doctor did not know about some of the most extreme examples of Reardon's proclivities. When Cohen said he had not seen seven notebooks filled with pictures of very young boys with deformed genitals, Brennan asked him to leaf through them. When Cohen said he'd never heard that Reardon had kept disposable cups of his victims' semen samples in the eaves of his closet, Brennan urged him to say that Reardon was too dangerous to be treatable.  But Cohen insisted that Reardon was not the worst case he'd ever treated in his 45 years rehabilitating sex offenders. He also elicited gasps from the victim's families when he said that research showed that crimes like Reardon's ''need not have major emotional psychological effects on a youngster.''  The defense also bolstered its plea for treatment with 16 letters of support from Reardon's friends and relatives.
    ''The question that haunts me is how does a child like Christopher Reardon grow into a pedophile,'' wrote one friend of the family, Mary McKenney. ''I firmly believe that if this could happen in the Reardon family it could happen to anyone.''

Colorado Addiction Study Wins Grant
Allison Sherry, Denver Post- 8/17/2001

The White House gave researchers at the University of Colorado $4.2 million on Thursday to buy a brain-scanning machine that could detect whether a brain quirk makes drug abusers more prone to addiction. Development of a portion of the brain called the singulum, which is responsible for reason and decision-making, lags in people diagnosed with schizophrenia, scientists have already discovered.
    Those who abuse drugs may have the same problem. "If we could detect these abnormal aspects, we're closer to finding treatments to help people before they start," Dr. Robert Freedman, chairman of psychiatry at the CU Health Sciences Center, said at a Fitzsimons news conference. It's a novel idea in the world of drug treatment, where prevention is now tackled with a blanket approach in schools and on the streets. Eventually, scientists hope to stave off addictions before they take hold, through medication or early preventive treatment, targeted to those who carry the genes.   Freedman believes that those with a well-functioning brain may rebelliously experiment, but they're not likely to become addicts.
    "If we could find a series of tests, we would no longer need to treat the brain like a black box," said Albert Brandenstein, a policy director in President Bush's anti-drug office who attended the news conference. But the study doesn't address the psychological part of drug addiction, which can be harder to overcome than the biology, some counselors said.
    Too little attention and money are paid to getting at the root of the problem: peer pressure and mental illness, both of which are often coupled with drug abuse, said Win Winsor, clinical supervisor at Milestone Counseling Services in Denver. "The physiological is the least important part," Winsor said. Even Dr. Thomas Crowley, who heads CU's Addiction, Research and Treatment Services, admits that half the reason people take drugs probably has to do with upbringing and environment. He just hopes that those with a genetic predisposition could get attention a little earlier. About 7 percent of the nation's youths are addicted to drugs.
    The $3.5 million MRI machine will arrive at the university late next year, with the rest of the grant money going to a building addition and other expenses. Researchers will study the brains of adolescent volunteers from Crowley's inpatient treatment program. "I think there are plenty of people who experiment, and then they're on to something else in life," said Tim McCarthy, manager of adult services for Arapahoe House Inc., a metro-area drug-treatment center. "Is that environment? Maybe some of it. I don't have data, just a hunch that there is some sort of predisposition in people."

Mental Health Law Stems from Tragic Death in a Bus Station
Sheryl James, Detroit Free Press- 8/17/2001

One year ago, Kevin Heisinger, a 24-year-old University of Michigan graduate student, was killed in a Kalamazoo bus station by a mentally ill man who had not taken his medication. The man, Brian Williams of Ypsilanti, had a long, troubled mental health history and had by that time tangled with police several times. Deficiencies in Michigan's mental health laws left Williams untreated -- and dangerous, say the sponsors of new bipartisan legislation they plan to introduce soon in the Michigan Legislature.
    If passed, Kevin's Law will help prevent such tragedies, state Rep. Virg Bernero, D-Lansing, said Thursday. Bernero and Rep. Tom George, R-Portage, are cosponsors of the legislation. Bernero said Michigan's mental health system has been "cut to the bone" and leaves vulnerable those suffering serious mental illnesses and their potential victims. The details of Kevin's Law are to be announced today at news conferences in Kalamazoo, Southfield and Lansing.
    The major goal of Kevin's Law is to ensure intervention before violence occurs, Bernero said. Among other things, it would allow intervention and treatment of people incapable of making decisions about their own treatment. It would also allow Michigan courts to order intensive outpatient mental health care for those most in need or who pose the greatest risk, and provide supervised treatment until the person is capable of maintaining his or her own care.
    Current Michigan law allows involuntary psychiatric services to be ordered only when a person is proven legally to be a threat to himself or others. That leaves people such as Williams to fall too easily through the cracks, Bernero said. "In Michigan today, you have to be homicidal or suicidal -- at this instant ...you have to have a ...weapon in your hand, practically. We've got to lower the bar to get some preventive medicine to these folks who need and deserve earlier intervention," he said.
    Pat Webdale, whose daughter, Kendra, was killed when a mentally ill man pushed her in front of a subway train in New York City, will be at the news conference. Kendra's death inspired New York's Kendra's Law, which the Michigan legislation is patterned after. Police officers from Michigan also will be present, Bernero said. Bernero said the police presence reflects concerns by officers who too often must handle people like Williams because the mental health system has not.

