John and LizzieB:
Liz with Carl Kelly at Baton Rouge Treatment Center:
Mobile methadone? NO! Mobile insurance? HELL YES
Church of Scientology to the rescue:
Choices of LA, MMT clinic in LaPlace, owned by Joanne and Roy Brown:
Inside at Choices of LA:
Medication booths -- when you're ready, you push the little bell, and they buzz you in... kind of nice system for privacy
Dan with Roy Brown at LaPlace clinic:
People trying to get back to normal:
Sloooooooow traffic moving toward checkpoints as people start moving back into NOLA (of course, this is the day before they decide everyone should move out again, thank you Lovely Rita)
traffic's moving slowly enough that John decided to walk beside the van and catch a smoke:
Police checkpoint to get into New Orleans:
Obligatory shots of the devastation in New Orleans:
New Orleans Narcotic Treatment Center, the only MMT program in New Orleans that wasn't virutally destroyed, opened Monday morning for business. The posted hours are 5AM to 12Noon
Alex and Diana John, still working at 5:30 PM on Monday.
Healthcare in Louisiana:
Monday 19 September 9:51 AM
Got to Baton Rouge Treatment Center around 7AM. Security guard greeted us with “New Orleans?” but let us thru when we said we had an appointment with Mr. Kelly.
Carl Kelly is a perfectly nice guy, seems to want to run a good program. CRC is a corporation. They have lots of rules. Like, they have a general policy that they don’t give split doses. Not even for pregnancy or medical reasons. We discussed Hepatitis C inducing cytochromes and stuff, but it’s corporate policy. It’s also corporate policy to get serum methadone levels if patients want to go over 130mg. It used to be they had to get levels to go over 180 mg, but they thought people were taking too much methadone, so they changed the policy to 130, and now most people don’t ask for doses over 130 because the serum levels are expensive. I’ll tell you, methadone programs have managed care beat all to hell for having administrators tell doctors how to practice medicine.
Oops. I just called methadone maintenance medical practice. Silly stupid me.
Anyway, even with that 130-mg-serum-level rule, Carl said their average dose was 120mg. I’m having trouble following the math on that one but I never was so good at arithmetic.
Louisiana state legislature passed a moratorium on new methadone programs – that’s the reason (one of the reasons) why BRTC isn’t going for a mobile program, it would count as a new program. ‘Course, the SMA didn’t tell us that. I told you it was just ONE of the reasons. The moratorium is in effect until 2007. Meantime, it will literally take introducing a bill to the state government to change it.
There were cars everywhere when we arrived at the clinic. Parking lot full, waiting room packed. Liz and I went in and talked to Carl while Dan and John worked the parking lot. The clinic is a perfectly nice little clinic, clean enough, very plain (no cows anywhere). Only two of three medicating windows were open, one for BR people, one for NO people. John’s observation from the parking lot was that people were waiting an hour or more to be dosed. Carl said that the waits were so terrible in the first weeks after Katrina that at this point people think it’s pretty good.
They had ~400 patients pre-Katrina, and have taken in 250 more, which is pretty astonishing. There is no FEMA money, nothing set aside to pay for methadone treatment. A lot of patients (we’re not sure how many) are being dosed for free. No one seems to be turned away, except the ‘pain management’ patients (see below where we visit the LaPlace clinic).
When Carl was able to contact the parent NOLA program, he was able to give patients their same dose with uninterrupted pickups. Most of the NOLA programs have been good about getting in contact with BRTC and other nearby clinics where their patients may have gone. One program however, he’s been unable to contact, and that program has made no attempt to contact him, so he’s been unable to give full service to those patients.
This is all because, BTW, Louisiana has no state registry for methadone patients. When a new patient comes to a clinic, the only way to see if he’s already registered at another clinic is to pick up the phone, dial the other clinics, and ask them, one by one.
In the week after Katrina, two of the BRTC nurses left the area, and one of the doctors died…there were no nurses to be found anywhere in the area to do methadone (all being used for medical relief) so CRC muled in a couple of nurses from elsewhere in the country – they’ve since gone home. So it’s been a bit stressful there. BRTC has, we believe, really made an effort to take care of the patients who showed up at their door. No outreach, of course, but that’s a foreign concept in MMT anyway. And they sure don’t want to take us up on our offer to DO outreach. Patients are being taken care of, but they’re not what you’d call welcome for the long haul.
Average counselor caseload at BRTC is 50, though LA recently passed a law that it can go as high as 75 without being out of compliance with accreditation. Carl hopes his counselors won’t need to carry caseloads that high for too long – but he needs to hire new people, and maybe expand the physical plant, to accommodate the new influx of patients.
Speaking of which, Carl was pretty clear that he wants all those New Orleans people to prosper, be well and happy,
BACK IN NEW ORLEANS. Carl likes to visit New Orleans, but he doesn’t want to live in New Orleans, and he doesn’t want New Orleans living in his town. NIMBY, you know. And the class of patient that’s coming in from NO isn’t really the sort they like in BRTC. BR is, as I’ve said, a cocaine town, not a heroin town. Opiate addicts tend to be white, middle class, prescription drug users who drive nice cars and pay their bills on time. Less than 3% of the BRTC clinic population is African American.
