Bertha Madras

Bertha K. Madras is a professor of psychobiology in the Department of Psychiatry and the chair of the Division of Neurochemistry at Harvard Medical School, Harvard University; she served as associate director for public education in the division on Addictions at Harvard Medical School. Madras has published research in the areas of drug addiction (particularly the effects of cocaine), ADHD, and Parkinson's disease.

Madras earned a BSc in biochemistry with honors from McGill University in 1963.[1][2] As a J.B. Collip Fellow of the Faculty of Medicine, she was awarded a PhD in biochemistry (metabolism and pharmacology, including hallucinogens) from McGill University in 1967.[1][2] She completed postdoctoral fellowships in biochemistry at Tufts University/Cornell University Medical College (1966–1967) as well as at the Massachusetts Institute of Technology (1967–1969).[1][2] Thereafter, she was appointed a research associate at the Massachusetts Institute of Technology (1972–1974) as well as an assistant professor in the Departments of Pharmacology and Psychiatry at the University of Toronto.[1][2] Dr. Madras joined the Harvard Medical School as an assistant professor in 1986 and was subsequently promoted to associate professor and (full) professor – with a cross-appointment to the Department of Psychiatry at the Massachusetts General Hospital.[1] Dr. Madras also founded and chaired the Division of Neurochemistry at Harvard Medical School's New England Primate Research Center (NEPRC) – a multidisciplinary, translational research program which spans chemical design, molecular and cellular biology, behavioral biology, and brain imaging approaches.[1]

She is married to Peter Madras and has two daughters, two sons-in-law, and five grandchildren..

Public policy work

Madras served as the deputy director for demand reduction for the White House Office of National Drug Control Policy;[3] She was nominated by President George W. Bush in July, 2005, and unanimously confirmed by the United States Senate in 2006.[4][5][6] in the Federal budget for Medicaid reimbursement, assurances that the majority of federal employees' healthcare insurers would reimburse for these procedures, that certain State Medicaid plans would reimburse for SBI services, that the Veterans' Administration would mandate SBI for alcohol throughout the VA system,[7] that the Federal Health Resource Services Administration (HRSA) would implement these services in underserved populations.[8][9][10][11][12][13][14][15][16][17]

Response to opioid fatalities

Although her term was largely consumed by oversight of federally funded programs, upon assuming office as deputy director of the ONDCP, Madras became aware of a newly emerging threat, fentanyl overdose deaths in heroin addicts. She rapidly organized a conference in Philadelphia with treatment providers, emergency responders, emergency room professionals, law enforcement officials, representatives from city governments, other healthcare professionals, to create a coordinated response to eliminate this threat to life. Within months and for a number of reasons, fentanyl overdose deaths declined rapidly. Of over 170 media events and interviews during her term, she gave two interviews on Narcan distribution to heroin addicts and friends. At that time, she strongly supported narcan rescue by trained healthcare personnel, but opposed distribution to heroin users and their friends, of overdose rescue kits of opiate-antidote naloxone (Narcan) in i.v. or nasal spray form. Her opposition was based on discussions with NIDA and SAMHSA and a scientific literature survey by NIDA. She voiced opposition to "take-home" narcan on the basis of inadequate scientific evidence to support this policy and on the basis of several publications of potential adverse outcomes. "Madras says drug users aren't likely to be competent to deal with an overdose emergency". This quote was based on several studies and the views of EMT responders, e.g. Seal et al., 2003, that indicated risks related to naloxone administration to opioid-dependent people, by untrained personnel. Her opposition to "take-home" narcan arose from a number of factors cited in a National Public Radio interview. These included quoting Seal's detailed study of heroin – injectors in the San Franscisco Bay area.[18] In this survey of 82 street-recruited IDU's who had experienced one or more heroin overdose events, 51% reported soliciting emergency assistance, 87% were in favor of participating in an overdose training program, 35% predicted they would feel comfortable using greater amounts of heroin if they had narcan in their possession, 62% would be less inclined to call 911 for an overdose, 30% would leave an overdose victim after naloxone resuscitation, and 46% might not be able to dissuade the victim from using heroin again to alleviate withdrawal symptoms induced by naloxone. Another article published by van Dorp, raised concerns that i) "the induction of an acute withdrawal syndrome (the occurrence of vomiting and aspiration is potentially life threatening)" – and that could lead to abandonment by a narcan provider/friend; ii) "the effect of naloxone may wear off prematurely when used for treatment of opioid-induced respiratory depression and require multiple doses and long-term vigilance". "Risks warranting the cautious use of naloxone and adequate monitoring of the cardiorespiratory status of the overdose person after naloxone administration where indicated".[19] Based on the Seal study, she was concerned that Narcan kits may encourage 35% of drug abusers to use greater amounts of heroin because they thought overdosing isn't as likely, again leading to unintended consequences. Madras also felt that in the presence of healthcare professionals, the opportunity to provide detoxification and referral to treatment would be greater than in a "take-home" narcan provision program.[20][21] She was concerned that in a "take-home" narcan program, not all resuscitated heroin overdose events could be safely left alone. This concern was based on an article by Etherington et al. (2000): "In the medical community, it is recommended that patients with heroin overdose be watched for 4 to 24 hours after naloxone. In a recent study, overdose patients were formally assessed 1 hour after receiving naloxone for presumed opioid overdose. Of 573 patients, 48% were discharged in less than 2 hours, 23% in 2–4 hours and 29% in >4 hours. 94 patients who were held in the emergency department (ED) or admitted required a critical intervention, including supplemental oxygen for hypoxia (74), repeat naloxone (52), antibiotics administered intravenously (IV) (14), assisted ventilations (13), fluid bolus for hypotension (12), charcoal for associated life-threatening overdose (6), IV inotropic agents (2), antiarrhythmics for sustained tachycardia >130 beats/min (1), and administration of bicarbonate for arterial [HCO3] <5 or venous CO2 <5 (1)". This study concluded that emergency physicians can clinically identify patients at risk of deterioration after naloxone reversal of suspected opioid overdose. She was concerned that in the "take-home program", additional emergency room measures needed for a significant number of people (e.g. 94/573), would not be available.[22] Finally, the majority of the scientific literature on take-home narcan (according to a NIDA survey requested by Dr. Madras) was based on pilot studies, feasibility studies, or letters to the editor, an inadequate body of research for developing public policy or advocating a major change in medical procedures that could potentially save or cost precious lives.

Research

Madras has authored over 130 scientific manuscripts and book chapters, and she recently co-edited a book on the Cell Biology of Addiction.[23] Along with her collaborators, she is the recipient of 19 patents.[24]

Honors

Her co-discovery of altropane was recognized by the Association of University Technology Managers in 2006.[25]

References
  1. "United States of America v. Schweder, et al. (2014). "Declaration of Bertha Madras, Ph.D". Case No. 2:11-CR-00449-KJM-16, in the United States District Court – Eastern District of California. Page 2" (PDF). Retrieved August 8, 2017.
  2. "Bertha K. Madras, PHD | McLean Hospital". Retrieved August 8, 2017.
  3. "Bertha Madras, Deputy Director for Demand Reduction, White House Office of National Drug Control Policy – ONDCP". Archived from the original on August 7, 2007. Retrieved 2008-01-15.
  4. "Office of National Drug Control Policy | The White House". Whitehousedrugpolicy.gov. Retrieved October 19, 2011.
  5. "Aphsa Health Services Division" (PDF). Nasmd.org. Retrieved October 19, 2011.
  6. http://staging.whitehousedrugpolicy.gov/about/madras.html%5B%5D
  7. "Archived copy". Archived from the original on May 10, 2009. Retrieved May 4, 2009.CS1 maint: archived copy as title (link)
  8. Archived December 31, 2008, at the Wayback Machine
  9. Stephanie Whyche (May 16, 2008). "Federal Workers Get Coverage for Substance Abuse Screening". Pn.psychiatryonline.org. Archived from the original on July 29, 2012. Retrieved October 19, 2011.
  10. "National strategy focuses on screening: ONDCP demand reduction chief urges early intervention. (Office of National Drug Control Policy)". Alcoholism & Drug Abuse Weekly. February 19, 2007.
  11. Tim Caron; Matt Gever; Allison Colker (July 15, 2008). "NCSL Substance Abuse Snapshot, July 15, 2008". Ncsl.org. Archived from the original on September 8, 2012. Retrieved October 19, 2011.
  12. "National Institute on Drug Abuse to Unveil NIDAMED, Physicians' Outreach Initiative, April 6, 2009 News Release – National Institutes of Health (NIH)". Nih.gov. Retrieved October 19, 2011.
  13. "Instituto De Salud Del Estado De México". Salud.edomexico.gob.mx. Retrieved October 19, 2011.
  14. "Addictologia Hungarica – What Works to Reduce Drug Use". Archived from the original on January 23, 2008.
  15. Madras, BK; Compton, WM; Avula, D; Stegbauer, T; Stein, JB; Clark, HW (January 2009). "Drug and Alcohol Dependence : Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later". Drug Alcohol Depend. 99 (1–3): 280–95. doi:10.1016/j.drugalcdep.2008.08.003. PMC 2760304. PMID 18929451.
  16. Madras, BK; Compton, WM; Avula, D; Stegbauer, T; Stein, JB; Clark, HW (January 2009). "Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later". Drug Alcohol Depend. 99 (1–3): 280–95. doi:10.1016/j.drugalcdep.2008.08.003. PMC 2760304. PMID 18929451.
  17. Bertha K. Madras: Office of National Drug Control Policy: A scientist in drug policy in Annals of the New York Academy of Sciences, 1187: Addiction Reviews 2; pages 370–402, 2010.
  18. Seal et al, Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area J. Urban Health: Bulletin of the New York Acad. of Med. 80: 291, 2003.
  19. van Dorp EL, Yassen A, Dahan A. Naloxone treatment in opioid addiction: the risks and benefits. Expert Opin Drug Saf. 2007 Mar;6(2):125-32. Review.
  20. Overdose Rescue Kits Save Lives National Public Radio (Jan 2, 2008)
  21. Heroin users, Prohibitionists, Critics and Enablers Archived June 10, 2011, at the Wayback Machine DrugWarRant (Jan 26, 2008)
  22. CJEM. 2000 Jul;2(3):156-62. Is early discharge safe after naloxone reversal of presumed opioid overdose? Etherington J, Christenson J, Innes G, Grafstein E, Pennington S, Spinelli JJ, Gao M, Lahiffe B, Wanger K, Fernandes C.
  23. Madras BK. Introduction to "Cell Biology of Addiction". Editors: Madras BK, Colvis CM, Pollack JD, Rutter JL, Shurtleff D, von Zastrow M, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, NY, pp 1–12, 2006.
  24. "United States Patent and Trademark Office". Uspto.gov. December 1, 1994. Retrieved October 19, 2011.
  25. Association of University Technology Managers 2006 Better World Reports: "Technology Transfer Stories: 25 Innovations That Changed the World"


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