Dr. Vincent Dole  5/18/1913 - 8/1/2006

In Memoriam: Methadone Pioneer Vincent P. Dole

8/4/06

http://stopthedrugwar.org/chronicle/447/vincent_dole_methadone_pioneer.shtml

This memorial piece for a great pioneer in addiction treatment was written and distributed by his friend and colleague, Dr. Robert Newman.

Dr. Vincent Dole (an internist) and his late wife, Marie Nyswander, MD (a psychiatrist), began their collaborative research with methadone with a handful of long-term heroin-dependent individuals in 1964. They did so in the face of overt threats of harsh criminal and civil action by federal narcotics agents. Their courageous, pioneering work demonstrated that methadone maintenance is a medical treatment of unparalleled effectiveness -- a superlative description that is as applicable today as it was four decades ago. As a result, well over three-quarters of a million people throughout the world are able to lead healthy, productive, self-fulfilling lives - over 200,000 in the United States, an estimated 530,000 in Western Europe, and many tens of thousands more in Eastern Europe, Middle East, Central Asia, Far East, Australia and New Zealand.

After the remarkable transformation they observed in their first few patients, Dr. Dole and Dr. Nyswander went on to provide direct supervision of the first methadone maintenance treatment program at Beth Israel Medical Center in New York. In so doing they demonstrated that it was possible to replicate on a large scale the therapeutic success they achieved in the small, controlled, research environment of the Rockefeller Institute (now Rockefeller University). Dr. Dole was also responsible in the early 1970s for convincing the New York City Department of Corrections (at the time headed by Commissioner Ben Malcolm) that detoxification of heroin-dependent inmates in the city's main detention facility at Rikers Island was imperative to save lives and lessen suffering (there had been a wave of suicides at the time that had been attributed to severe opiate withdrawal). The detoxification program continues to this day, and has become a model for enlightened corrections officials in other countries

. Dr. Dole and Dr. Nyswander's contributions, however, transcend the life-saving clinical impact on patients and the enormous associated benefits to the community as a whole. They had prescience to hypothesize, years before the discovery of the morphine-like endorphine system in the human body, that addiction is a metabolic disorder, a disease, and one that can and must be treated like any other chronic illness. What was at the time brilliant insight on their part is today almost universally accepted by scientists and clinicians alike, and remains the foundation upon which all rational policies and practices in the field rest.

In his mid-80s Dr. Dole traveled to Hamburg to be present at the naming ceremony of the Marie Nyswander Street; in less than ten years Germany moved from methadone being illegal to having over 60,000 patients in treatment! His efforts during recent years were devoted to fighting the stigma that, tragically, remains so widespread against the illness of addiction, the patients and the treatment.

Todd Rosendale (SAMHSA/CSAT) submitted this piece that Dr. Westley Clark (SAMHSA/CSAT) sent to him and others....

From: Clark, Westley (SAMHSA/CSAT)
Sent: Wednesday, August 09, 2006 2:52 PM
To: SAMHSA - ALL
Subject: Vincent Paul Dole
May 18, 1913 ~ August 1, 2006

On Tuesday August 1, 2006 the remaining member of the precedent setting scientific research team of Dole and Nyswander, Dr. Vincent P. Dole died at New York Presbyterian Hospital; he was 93 years old.

In the field and practice of methadone maintenance treatment as it has been called over these past four decades, it is difficult as a practitioner or recipient to not be familiar with the names of Dole and Nyswander. In the early 1960s at Beth Israel Medical Center, this husband and wife research team formed a collaboration in which they challenged the current underpinnings of narcotic addiction and its treatment resulting in a new, yet logical discipline of medicine and clinical treatment known as methadone maintenance. They had become convinced that there was more to addiction than environment, poor choices and the seemingly endless revolving doors of the criminal justice and prison systems. The fact that addicted people would be arrested for committing crimes to get money for drugs, be convicted of the crime and go to jail only to finish the sentence, get released and immediately resume heroin use on the way home from being released, was a riddle and the answer appeared that it was a disease. They initiated research which at the time was seen as quite unorthodox and would fly in the face of societal norms as well as some colleagues opinions; however, in 1964 in spite of the increasing pressure, they initiated their research utilizing a little known pain medication, methadone and a dozen or so individuals with long histories of heroin addiction interspersed with reoccurring visits to Rikers Island.