New York Doctors Group Sues Six HMOs
Joel Stashenko, Associated Press- 8/17/2001

ALBANY, N.Y. -- A state doctors group Wednesday sued six leading HMOs, alleging they harmed patients and breached contracts with doctors by denying medically necessary care, reducing reimbursements and denying claims. The Medical Society, which has 27,000 members, filed its lawsuit in state court in New York City on the same day individual doctors sued the six HMOs in lawsuits that seek class-action status. Named in the lawsuits are Aetna, Cigna, Empire Blue Cross-Blue Shield, Excellus, Oxford and United Healthcare. They account for nearly half the managed care contracts in New York state, according to the Medical Society.
    The lawsuits contend that the HMOs harmed enrolled patients and physicians by the alleged continual denial of medically necessary health care, by "capricious" reductions in reimbursement claims, by the use of computer programs which deny claims based on arbitrary guidelines and by breaching the terms of contracts between doctors and HMOs. "It is a sad comment on the way these insurance carriers conduct business that we have to go to the court system to force them to live up to their obligations," said Dr. Robert Bonvino, president of the Medical Society. The lawsuit is similar to actions brought in courts in New Jersey and Connecticut by physicians in those states.
    Paul Macielak, who heads an HMO umbrella group, New York Health Plan Association, called the lawsuit "a copycat action aimed at enriching doctors' pocketbooks. "If doctors were truly concerned about patient care, they would use their considerable resources on efforts to improve overall quality of care and reduce medical errors," Macielak said. Among the members of Macielak's group are Aetna, Cigna, Oxford and United Healthcare. A spokeswoman for Empire Blue Cross-Blue Shield was not available Wednesday to comment.

Probing the Brain: Procedure Treats Debilitating Muscle Disorder
Logan Nakyanzi, ABC News- 8/17/2001

When he was in sixth grade, Ed Cwalinski began complaining of cramping in his hand. By the time he was a junior in high school, he suffered from excruciating pain throughout his body. He had contracted a rare disease called primary dystonia that causes one's muscles to work against each other. But thanks to a new treatment in which doctors probe deep into his brain, Cwalinski, now 19, has regained control of his body.
    Dan Laurent, spokesman for Pittsburgh's Allegheny General Hospital, where Cwalinski has been treated, describes the disease as "a rare, insidious genetic neurological syndrome characterized by involuntary, sustained and often repetitive contractions of opposing muscles, causing hideous twisting and spasmodic movements." "He could get up and walk but he'd be falling all over the place," his mother remembers. "He'd stumble up the steps or he'd try to feed himself and the food would be flying everywhere."
    Doctors don't know how or why Cwalinski contracted dystonia. In fact, he went to doctor after doctor before being properly diagnosed. According to Margie Walden, executive director of New York's Bachmann-Strauss Dystonia & Parkinson Foundation, only about 10 percent of the 300,000 Americans who have the disease have been correctly diagnosed. Dr. Susan Baser, a neurologist at Allegheny General, finally put the clues together and diagnosed Cwalinski with dystonia. She remembers his parents' reaction.   "It was devastating," she says, "to see their only child just deteriorate before your eyes and their eyes and really being powerless to do anything about it." Identifying the disease should have helped, but the symptoms kept getting worse. Cwalinski admits there were times when he didn't want to live anymore.
    Cwalinski's doctors were powerless until last year, when Dr. Donald Whiting, an Allegheny General neurosurgeon, proposed an innovative and risky new procedure called deep brain stimulation, or DBS, which is commonly used to treat movement disorders like Parkinson's disease. The procedure involved probing into Cwalinski's brain with a microphone to find which nerve cells were triggering the spasms. Deep in the brain, a trained ear can actually hear abnormal activity. It was a long shot, and Whiting says Cwalinski and his parents were sober about the prospects. "The family really understood it very well and understood that they could expect nothing for sure," he says.
    During last year's surgery, Cwalinski was awake, despite having a series of screws driven into his scalp to guide the surgeons operating on his brain. When the microphone revealed the problem area, surgeons sent a small amount of electricity to the abnormal nerve cells, causing them to slow down. Cwalinski's doctors installed electrodes on either side of his brain. These electrodes, which are powered by batteries in his chest, send impulses to his nerve cells to keep the spasms in check.
    The procedure was a success. Cwalinski's body responded immediately. Baser, who stood beside him in the operating room, lifted his hand during the procedure and felt that his joints were suddenly limber. "It was wonderful. I just thanked God for giving this to me," says Cwalinski, who can now do just about all the things he wants to do, which include studying computer technology at IT Technical Institute in Pittsburgh.
    The following organization can provide more information about dystonia, including facts about diagnoses and less invasive treatments:   The Dystonia Medical Research Foundation: www.dystonia-foundation.org