Dan and John talked to a couple who were staying at the River Center with their baby. They said they had spent about 3 hours taking buses and other public trans to get to the clinic, and would take another 3 hours to get back. They said that, to their knowledge, there are about eight or nine people from the River Center who are coming to BRTC. They said there was talk of a van to transport people from the River Center to the BRTC, but it hasn’t been running.
The Red Cross doc had specifically told me that transportation had been arranged to take patients back and forth between River Center and BRTC – it’s the reason she gave that she didn’t need our help.
Also, the low number of patients in River Center who need methadone jibes with the reports we’ve had from several sources that patients are being put out if they use. Saturday night we walked past the River Center a little past midnight… there was a woman sitting on the curb with her husband and all her possessions, said she’d been put out for fussing with her brother. She said she was trying to get a cab to a hotel. We advised her that she wasn’t going to find a hotel room closer than, like, Atlanta. When we walked back past around 1:30 AM she was still there. She was quite intoxicated, cocaine and alcohol would be my guess. We would have given her a ride to wherever she wanted to go, but there was nowhere TO go, and we figured she was safest there, with a police and National Guard cordon around the River Center.
BTW, the Red Cross is not allowing 12-step meetings in the shelters. Yes, you heard that right.
***
Choices of Louisiana is a program run by Joanne and Roy Brown in LaPlace. Beautiful physical plant, very new and clean and medical, staff were fairly friendly to us. Joanne was busy and had only a few minutes to talk to us… in fact was downright brusque. Then again, she’s been busy. Roy chatted a little while longer… in general the message is the same: “We have the situation under control, we know how to manage our opiate addicts, Yankee Go Home.”
I have been suggesting to them the strategy of “don’t waste your disaster” – use this situation to point out the flaws in the LA addiction treatment system, use the momentum of Katrina to drive systems change.
BTW, the program in LaPlace is 91% white as well. Don’t any African Americans in Louisiana use heroin? Very odd.
Their census pre-Katrina was 300-odd, swelled by at least 150 – though their clinic also lost some patients who had lived in NOLA and evacuated to Texas. They’re not requiring any patients to pay, though they’d like to be paid… Roy said ‘this could drive us to bankruptcy’.
The potential for disaster is pretty bad here. The AA addicts coming out of NOLA are very much ‘undesirables’ everywhere they go…. And the treatment system is already set up to exclude and marginalize them. The culture shock that BR will undergo when they realize these undesirable people are going to stay in their neighborhood… well it ain’t going to be pretty, and addictions is gonna take it on the chin… “we didn’t have these problems before
those people came up from NOLA”, etc… racism feeding anti-addict sensibilities, re-feeding the racism in a downward spiral.
As we arrived at the LaPlace clinic a young woman was leaving quite profanely… she was a ‘pain patient’, with a prescription for 90 40mg diskettes of methadone a week, and the clinic didn’t feel comfortable just writing that prescription… which I can understand, I’d have a bit of trouble with that myself. This ‘pain clinic’ situation is quite a problem here in LA. We see billboards on the highway for “Pain Management”. Evidently there was a big ‘pain clinic’ prescription mill in BR… half a dozen docs, each doctor saw 700 patients/month; when DEA infiltrated they found that the agents would go in, be seen for less than 60 seconds, and walk out with an average of three prescriptions, for schedule II narcotics and schedule III benzodiazepines. Patients were bringing in an MRI of someone’s knee – the name on the MRI didn’t even need to match their own.
The reason for these ‘pain clinics’, of course, was to address the enormous need left by the huge inadequacies of the methadone treatment system. The solution, of course, is to arrest the ‘dirty doctors’ – and the patients; when they made the sting a lot of patients got scooped up as well.
OH!!! I almost forgot to tell you the really good news! Louisiana has a goal of making all its cities Drug-Free, and New Orleans will be the pilot project. They will be very careful about
not allowing the criminal element to re-enter when New Orleans is repopulated… Babylon has been destroyed, let’s rebuild Jerusalem in its place.
Although in this case I think it’s more Epcot Center than Jerusalem. I mean – New Orleans as the pilot project for New Drug Free Cities???
New Orleans??? Bzuh?
1:52 PM
we’re driving over the Spillway at Lake Pontchartrain now. Very wet, but it always was… lots of trees down.
6:13
quite a fucking afternoon. It was a challenge just to get close to NOLA… had to go through several Army checkpoints, where the Power of the CRA Identification Badge was once again manifest hooray! Anyway, we got past… drove thru several areas, including the Garden District, saw lots of … well, sights. I’ll put up a couple of pics just to prove we were there, but CNN does a better job of giving you pics of what it looks like in New Orleans.
The big news is that finally we found New Orleans Narcotic Treatment Center, and after the other programs we’ve visited today, it was very refreshing. The hours posted on the door are 5AM – 12noon. We arrived at 3:15, stayed till six, and they were still medicating people when we left… a nice contrast to BRTC and LaPlace, where the hours were NOT extended. Of course, this was NONTC’s first day back in business since Katrina… and now they may have to evacuate again tomorrow for Rita. Jesus.