The logic, simplicity and success of their initial hypothesis that narcotic addiction or dependency was capable of being treated much like many of the chronic diseases of the day, quickly gave rise to the availability of Federal funding for treatment and infrastructure development which would specialize in the study of narcotic addictions.

Currently there are several hundred thousand patients treated daily in the 1,150 SAMHSA Certified Opioid Treatment Programs throughout the United States and Puerto Rico, and many more patients in treatment with methadone across Europe and other parts of the world.

The American Association for the Treatment of Opioid Dependency (AATOD), once known as the American Methadone Treatment Association (AMTA) was formed as a non-profit organization to represent this new discipline of medicine as well the treatment clinics, and to further the treatment goals and ideals of Drs. Nyswander and Dole. As a tribute to them, AATOD created the Dole-Nyswander award to be given to clinicians who best exemplify Nyswander and Dole’s ideals in treating patients, and since its inception, 174 individuals have been so honored. It is now referred to as the “Marie Award” because upon learning the awards name, Dr. Dole immediately stated that it should be the Nyswander Award, or at least his wife’s name should come first, which was typical Dr. Dole behavior. He would also become very embarrassed when patients would stop him on the street or during conferences and thank him for “saving their life.” He appeared somewhat uncomfortable with the recognition and preferred for his wife, Marie to receive it. One of the recipients of the award, Todd Rosendale, is a member of CSAT’s Division of Pharmacologic Therapies.

The work of Drs. Dole and Nyswander did address the riddle of the revolving criminal justice door and addictive behavior, and both AATOD and CSAT continue to work with various state agencies and court systems to encourage the treatment and not incarceration of individuals with this disease. The discovery of methadone maintenance, the daily routine ingestion of methadone and the resulting 24 hour steady plasma level free of withdrawal, eventually transcended the treatment of addiction and gave way to the maintenance use of narcotic medications in the relief of pain which was previously thought to be intractable. Patients disabled due to intractable pain, as well as patients disabled due to their dependence on heroin and more recently pain medications, were returning to work.

So, the life’s work of these two brilliant physician researchers was not only successful in their own discipline, but also in that of neurology. Their early work relative to the brain’s receptor sites had implications for the treatment of pain, alcoholism, autism, and countless other diseases whose parameters are defined by the brains neurochemistry. Yes, they did both save lives; and they are, and will continue to be our family, friends, colleagues, coworkers and others who are unknown to us; and a finer legacy could not be written.

MMT Pioneers: Vincent Dole , MD – “Father” of MMT

*Thanks to Mr. Stewart Leavitt for allowing us to use this profile he did at AT Forum.  It was written a little more than a year ago....was personally approved and liked very much by Dr. Dole.  Mr. Leavitt will also be doing a personal followup in their Summer edition of AT Forum.

http://www.atforum.com/SiteRoot/pages/current_pastissues/spring2005.html#mmtpioneer

Vincent Dole, MD, has been acknowledged worldwide as the “founding father” of methadone maintenance treatment (MMT) for opioid addiction. Yet, he is always quick to acknowledge the contributions of the research team he put together at The Rockefeller University in the mid-1960s to develop MMT.

From Math to Medicine

Dole was born in 1913 and raised on the north side of Chicago, Illinois. He attended Culver Academy, a private college preparatory school in Indiana, and then went on to major in mathematics at Stanford University – graduating in 1934.

He decided to pursue a medical career but had not taken some of the required premedical courses. By the end of his second year at the University of Wisconsin, where he went to pursue the necessary science courses, he was accepted into Harvard Medical School, from which he graduated in 1939.

During his medical internship and residency at Massachusetts General Hospital, Dole developed a special interest in metabolic diseases. In 1941, he joined the faculty of The Rockefeller University in New York City to conduct research on hypertension, lipid metabolism, and obesity.

A Fortunate Discovery

In the early 1960s, Dole had an opportunity to assess the health care needs of New York City and concluded that a major problem there, and elsewhere around the country, was heroin addiction. However, at the time, treatments for heroin addiction – largely based on forced detoxification and drug-free behavioral therapies – were remarkably unsuccessful.

He decided to redirect the efforts of his research to address opioid addiction. Shortly thereafter, Dole recruited Marie Nyswander, MD, and then Mary Jeanne Kreek, MD, as key members of his research team. To this day, he especially recognizes the contribution of Nyswander in teaching the team about drug addiction and the importance of listening to the patients. (She was featured in the Winter 2005 edition of AT Forum.)

After first unsuccessfully testing short-acting opioid medications, the team discovered that longer-acting methadone provided the qualities they were seeking. It was orally administered, stemmed withdrawal and drug craving, did not induce opioid tolerance, and blocked effects of illicit opioids if any were taken. They published their first research findings in 1965, reporting on 22 patients, in the Journal of the American Medical Association.

As an explanation for methadone’s usefulness, Dole proposed that there is a physiologic basis for heroin addiction involving altered metabolic processes and irreversible changes in brain chemistry. Methadone helps “normalize” those functions; however, for most patients daily methadone could be required for a lifetime, much like insulin is for controlling, but not curing, severe diabetes.

In essence, they focused on opioid addiction as a medical condition, rather than as a character defect, moral failing, or behavioral disorder as had been so commonly believed in the past. Perhaps, Dole’s greatest contribution to the field has been the concept that, despite whatever other troubles an opioid-addicted patient may have – of which there might be many, including mental, social, and economic problems – addiction is first and foremost a brain disease that can benefit from pharmacologic intervention.

Dole once commented, “The interesting thing about methadone treatment is that it permits people to become whatever they potentially are.” MMT has demonstrated that so-called “addict traits” are a consequence, not a cause, of addiction and that substantial numbers of opioid-addicted individuals can be rehabilitated to become productive members of society.

Enduring Passion for Science

One of Dole’s enduring qualities is his open-minded interest in new treatment approaches, albeit tempered by an insistence on sound research evidence. He has acknowledged that methadone is but one medication and other medical treatments for opioid addiction may be worthy of consideration. However, none of them to date has demonstrated superiority over methadone in well-documented clinical trials.

He candidly criticizes the ignorance of fellow physicians who close their minds to the disease concept of addiction. And, he has had little tolerance for those claiming that methadone merely substitutes one addictive drug with another, or touting alternative addiction treatment therapies that do not have a firm footing in science.

In the tradition of “listening to patients,” Dole has been a strong supporter of methadone-patient advocacy groups. He has emphasized that involved patients with legitimate concerns for how they are being treated can bring about real changes that are otherwise difficult to achieve within the present system.

More Rational Attitudes

Through the years, Dole has been a prolific writer and frequent speaker on addiction and MMT. He has received many honors and awards for his work, including the prestigious Lasker Award in 1988.

He told AT Forum nearly a decade ago, “My job always has been to promote the question: What can be done about addiction?” He believed that experience and the truth would bring us to more rational ways of dealing with addiction treatment, and that rather medieval attitudes toward addiction would be overcome in favor of viewing it as a medical disease.*

As this present article was being developed, Dole was recovering from a series of debilitating strokes. Asked if he had some thoughts about the status of MMT today, he said, “I would love to believe that the medical profession has come to accept addiction as a medical problem. That would be my dream. However, there is still so much ignorance and prejudice that it saddens me.”

“MMT has exceeded my expectations in terms of its success and its demonstrated positive results; it is surprisingly useful if one believes in addiction as a disease,” he continued. “On the other hand, if one is trying to disprove that methadone works, and inadequate methadone doses are used, failure is almost certainly guaranteed.”

Unfotunately, there is a MAXIMUM LENGTH in the message field of the Condolence Book. It's quite long and shouldn't affect most people.....however, if your message does NOT fit, please drop me an email with the message you'd like posted and I will post it on this page with the other articles instead.
Thanks!....Carol  Carol@MethadoneSupport.org