Reardon Is Sentenced to Forty Years
Farah Stockman , Boston Globe- 8/18/2001

SALEM - Doling out a punishment that even he called rare in his career, Judge Isaac Borenstein said yesterday that the ''secret world of sexual abuse'' Christopher Reardon created with young boys was so callous and obsessive it merited 40 to 50 years in prison and parole supervision for life. ''It is clear to me that unless you are in jail for most of your life, there is a serious risk to other people,'' Borenstein said, as Reardon sat stone-faced at the defense table. ''I do not do this, Mr. Reardon, with one ounce of happiness or glee.'' With that, a clerk stood and read the sentence that ended the state's largest child molestation case in recent memory.
    Last month, the church youth worker and YMCA camp counselor pleaded guilty to 75 counts involving 24 boys, including child rape, indecent assault on a child, and giving pornography to minors. Though Borenstein sentenced him on each of the 75 counts, all sentences will run concurrently with the 40- to 50-year sentence for child rape. Because of truth-in-sentencing laws, he must serve at least 40 years before he is eligible for parole.
    As the sentence was read in Superior Court, the anxious parents of Reardon's victims held hands tightly with their teenage sons. Reardon's father kissed his crying wife on the cheek as their relatives wept. But Reardon, 29, in handcuffs and leg irons, showed little emotion as officers led him from the courtroom. ''He's numb,'' said his lawyer, John Andrews, adding that the defense team was disappointed with a sentence that would not make his client parole-eligible until age 68. Andrews, who is considering an appeal, said he had ''serious doubts'' about whether his client will get psychological help in prison, since ''for the practical matter, the sentence is for the rest of his natural life.''  But Essex District Attorney Kevin Burke hailed the sentence as an ''appropriate and successful'' conclusion to an intense and often agonizing 14-month case. ''I am not aware of a sentence of this magnitude,'' Burke told reporters after the hearing. ''Nor was I aware of a crime of this magnitude.''
    In a case that came to symbolize how danger can lie within those we trust most, Reardon was arrested at a church picnic last year after one boy confided in a relative. He soon became the focus of an investigation that shocked police and divided the close-knit town of Middleton, and prompted the resignation of the pastor of St. Agnes Catholic Church, where Reardon was a religious education teacher. Originally suspected of abusing seven boys, the number grew to involve more than two dozen. The evidence seized from Reardon's home and office was overwhelming and seemingly irrefutable: computer-generated charts with names and graphic descriptions of what he'd done, a videotape of him engaging in a sexual act with one boy in the St. Agnes rectory, and a backpack filled with sex toys and pornography that the youth worker carried from one youth-oriented job to another. In the wake of Reardon's arrest, his church supervisor, the Rev. Jon Martin, left his post. The case also spurred several potential civil suits against the Archdiocese of Boston and the Danvers YMCA. Many of the crimes took place in Reardon's office at the rectory of St. Agnes, where he was a youth minister, and in the YMCA, where he taught children to swim and ran a summer camp.
    For months, Reardon's lawyer seemed to be setting up a defense, and many expected Reardon to disclose that he had been abused as a boy. The town braced for an agonizing trial in which boys would describe in open court how Reardon abused them. But in a stunning move on the eve of jury selection, Reardon pleaded guilty last month to half of the charges on the 120-count indictment, without a plea deal or any guarantees for leniency from the prosecution or the court. That led to wrenching pre-sentencing hearings on Tuesday and Wednesday, during which some victims and their parents spoke publicly for the first time from the witness stand.
    Parents holding tissues in clenched fists told Borenstein how they trusted, befriended, and admired Reardon, a lifelong member of their community who seemed so generous and well-loved by the children in his care. But a battery of defense psychiatrists testified that Reardon was a nonviolent man whose phobias and personality disorders could be treated - and whose sexual fantasies were not necessarily dangerous.
    As yesterday's hearing unfolded, the tension in the courtroom - packed with victims and their families, police investigators, reporters, and Reardon's parents - was almost palpable. The faces of the victims' families grew anguished as Borenstein warned them not to cry out during his sentence, even if they didn't agree with it. And as the judge began, there were few indications on how harshly Reardon would be punished. The judge explained Reardon's rights, noted his past good works and reminded his audience that the admitted child molester was still ''somebody's child.'' ''You are not all evil, Mr. Reardon. There are good parts of you,'' Borenstein said, prompting worried glances between prosecutors, police, and the victims.
    But after a long portion detailing what he did not consider during the sentence - judicial vengeance, the opinion of the media - Borenstein tore apart Reardon's defense in a way few who know the judge have seen before. ''I am ... going to reject claims that the harm caused to these boys was less than that of a sadistic rapist,'' the judge said. The fundamental harm, he added, is ''if you can't trust Chris Reardon, who can you trust? It is much harder to protect children from those we trust than from the sadistic stranger.'' Borenstein dismissed the testimony of three defense psychologists. The doctors - one of whom joked on the witness stand that his therapy helps teach pedophile patients how not to reoffend or ''not get caught'' - minimized the harm Reardon inflicted on his victims, the judge said.
    The judge reserved his highest scorn, however, for Reardon's self-serving view of his crimes, as recorded in a presentencing report by a probation officer who interviewed him in jail. According to the officer, Reardon said he was merely teaching young boys about sex, as if he were their peer. He also blamed Pamela Moline, his newlywed wife, for not having sex with him. ''Mr. Reardon, I have got to tell you, you did not perform oral sex on four boys - or had them perform it on you - to educate them,'' Borenstein said. ''This is not conduct that can be blamed on your wife. You did this, sir, not your wife.'' Moline, who has filed for divorce, wrote to Borenstein, describing how Reardon was at fault for not consummating their brief marriage. But the judge did not consider her letter as evidence.  Borenstein also said the fact that the offenses were committed in places of ''safety, reflection, fun, and healthy growth,'' and that Reardon used the boys to manipulate each other, made the crimes all the more insidious.
    After the hearing, the victims and their families filed from the courthouse, hugging one another. One 19-year-old victim who met Reardon at a summer camp years ago recalled how, after investigators tracked him down nearly a year ago, he denied at first that Reardon had abused him. ''But then I came clean,'' the youth said, smiling. ''I'm relieved. I'm glad it is all over.'' One mother, who took her vacation this week so she could attend the hearings, said her heart sank when she first heard the sentence, but that she grew satisfied after prosecutors told her after the hearing that it was a harsh sentence for such a crime. ''I kept thinking, 40 years, he could still go after children when he's 70,'' she said. ''But I'm relieved that he's going to prison, not a hospital. Thank God this nightmare is over.''

Fire That Killed Chained Patients Throws Harsh Light on Mental Health Care in India
Dilshika Jayamaha, Associated Press, 8/18/2001

ERWADY, India -- The rusted iron chains that once shackled the woman are gone, but she is still bound by the horror of the fire that killed 28 other mental patients chained to stone pillars. The woman rocks slowly as she sits inside a thatched hut, wrapped in a dirty cotton sari. No one knows her name or where she came from, so she must remain in the asylum where she saw other patients die. The tragedy in this southern Indian village has drawn attention to the woeful plight of the nation's mentally ill. No one is certain how many of India's 1 billion people suffer from mental illness; it is clear many don't get adequate care. Only a few scorched pillars remain of the row of huts that once housed 46 patients in the Badshah asylum. All the survivors except the nameless, unclaimed woman who was unshackled before the fire reached her have been sent home.
    Until the Aug. 6 fire, Erwady was known only as the site of a 400-year-old Muslim shrine that some believed could heal mental disorders. It was also a village with about 16 small asylums for the mentally ill. The town of 10,000 is a mix of concrete houses and woven coconut thatched huts. Along its narrow alleys, goats dig through stinking piles of garbage. At another asylum, the Bismi Home for Women Mental Patients, a 30-year-old woman said what the nameless woman could not. ''Please take me to a hospital,'' she pleaded through tears. ''I promise to be good,'' said Bathmavathy, who like many people in Tamil Nadu state uses one name.
    According to Pakir, the man who runs the Bismi Home, the only treatment for patients is to ''take them for prayers at the nearby mosque twice a day and one day they will be cured.'' The seven women he oversees bear the scars of shackles on their ankles. Pakir, who also uses one name, seems not to notice their emaciated frames and skin lesions. ''If I don't beat them, I can't control them,'' he said. Berham Beebi, 50, sits on the asylum's dusty floor. She is bloated and her joints are elephantine. She says she eats soil. ''Please, please, take us away. They are beating us. My genitals are injured,'' she said.
    Although the fire cast a harsh light on the treatment of the mentally ill, it was not the first sign of trouble: At least two reports detailing the desperate conditions of mental patients have been forwarded to state and federal health authorities in India since 1998. ''This a crime against humanity,'' says I. Nazneen, principal of the Government Arts College for Women not far from Erwady. She has been lobbying the state for two years to address exploitation and cruelty toward mental patients appeals that have been waved off.
    S. Swamylal, chief of the state psychiatric hospital in Madurai, the main city near Erwady, says the government makes periodic visits to the thatched hut asylums to advise owners on hygiene and patient welfare. He notes that many Hindus and Muslims believe in the healing powers of places of worship rather than taking advantage of what medical care is available. ''Enforcing the law takes time, especially because it involves religion. This incident may hasten the process,'' Swamylal said.
    Tamil Nadu's health secretary, Syed Munir Hoda, said many people prefer to stay in private asylums because of their religious beliefs. He said a psychiatrist was posted at a government clinic near Erwady last year, but few sought his advice. ''This has been a bad experience, we must now move forward,'' Hoda said of the fire. For Erwady's mental patients, moving forward will not be easy. Many of their relatives and their caretakers believe the soil and even the chains are part of a mystical cure.   Nurjehan, 52, has been chained to a tree at the Erwady shrine for five years. She growls softly as Muslim prayers come through loudspeakers. Her husband and their two daughters sleep beside her. ''The chains will spring open when she is cured,'' her husband said.
    The state government, facing increasing criticism since the fire, has ordered the asylums in Erwady to close this month. It plans to transport remaining patients to government institutions, said C. Semmalai, Tamil Nadu's health minister. ''It is the previous government's inaction that has led to this situation,'' he said, trying to shift blame. India's federal government has worked on developing community-based approaches to mental health care. But the $62 million program begun in 1997 hasn't reached enough people.
    There are non-governmental rehabilitation centers with better conditions. In Madurai, 55 people are housed at Shristi, a clean, pleasant facility where patients make greeting cards and other items for sale in nearby towns. The profits help run the home. The fire in Erwady also has reignited debate on conditions in government-run institutions.
    Water drips from the pipes at the Institute of Mental Health in Madras, the state capital. Sanitation facilities for its 1,600 inmates are abysmal. Some improvements to the old buildings have been made with private donations. Dozens of women, some filthy with mucus and dirt, sit around or plead for attention while children and adolescents, some naked, crouch or crawl nearby. It is Erwady without the chains or even the prayers.
    On the Net:
Aid organization site, http://www.aidindia.org
Disability site, http://www.disabilityindia.org

Massachusetts Legislature Sidelines 6 MADD Proposals
Catherine Holahan, Boston Globe- 8/19/2001

Half the bills filed in the Legislature to strengthen the state's drunken-driving laws, which are among the weakest in the nation, have been effectively killed this summer. Of 12 measures proposed by Mothers Against Drunk Driving to stiffen penalties for drunken driving and make it more difficult to fight drunken-driving charges in court, six were sidelined by study orders in July.
    ''You don't have to be a rocket scientist to know that when a bill goes to study it means the last one out turns off the lights,'' said Senator Stephen M. Brewer (D-Worcester), chairman of the Steering and Policy Committee and vice chairman of the Joint Committee on Public Safety. A bill filed by Brewer would allow breath analysis results showing a blood-alcohol level above the legal limit to be admitted at trial as proof, not just evidence, of drunken driving. Such a law would bring Massachusetts in line with every other state in the nation. It was given an order for further study last month, as was a similar bill filed by MADD. ''Oftentimes it takes some catastrophic event to get legislation passed,'' said Brewer. He added that the state's drunken-driving related fatalities are largely ignored because ''they happen one at a time.'' The Globe reported last week that the National Highway Traffic Safety Administration - using broader criteria than the Massachusetts Registry of Motor Vehicles - puts the state rate of alcohol-related traffic deaths at 49 percent, 11 percentage points above the national average and one of the highest in the nation.
    Of the remaining six drunken-driving bills filed by MADD awaiting committee action, only two have been favorably referred by one committee to another. One would eliminate a law prohibiting judges from considering offenses more than 10 years old when sentencing repeat drunken-driving offenders. The other would establish a fee for convicted drunk drivers to have their licenses reinstated, using the revenue to support victims of drunk drivers.
    The remaining four bills received public hearings in May and are awaiting decisions by the Committee on Criminal Justice. Barbara Harrington, executive director of MADD's Massachusetts branch, said lobbying by the alcohol and hospitality industries has helped defeat drunken-driving legislation. Neither group, she said, wants ''to draw attention to the negative effects of alcohol, which spills over to drinking and driving.'' The other difficulty in getting tougher laws passed is the number of lawyers in the Legislature, Harrington said. Because legislators can keep their legal practices and drunken-driving litigation is ''very lucrative,'' Harrington said, lawyers in the Legislature fear that strengthened laws will make defending such cases more difficult, and cause more people to plead guilty.
    Disputing MADD's view is attorney Stephen L. Jones of Norwell, who specializes in drunken-driving cases. Jones says harsher laws and penalties would lead to more business for defense lawyers. ''The more rigid the laws on drunken driving and the stronger the penalties, the more people choose to fight it,'' said Jones. As an example, he said, the automatic loss of a driver's license following a drunken-driving conviction ''is very often why people decide to fight it.'' More than 50 percent of people who contest drunken-driving charges are found not guilty or plead guilty to a lesser charge, said Jones, who is writing the ''Massachusetts Practice Series Volume on Drunk Driving Defense,'' a reference book for Massachusetts defense lawyers that is expected to be published next year.
    Cynthia S. Creem (D-Newton), chairwoman of the Senate Committee on Criminal Justice, said she favors reform of drunken-driving laws but added that the problem is not the lawyers in the Legislature. She pointed instead to the large numbers of drunken-driving bills filed each year. ''There have been so many bills pointing in so many different directions,'' she said, ''it's hard for people to focus on one or two and get them out.''

School's Backing of Behavior Drugs Comes Under Fire
Kate Zernike & Melody Petersen, New York Times- 8/19/2001