Anyway… Diana and Alex John run a very friendly, homey clinic. Their census is in the 300’s range, and they expect that to at least double this year, as they’re the only clinic on the West Bank… and all four East Bank programs were pretty much completely destroyed – they’re still closed and likely to remain so, especially with Rita coming through.
NONTC has a nice feel to it. Their average dose is only around 60mg, which I don’t like so much, but I suspect that the other programs actually have an average closer to that as well. I just can’t imagine that a clinic who has ‘nobody going over’ 130mg has an average of 120mg.
Patients at NONTC seem to like the program… after they’re medicated, people wait so they can say goodbye to Alex and Diana before they leave, stuff like that. John and Dan talked to a few folks in the parking lot, Liz and I to a couple in the waiting room, and they all said that, in general, they were treated well at BRTC while NONTC was closed. One guy said that BRTC was very clear with him when he medicated and picked up his bottle on Sunday that NONTC was going to open Monday, so he should move on from BRTC. That’s not unreasonable….
Anyway, here’s the good news: Diana and Alex know there are patients in several different shelters through Louisiana and Texas who are not being medicated, and they would very much like our help in getting methadone to them. They are aware that the Louisiana SMA has not been enthusiastic about us doing mobile methadone in BR, but think it’s possible we can work something out for NOLA… particularly with another hurricane moving in.
Tonight Liz and I are headed back to BR – we have to, we stupidly didn’t bring our bags with us – John and Dan are staying with Alex and Diana… unless traffic is totally impossible Liz & I will come back down tonight. Terri has been wonderful, and it’s time we got out of her hair. Traffic is totally impossible at the moment, but that’s headed OUT of New Orleans, which is the way everyone wants to go right now. Did I mention there’s another hurricane coming?
So we probably won’t stick around in NOLA to see a hurricane first hand… the Johns own several other clinics so we’ll probably be moving west with them to Lake Charles LA and maybe on to Houston. They know there are several people in the Lake Charles area shelters that haven’t been medicated, so maybe we can actually HELP, what a concept.
If there’s no pics with this post, well, I’ll get some up tomorrow…. Sorry, internet access is just kind of an issue around here. So is cell phone access, come to think of it.
Tuesday 20 September 10:30 AM
Well… Liz and I drove to BR, got our stuff, drove back down to NO, but Dan and John didn’t have any idea where they were, just the address of Alex & Diana’s house, which was in a gated community somewhere in Harvey Louisiana. Evidently Dan hadn’t been paying close attention as they drove there, said he had no idea where they were and couldn’t give us directions, and Diana and Alex had already gone to bed when we called (at about 9:30, poor people were exhausted).
Liz and I drove around Harvey Louisiana for about an hour and a half and couldn’t get any clue of where the address might be. It was pretty spooky, out after curfew, armed men cruising around in humvees… around 11:30 we gave up and drove back out of town to a Walmart we had seen. People in cars and trailers were camped in the Walmart parking lot, so we did the same; each of us took an Ambien and slept in the car.
Plans today look hopeful… maybe. First, a little background: On Thursday or Friday, there had been a conference call between Duffy, the Louisiana methadone authority, and the various clinics: BRTC, LaPlace, NONTC, and a few others. Basically, as we hear it, the programs were warned off from this group of crazy people coming down from the North to stir things up. On Monday the group talked again, and everyone but LaPlace wanted to see if we could help them; LaPlace was still very negative toward the idea, and that’s the way the decision went: the state would not support us.
LaPlace, BTW, actually
lost some patients after Katrina, as they had several dozen from NOLA, and those patients were all affluent enough to evacuate out to Texas and other parts distant. So… looks like they definitely have a vested interest in keeping evacuees out of their clinic.
Here at NONTC this morning it’s a madhouse. Patients everywhere, Alex and Diana run off their feet. Evacuation order starts today, and everyone is supposed to be OUT by tomorrow evening, so patients are frantic to get their methadone. NONTC is giving out at least 5 days’ pickup on special exception to virtually everyone, and encouraging everyone to go to Lake Charles, where they can be treated at the clinic there.
It looks like we’ll be heading for Lake Charles today or this evening. Liz is still talking with Nick Reuter and Bob Lubran, trying trying trying to get us Suboxone. Nick can’t ship it till he has the address of a treatment program that is working with us. Evidently he couldn’t get a commitment from BRTC that they were working with us, when he called them trying to arrange the shipment. Or something! Please be aware, we’re getting information from about 50 sources simultaneously, and the only way we know what’s true and what isn’t is to wait and see what happens.
So, once again, we’re waiting to see what happens. It’s not my favorite thing to do.
11:33 AM
Liz is talking to Bob Lubran. Dan and I talked to Holly, who’s talked to Bob Lubran. We’ve all talked to Nick Reuter. We’re all talking and talking… amazing, considering how poor cell phone reception is down here. I’m going to try to get an internet hookup in the clinic and get this posted
and in closing, our obligatory daily shot of Lizzie's rear end:
