http://exhibits.library.stonybrook.edu/mfp/files/original/1fe493c34a03197ff8babc2cd62327ee.pdf adb537c44cd3cc86af9e2c417662667a PDF Text Text December 22, 1971 Dr. Paul H. Blachly Professor of Psychiatry University of Oregon Medical School 3181 S.W. Sam Jackson Park Road Portland, Oregon 97201 Dear Paul; again, I find your questions thought—provoking and most relevant to public issues. I accept your premise that ”those who are physically dependent or have been so in the past” should be admitted to methadone programs ~ and our program is limited to those males with at least a Zwyear history and one confirmed treatment failure. In answer to your questions: Once (1) We (2) I (3) We do not use naloxone to screen routinely. know of no program that does. do not use naloxone to screen, for we admit all patients to the ward, observe for withdrawal symptoms, and then detoxify with methadone if symptoms are observed. to run a large methadone program, I would use naloxone give naloxone for test purposes auout 4m7 days post—withdrawal (0.8 mg IV) 24 hours (or more) before we give heroin challenges. At various times, 3-6 days after the last does of methadone, our patients have had chills, piloerection, irritability, and insomnia ~ sufficient for the staff not to wish to do a naloxone challenge routinely. tests. Wereel We (4) About prisoners, your suggestion is interesting. In nor~ subjects, naloxone has no effect on behavior, pupils, heart rate, or EEG. In the recent post~addict, symptoms are precipitated. I do not know what to expect in an addict, ”clean” for some weeks or months, although I would anticipate he would be like our normals. Surely, a man claiming to mal be dependent - and using opiates within easily by a naloxone test. 3—6 days - would be identified �(5) The suggestion about naloxone's availability to police and objection would be the rare sadist who would enjoy the discomfort of precipitated abstinence - but this is a miniscule risk compared to the possible saving in overdose deaths. I would anticipate a coma from non~opiate cause would have no adverse consequences from the naloxone. ambulance drivers is brilliant. On two The only occasions, in patients receiving 100 mg methadone daily, our heroin challenges (50, 75 mg) elicited euphoria, respiratory slowing, and miosis evidence of insufficient blockade (cross-tolerance). We gave 1 mg naloxone IV, and in each case, precipitated a severe abstinence syndrome, unresponsive to additional heroin, methadone, and chlorpromazine, and being relieved only by time (3-6 hours). — Note also, that naloxone IV is usually effective for only and in overdoses, must be repeated frequently. 2—3 hours I would support the suggestion that naloxone be freely available to ambulances, police, physicians', and pharmacies; would not object to an over—tne—counter availability; and would encourage studies of naloxone in prison (or hospital) units as a test for eligibility for methadone maintenance. Incidentally, our acetylmethadol study is completed and it coninitial optimism in 1969. It will appear in JAMA a copy is enclosed for your interest. Also, Eur first trials with naloxone pamoate firms your — began December 16. My thanks for the good wishes about these provocative questions. — and for the opportunity to think Sincerely yours, Max Fink, M.D. Professor of Psychiatry MF:ig Enc. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence to: Blachly, Paul H. 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