Children return to classrooms this fall amid an increasingly pitched battle over Ritalin and other drugs used to treat millions with behavioral and emotional problems in school. Drug companies are breaking with 30-year-old international marketing restrictions to advertise directly to parents, selling the idea that drugs may be the answer to their children's problems in school. At the same time, state legislatures are moving to prevent schools from recommending or requiring that parents put their children on medication.
    Last month, Minnesota became the first state to bar schools and child protection agencies from telling parents they must put their children on drugs to treat disorders like attention deficit hyperactivity disorder. In October, Connecticut will go a step further when a new law takes effect prohibiting any school staff member from discussing drug treatments with a parent to assure that such talk comes only from doctors. Similar bills have been introduced in Arizona, New Jersey, New York, Utah and Wisconsin.
    The legislative push is a reaction to what its advocates call over-prescription of the drugs. They say an excessive reliance on Ritalin and several competing drugs is driving parents away from traditional forms of discipline and has created a growing, illegal traffic in what are potent and dangerous speed-like stimulants. Last year, doctors wrote almost 20 million monthly prescriptions for the stimulants, according to IMS Health, a health care information company. Most of those prescriptions were written for children, especially boys. The drugs had sales last year of $758 million, 13 percent more than in 1999.
    The political concern comes as producers of the drugs have begun an advertising campaign that is unparalleled in spending and technique. In the back-to-school section of this month's Ladies' Home Journal, tucked among the ads for Life cereal, bologna and Jell-O pudding, are three full-page advertisements for the ADHD treatments. The ads evoke a sense of Rockwellian calm. Children chat happily next to a school bus. A child's hand gently touches the hand of an adult. In one for the new drug Metadate CD, an approving mother embraces her beaming son as the drug itself is named and promoted. This is a first. Metadate CD, like Ritalin, Adderall and similar drugs, are what are known as Schedule II controlled substances, the most addictive substances that are still legal. Schedule I drugs like heroin and LSD are illegal.
    In keeping with a 1971 international treaty, such controlled substances have never been marketed directly to consumers, only to doctors. There is, however, no federal law to prevent drug companies from doing it. Yet the new magazine advertisement by Celltech Pharmaceuticals, the British maker of Metadate CD, states, "Introducing Metadate capsules. One dose covers his ADHD for the whole school day."
    Terry Woodworth, deputy director of the Office of Diversion Control of the Drug Enforcement Administration, said, "W have had a 30-year agreement with the pharmaceutical industry not to advertise controlled substances." "Celltech has stepped up and beyond everyone else," Mr. Woodworth said, "by advertising a drug with a high potential for abuse." He said the campaign could have "diplomatic repercussions" and that Celltech had been recently asked to stop.
    Ivan R. Garland, chief operating officer of Celltech, would not comment on discussions with drug enforcement officials but said that the advertisements had been reviewed by regulators at the Food and Drug Administration and comply with federal regulations. Celltech also said the ads were aimed at parents whose children had already been diagnosed with ADHD. The FDA said the drugs can be advertised as long as their dangers are described in the ads.
    McNeil Consumer Healthcare, which makes a drug called Concerta and Shire Pharmaceuticals, a British company that makes Adderall, are also advertising directly to consumers, but they are not naming their products. Instead, parents are urged to call a toll-free number where they can request that brochures be sent to them. That information mentions the drugs by brand name as one treatment option.
    Mr. Woodworth of the Drug Enforcement Administration said such ads--McNeil is running 60-seond commercials on cable television networks like the Discovery Channel and A&E--still violate the spirit of the international protocols. Officials of both companies say they are not promoting a brand and are not breaking any law.
    Some parents and doctors say they welcome the new drugs and the publicity which, they believe, helps inform parents of new treatments. Little is known for sure about how the drugs work, but they seem to help children with attention-deficit disorders to focus. Concerta and Metadate CD work longer than Ritalin, the best known of these drugs, so children who take them do not have to see the school nurse at lunch for a booster dose. That avoids embarrassment and reduces the risks associated with drugs being stored at school
    Some physicians who have done research on Ritalin say the state laws are too severe. "To argue that these treatments are inappropriate or ineffective just flies in the face of a scientific knowledge base that is impossible to ignore," said Howard Abikoff, director of research at the Child Study Center at New York University. "You can't close your eyes to this. It's made differences that are monumental in the lives of these kids and their parents." He was one of the principal researchers in a National Institute of Mental Health study of Ritalin that found that medication was more effective than behavioral therapy in treating ADHD.
    Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, California, who wrote a book called "Running on Ritalin," said that, as the ads have appeared, parents have begun asking for the drugs by name. Celltech has created a Super Man-like character with "CD" emblazoned on his chest. "A new hero for ADHD patients is here!" pronounces the company's brochure. Dr. Diller said a Celltech sales representative gave him such a brochure which seemed intended to be passed on to parents. But the company said the brochures were only meant for doctors and pharmacists.
    Evelyn Green, a teacher in Chicago and the president of CHADD, Children and Adults with Attention Deficit/Hyperactivity Disorder, a non-profit group that represents people with the disorder, said that one of her sons has been taking medication--first Ritalin and now Adderall--for eight years. Some parents may not be aware of the new longer-acting drugs, Concerta and Metadate CD, which have genuine benefits for many children, Ms. green said. "The danger of the ads," she said, "is that parents could get the message that medication is all there is."
    The problems associated with these drugs have escalated. The Drug Enforcement Administration says Ritalin and other stimulants are among the most frequently stolen prescription drugs. Some students are crushing an snorting pills for a speed-like high; in Orem, Utah, an elementary school principal was sentenced to 30 days in jail after he stole his students' Ritalin pills and replaced them with sugar pills.
    The Journal of the American Medial Association in February 2000 noted a "disturbing" rise in the number of prescriptions for stimulants and anti-depressants for children under five, most of whom are too young, according to the drugs' labels, to take them. "Before they came out with these, how did we grow up?" asked Lenny T. Winkler, a nurse and state representative who sponsored Connecticut's new law. "If a child has a problem and it's diagnosed properly, I support than. But I think teachers are far too quick to blame the problem on attention deficit, and say to parents, "this is what needs to be done.'"
    Children who take medication for emotional or learning problems in school tend to be labeled "learning disabled" under special education laws, and now account for over half of those in special education. The diagnoses for many of the problems have long been controversial, in part because there are no blood or lab tests for attention deficit disorders.
    Sales of Ritalin, which was approved in 1955, have been declining for years as doctors prescribe lower-cost, generic versions. In 1999, Adderall overtook Ritalin. Adderall was first sold in the 1960's as a weight loss drug. Its success has changed Shire from a small company with offices in a farmhouse into an international pharmaceutical firm. Now McNeil's Concerta has captured 16 percent of the market. Metadate CD was approved in April. Mr. Garland said the company felt forced to advertise to parents after the other companies did so. "We felt we had to follow their lead," he said.
    The Connecticut legislation began with Ms. Winkler's work as an emergency room nurse, where she said she saw more and more children coming in who were on psychotropic drugs, from stimulants to anti-depressants and anti-anxiety medications, and requiring metabolic tests and cardiograms. "Why, unless these drugs have some impact on the other body systems, would we have to do these tests?" she said. Then she began receiving calls from constituents who complained that schools had encouraged them to put their children on drugs, even in some cases, making it a condition of attending class or after school.
    In Millbrook, N.Y., Patricia Weathers said her son's school told her to put him on Ritalin in first grade. By fourth grade, he was showing signs of severe anxiety, she said, chewing his clothes and paper. When Ms. Weathers took him off the drugs, she said, the school called the state's office of child protective services and accused her of medical neglect. "You have the school psychologist, the teachers, the principal, all bombarding you, saying this is the only way to go," she said. "I fell for it, and I believe most parents fall for it. They want to do what's right for their child, and if the professionals are telling them this is right, you think, 'They must be right.'" She, like many parents who think Ritalin is over-prescribed, complain that there is no scientific basis for the diagnosis of the disorders for which it is prescribed. "You can't tell me they all have this brain disorder during the school year, when during the summer they're fine," said Ms. Weathers, who now instructs her son at home.

