LOCAL RESIDENTS TURN OUT TO BLOCK MMT FACILITY

Local residents turned out to vigorously support a zoning rule designed to preclude facilities that would provide methadone maintenance treatment. The current ordinance requires that "the distance from another developer has to be 1000 feet, and the distance from a playground, school, licensed bar, nursing home, is a half mile." An attorney for the corporation that wishes to open a clinic in the Keystone Industrial Park noted, "There is not a single location in Dunmore that would meet those requirements.”

It would seem a tossup which perceived threat is more ridiculous – that to playgrounds, or to schools, or to bars or to nursing homes.

For the full story (dated Oct 6) click here.

“YOUNG AND SUBURBAN, AND FALLING FOR HEROIN”

On September 27, 2009 The NY Times headlined: “Young and Suburban, and Falling for Heroin.” According to the article, “… officials across the New York region are grappling to understand” the devastating resurgence of heroin use in suburban America (and surely throughout the land), one conclusion seems inescapable: America ’s decades-old policy of absolute prohibition, and the overwhelming focus of Government on supply rather than demand, have been a disastrous failure. The cost of this failure is measured not only in hundreds of billions of dollars, but in the increasing toll of lost lives, including the 25 heroin overdoses in Nassau County alone in the first six months of this year. It is incredible – and irresponsible – that no one seems to be considering alternatives to this deadly, failed strategy.

To read the article, click here.

COST OF WAR ON DRUGS - AN AUSTRALIAN PERSPECTIVE:

This headline appeared in Sydney Morning Herald 3 Oct. The conclusion that Australia would save almost $Au5 billion ($US4.2 billion) "if illicit drug sales were regulated and taxed the way tobacco is" rests on a number of assumptions that are less than rock solid. What is of note, however, is the statement attributed to an economist with the Australia-based policy institute Centre for Independent Studies, John Humphrey: "It gets interesting when you try to do a cost-benefit analysis on the prohibition [of drugs]. Basically, there aren't any benefits." Food for thought - in Australia and everywhere else! For the Full article

THE BLURRED LINE BETWEEN LAW ENFORCEMENT AND HEALTH CARE:

From Pain-Topics.Org News, Oct 3, some observations regarding the DEA and opioid prescribing: “Involvement of the U.S. Drug Enforcement Administration (DEA) in the FDA’s plans for an opioid-REMS (Risk Evaluation and Mitigation Strategy) initiative is still unknown. However, if what is happening with the prescribing of buprenorphine is any example, practitioners prescribing opioids for pain may be headed for considerable aggravation in the name of “regulatory responsibility. … While the vast majority of buprenorphine prescribers would probably have nothing to fear from DEA inspections, healthcare providers are understandably loathe to have government agencies scrutinizing their practices for any reason. Many will no doubt opt out of the buprenorphine program. Is this what the future might hold in store for opioid analgesics under REMS initiatives?” For Full story.

PROPOSED RULE AMENDS FEDERAL OPIOID TREATMENT PROGRAM REGULATIONS REGARDING DISPENSING OF BUPRENORPHINE

The Substance Abuse and Mental Health Services Administration (SAMHSA) requested comments on the proposed rule ammendment regarding the Federal OTPs dispensing requirements for buprenorphine and combination products. My comments are outlined below.

“Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction; Buprenorphine and Buprenorphine Combination; Approved Opioid Treatment Medications Use”

Current regulations demand of all patients receiving buprenorphine in OTPs (Outpatient Treatment Program) daily attendance for several months followed by rigidly defined criteria for less frequent visits thereafter. In marked contrast, patients receiving buprenorphine outside an OTP setting can receive at the first physician visit a prescription to be filled at any pharmacy for a month’s supply of the medication. The proposed rule-making change eliminates this arbitrary and unwarranted disparity by providing that precisely the same flexibility will apply to OTPs as has governed “waivered” physicians for several years; it is to be welcomed!

The proposed regulatory change, however, is exceedingly narrow in scope, focusing exclusively on the administration, dispensing and prescribing of buprenorphine. In stressing that buprenorphine providers and patients in OTPs shall be obliged to “adhere to all other Federal treatment standards established for methadone” the proposed rule-making notice calls attention to these “other standards,” and they demand comment. To say they are extraordinary would be an understatement; they would appear to be unique in American medicine.

For complete comments click here .

NIMBY IN CANADA:

A tale of 2 cities: two stories on 23 Sept, one from Bracerbriudge, 120 miles north of Toronto, the other from Oakville, 20 miles southwest of Toronto. The former: reportedly very favorable response to news of a new methadone clinic to open in a mall. The manager of a store next door to the site is quoted as saying, “I don’t have any concerns about it. We need places like that. People need help.” And a local outreach and support organization promised to provide its services “in any way we can.”

On the other hand, the site in which a new clinic is expected to open in Oakville generated major opposition. “It’s the right business, but the wrong location.” The President of a local Residents’ Association worried because “When my daughter goes down to catch the bus at 8AM, there may be people lining up before the clinic opens.” According to her, “There’s got to be somewhere better.”

Bracebridge story

Oakville article

UK EXPERTS CALL FOR NATIONAL NETWORK OF 'SHOOTING GALLERIES' AFTER HAILING SUCCESSFUL TRIALS:

“A group of government-appointed drug experts will call for a nationwide network of ‘shooting galleries’ to provide injectable heroin for hardened drug addicts across the country. A pioneering trial programme prescribing heroin to long-term addicts has shown ‘major benefits; in cutting crime and reducing street sales of drugs.” A positive accompanying editorial was headlined, “An injection of common sense.” Full story in the Independent (London)

ANTIDEPRESSANT MEDICATION DURING PREGNANCY:

A just published article (Clin OBGYN, 52(3):469-482) concludes: "The decision to expose the fetus to anti-depressant medication during pregnancy must be weighed against the risks of untreated maternal depression to both mother and fetus." Precisely the same orientation should apply to treatment of opioid dependent pregnant women, but in those cases all too many judges and probation officers and child welcome authorities and others (including some physicians!!!!) have only one position: JUST SAY NO TO METHADONE!

PERCEPTIONS OF METHADONE TREATMENT FROM AN IRISH GP:

In the Irish Medical Times, 9/9/09, a GP, Dr. Cathal O’Sullivan, notes the absurdity of the officially recommended Irish urine toxicology schedule – "at least once weekly" for a total annual cost of approximately $US 10 million.

Some of Dr. O'Sullivan's other observations:
“Relatively new to the drug treatment world, I was struck by the difference in the relationship between the patients and the treatment service and the staff, including doctors, who were treating them. Supervised collection of urine samples seemed to me, at the very least, an undignified process, both for the patient and the person supervising the sample collection. Even the language used around urinalysis was different. Positive opiate tests were called ‘dirty’, negative were ‘clean’. One can still hear doctors working in the addiction service today, referring to a patient, say, ‘he’s dirty this week’. Raised a strict Freudian, I found this very strange (but very interesting).”

Most significant is his summation: “Compared to patients in general practice, where I had worked for the previous twenty years, drug users were seen and treated as a completely different category of customer. They were considered to be inherently untrustworthy, and incapable of telling the truth about their drug use.”

The same must be said of methadone treatment in the US and many other countries.

For Full article

TO THOSE WHO WOULD CRITICIZE SEMANTICS...

Especially in the US, advocates of methadone (and buprenorphine) maintenance treatment express outrage over the word “substitution”! It would seem more productive if they focused their attention on acts, rather than on words. Thus, one of the oldest and most effective self-help and advocacy groups in Germany calls itself (itself!) JES...“Junkies, ex-junkies, and those being substituted.” And what have they and allies accomplished? First, there are over 70,000 patients receiving “substitution” with methadone in Germany - hardly 20 years earlier there were none; no one group or individual can claim the credit, but JES has been a critical voice. Also, this year on July 21 the 11th national “memorial day in tribute to the victims of the drug war” was marked in dozens of cities, large and small, throughout the country. A journal (cover image shown here) put out jointly by JES, parents’ groups and “German-AIDS Help” gave the highlights of the day for many of these cities. A case in point: Recklinghausen – “the 60th largest city in Germany”, describes its treatment efforts as follows: SUBSTITUTE FOR DRUGS - dependent patients participate in the substitution program and thereby avoid the possibility of death.”