ERs Under Strain: OxyContin Abusers Try to Get the Painkiller
Jenette Restivo, ABC News- 8/20/2001

Thwarted at pharmacies and doctors' offices, addicts and others who want the powerful new painkiller OxyContin are straining already strapped emergency rooms in their hunt for the narcotic, doctors and other experts say. And, they say, some of the drug abusers go to extraordinary lengths to convince doctors they are legitimate patients in need of the drug, sometimes even endangering those doctors, and ultimately even keeping legitimate patients from getting it. "We're seeing a lot more patients coming in to the ER actually asking for OxyContin, and many times demanding it," says Dr. Larry Alexander, medical director of the emergency department at Central Florida Regional Hospital in Sanford, Fla., near Orlando. "We're beginning to see it more routinely because they can't get it on the street or the pharmacy."
    In just six years on the market, OxyContin has become the No.1 selling brand-name prescription painkiller, and has a reputation for being easily and frequently abused. Federal officials say no prescription drug in the last 20 years has been so widely abused so soon after its release. OxyContin, often known as "Oxy," is the latest in a long line of "hot" drugs illegitimate users have sought through the ER. Vicodin was the drug du jour a few years ago, and before that it was methadone. While no hard figures are available on the degree of abuse, ER doctors in urban, suburban and more rural locales all spoke of a sense of siege, and said the demand for OxyContin was having a significant impact on their work. Nationwide, a rash of thefts has prompted several drug-store chains and pain centers to stop selling the drug and post "no Oxy" signs in windows. The Drug Enforcement Agency has asked the drug's manufacturer to limit the drug's availability to pain specialists only.
    Dr. Charlotte Yeh, chair of the American College of Emergency Physicians, and a practicing physician for over 20 years, explains that a hospital's emergency department is a window on society. "For those of us 'longtimers', we could always predict when illicit narcotic supplies are low in the field, because we would get increased number of drug seekers in the ED desperate for a fix. The tightening up of OxyContin supplies is part of the reason for seeing increased drug seekers in the ED." Dr. Richard O'Brien, a spokesperson for the American College of Emergency Physicians who practices in Scranton, Pa., says that spillover into the ER is "inevitable." "Oxy was not such a popular drug a year ago," says O'Brien. "I have noticed more people asking for it, both hard core addicts and pain sufferers who are tolerant."
    And while addicts who seek Oxy from the ER are likely to have a very hard time getting their hands on it — the drug is very rarely prescribed there because it is slow-acting — ER doctors can nevertheless be tempted to prescribe it when patients say they've lost their prescriptions or are on vacation and can't reach their regular doctors. Those excuses can add force the already overloaded ER physician to have to painstakingly check on records and verify claims.
    Remarkably, say doctors, the opiate-dependent person will always tend to "run out" of his or her medication at 5 p.m. on Friday, when their alleged doctors can't be reached for a few days. Abusers will go to great lengths to pose as legitimate patients, too. Yeh says she has witnessed patients tape rocks to their backs to simulate kidney stones on X-rays. Others deliberately cut themselves to contaminate urine samples with blood to feign a kidney stone. "People will let you do amazing things to them," says O'Brien, "CAT scans, MRI, physical therapy, spinal taps; they will let you mutilate their bodies to get narcotics." "Hard core addicts and the occasional young male who likes oral narcotics and who has come up with an amazing array of allergies and medical problems for which there is no other medical answer other than OxyContin" is typical, he says.
    Not all narcotic seekers leave in peace when their requests are denied. Yeh was nearly assaulted by a woman seeking a narcotic in the ER after the woman realized that her story was being verified. "They're tough people to manage," says Yeh, who also witnessed a man claiming to be in pain use his crutches as a weapon when he was denied narcotics. Alexander notes that his hospital was reported to state authorities for alleged malpractice for refusing to prescribe OxyContin. The case was eventually dropped. The time required to do a work-up, check medical records, notify the primary care physician and investigate a substance abuse program, says doctors, can be significant, especially when there is a room full of patients in need waiting. And once the doctor realizes that the medical claim is fraudulent, they don't just leave it there. "We don't just blow it off," says Alexander, "it takes time to sit down with them and explain why we're not going to give them their drug."
    But such experiences have an even deeper impact on the practice of medicine, according to some physicians. Dr. Donald Yealy, professor and vice chair of emergency medicine at the University of Pittsburgh, says that abuses of OxyContin instill a fear in physicians of prescribing the medication, possibly causing some physicians to hold it back. "In the long run," says Yealy, "there will be more harm to those people who really need it." Which is precisely what Penny Cowan, founder and director of the American Chronic Pain Association, does not want to see happen. "It just adds insult to injury," says Cowan. "Imagine the worst headache, the worst pain, and you go to the ER for help and are only questioned. It can be very frustrating. Sometimes they're leaving without medications or with just enough for the moment."
    O'Brien, however, believes that ERs are getting better at managing narcotic fraud. "They're getting better at checking photo IDs. They will dispense only the adequate milligrams and number of pills and then refer the person to a primary care physician. Paper prescriptions now are multi-colored and do not photocopy well. "We call in narcotics to the pharmacies which have pretty thorough systems for keeping medical information. The technology has also improved. CAT scans tell us with 97 percent accuracy in 10 minutes whether someone really has a kidney stone."
    Still, doctors like Larry Alexander hope that the efforts of the manufacturer of OxyContin, Purdue Pharma, will help the situation. Earlier this month, Purdue Pharma said it was working to develop a painkiller like OxyContin that would also contain an ingredient to prevent abuse. Though the formulation would probably take three to five years to develop and be tested, doctors faced with narcotic seeking in the ER will likely be relieved when it's released. "You feel angry many times," says Alexander. "You're put in a position where someone is seeking your help and you can't give it. It's a tough situation to be in."

Number of US Drug Trafficking Charges up, Study Says
Karen Gullo, Associated Press- 8/20/2001

WASHINGTON - More than 30,000 people were charged with federal drug offenses in 1999, more than double the number 15 years earlier, and most of those convicted were drug traffickers, according to a Justice Department study released yesterday. Attorney General John Ashcroft said the report shows that federal drug laws are catching the serious criminals and keeping them behind bars longer. One criminologist disputed that assertion, saying that only a fraction of traffickers are being arrested.
    The study released by the department's Bureau of Justice Statistics found that only 4 percent of drug criminals were convicted of simple possession. Ninety-one percent were convicted of trafficking. It also found that drug offenders are serving longer sentences. The average prison stay rose to 51/2 years in 1999 from 21/2 years in 1986. The longer prison times result from federal laws passed in the past two decades that require mandatory minimum sentences for drug crimes, researchers said. ''Tougher federal drug laws are making a real difference in clearing major drug offenders from our nation's streets,'' Ashcroft said. The report showed that 30,099 defendants were charged with a federal drug offense in 1999, the most recent year for which data were available. In 1984, 11,854 were charged with drug crimes.
    James Alan Fox, a criminologist at Northeastern University, said that while the jump reflects the government's increased drug-fighting efforts, prosecutors are getting just the tip of the iceberg. ''We are devoting a tremendous amount of money and resources to this relentless war on drugs, which is not winnable,'' he said.
    Almost half of those charged with drug offenses in the period studied were Hispanic, 28 percent were black, and 25 percent were non-Hispanic white. John Scalia, the report's author, said the Hispanic count was high because many cases involved drug smuggling across the US-Mexico border. About a quarter of defendants were not US citizens.
    About half of defendants had a prior conviction and a third were under justice supervision when they were arrested. Drug prosecutions made up 32 percent of the federal criminal caseload in 1999, compared with 18 percent in 1984. More than 25,000 defendants were convicted. Almost half had no prior convictions. Nearly a third were involved with marijuana, 42 percent with powder or crack cocaine, and 13 percent with methamphetamines. Most were subject to mandatory minimum prison sentences. But about 21 percent of convicted drug criminals received a reduced sentence under a 1994 law exempting many first-time, nonviolent drug offenders from mandatory sentences. The average sentence rose to 74 months from 62 months in 1986.