Critics, and especially American critics, of the label German drug users and former users adopt for themselves should reflect on the situation at home: can anyone imagine a large public demonstration in America honoring the memory of victims of the drug war? Let alone dozens of such demonstrations coordinated throughout the US? Would anyone deign to condemn a group as courageous and effective as JES because of the name it uses - proudly and unapologetically - to define itself and its members?

ADDICTION TO NICOTINE - SOME PARALLELS TO NARCOTIC ADDICTION:

An article in the current issue of Lancet by JD Pollack and colleagues notes that of the estimated 45 million American smokers, over 43% had tried to quit during the past 12 months. Of those who tried to quit on their own, 80% relapsed within one month and only 3% were abstinent at 6 months. The results were better with pharmacotherapy, but "only 15-35% ... were able to remain abstinent for more than a year." Interestingly, there is no mention of anything less than total smoking abstinence - smokers who cut down from, say, two packs a day to five cigarettes apparently were not distinguished from those who never cut down consumption at all.

SCOTLAND DISCOVERS ADDICTION CAN BE FATAL:

An Aug 12 article in the Guardian headlined: "Scottish drug deaths reach record levels." It would almost appear that Scotland has just now discovered what the world has known for decades: addiction is a chronic, notoriously relapsing, medical condition that often has a tragic, deadly end. What it seems not to have understood is that addiction is eminently treatable but – to date – incurable. Failure to accept this reality with regard to drug dependence is surprising, since “treatable but incurable” has for well over a half-century been the near-universal axiom governing the approach to the related condition of alcoholism.

And yet, critics rail against what they see as "excessive" numbers of patients receiving methadone treatment in Scotland, and damn methadone providers because reportedly only 3% manage to achieve a lasting abstinence. The article quotes the Torie view that “…the SNP are losing the battle against illegal drugs;” to the extent this is the case, it would reflect the fact that there are too few addicts in treatment, and not too many!

HEROIN TRIAL RESULTS - SO MUCH FOR THE IMPACT OF EVIDENCE:

The Globe and Mail ( Canada ) of August 22: “The Quebec government's decision to cut $600,000 in funding from a study that would give heroin to hard-core drug addicts jeopardizes research into the controversial treatment that would have been a worldwide first. Doctors involved say they're baffled by the decision, which came to light the same week research from a separate study was published that said giving heroin to people with entrenched addictions was far more effective than administering methadone. . . . The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) would have been the first in the world to compare the effectiveness of medically prescribed heroin against Hydromorphone, a licensed narcotic and whether users will accept the drug in pill form instead of injecting it.” Full story click here.

PROFIT AND MMT

An article in the Chicago Tribune (August 16, 2009) quoted a Drug Enforcement Administration official expressing concern "... when the motive for treatment is profit," with no evidence to suggest any difference in quality of care. And this at a time when many Americans are expressing their fear and fury over proposals to include a government option for health insurance, to be available alongside those offered by a host of (extremely profitable!) insurance companies!

When it comes to treatment of addiction private facilities are helping to fill the unconscionable void resulting from woefully inadequate services of the Government and voluntary sectors. Their role in lessening demand for illicit drugs is an indispensable component of the nation's efforts to address the problem of drugs in America. No one should know this better than law enforcement officials.

MARIJUANA IN NYC: TWO FACTS

Fact 1: In NYC marijuana possession has been decriminalized since 1977; one can be given a ticket and fined $100, but no fingerprinting and no jail.

Fact 2: Since 1997 430,000 arrests have been made by the NYPD for possession of small amounts of marijuana; in 2008 alone there were 40,300 such arrests – over 100 a day, every day.

To understand what explains this apparent dichotomy check out an
article by Harry Levine, posted Aug 10 on AlterNet.

MASS EXECUTIONS IN IRAN:

That's the headline of a joint report of Austrian Presse Agentur and Agence France Presse based on a story in the "reform newspaper", Etemad. It is stated that on 30 July there were 24 hangings for alleged "drug trafficking" in a single day in a prison near the capital. The same prison was the site of 20 hangings earlier in the month, and since the beginning of the year the number of executions in Iran is said to be 219, though Amnesty International puts the total at 246. Human rights activists say that opponents of the regime are being charged with drugs offenses and sentenced to death.
Full APA/AFP report (in German) click here.
(Thanks to our colleague Prof. G. Fischer in Vienna for forwarding this article.)

FROM LONG ISLAND TO IRELAND EXPANSION OF TREATMENT IS NEEDED

The following Letters to the Editor by Dr. Newman was recently published

Addiction treatment delays are deplorable (Irish Examiner, August 4, 2009)

It is simply irrational to force those wanting to give up their illicit opiate habits to wait two years or more for treatment proven in Ireland and around the world to be enormously effective. Countries as divergent as Germany , Hong Kong, the US and, most recently, Iran and China have been able to achieve massive expansion of services almost from one year to the next.

The only prerequisite has been commitment.

It reflects a perverted sense of priorities when government agencies and committees debate strategies for increasing the "monitoring" of patients who, as you report, may have been in treatment 10 years or more, while continuing to ignore those who are being abandoned by shortsighted policies and practices that tolerate - indeed, ensure - multi-year waiting lists. Not only drug-users but the nation as a whole deserve better.

Robert Newman MD, MPH


Newsday --Letters to the editor, August 2, 2009

Get help for heroin Newsday reported in separate articles on July 24: "Drug deaths up in Nassau " and "Heroin fight: It's just 'everywhere'; 110 nabbed in coordinated raids over 4 months in Suffolk ."

Law enforcement efforts have never made a significant impact on use of heroin or the death rate with which it is associated. For decades it's been documented that heroin addiction is a medical condition that can be treated.

When is the last time anyone heard a public service announcement in Nassau or Suffolk urging those who desperately need help to get it? It is irresponsible - and inexcusable - that treatment services either are unavailable, or are being kept secret.

Robert Newman

DEA "MONITORING" OF BUPRENORPHINE-WAIVERED PHYSICIANS:

From the Am Soc Addict Med comes this notice:

"It appears the DEA plans to increase its efforts to monitor physician prescribing [of buprenorphine] under DATA 2000." To let docs know what's in store for them, ASAM comments as follows on past DEA "monitoring" - "Investigations usually last one to two hours . . . [and] In 52% of the 425 physicians inspected up to 12/07, no problems were noted. . . " One can imagine the eagerness with which physicians will be seeking to exercise their "waivers" to treat opiate addicts, and the demand by other prqctitioners to join the ranks of those who enjoy the privilege of prescribing buprenorphine!

COULD THERE BE AN AFGHANI POPPY GROWERS’ LOBBYIST IN WASHINGTON?

According to Join Together (30 July), “… the Obama administration is considering paying local farmers to cease planting poppies, the Associated Press reported July 21”. The possible influence of powerful lobbyists is one of the more generous possible explanations. Regardless how many hundreds of millions of US taxpayer dollars are given to Afghan farmers, can anyone doubt how they will respond when the Taliban make them “an offer they can’t refuse,” offering MORE money with one hand, and holding an AK-47 in the other? Scary! The Join Together story

TRAGEDY OF INACCESSIBLE AND/OR IRRATIONAL TREATMENT OPTIONS FOR ADDICTS:HUGE “REWARDS” WON’T WIN THE DRUG WAR

Miami Herald on 20 July reported that the US is offering $50 million in rewards for information leading to the arrest of “10 top Mexican drug suspects.” Does anyone believe that even if this phenomenally generous reward (paid for by US taxpayers) leads to the arrest and conviction of these bad guys it would have the slightest impact on availability of drugs in our streets or the number of American drug users? The money would be far better spent supporting treatment for the many drug-dependent Americans who need and desperately want help.
Click to Read the Article

FACTORS ASSOCIATED WITH BUPRENORPHINE VS METHADONE FOR OPIATE DEPENDENCE:

A UK study has just appeared that assesses factors involved with the choice of opiates for maintenance and detoxification. Although both providers and patients are said to contribute to the decision, a stated preference for buprenorphine was more likely to be honored than a preference for methadone. In any event, patients generally rated the medication they received in this study as the “most helpful” in their previous treatment experiences. The authors’ conclusion: “The results . . . suggest that patient preferences and beliefs about opioid agonist treatments can serve as important influences upon clinical prescribing practices.” And indeed, they should; in the absence of data allowing reliable predictions regarding which patients might expect to do better with one or another opioid medication, one must wonder why patient preference is not always respected.

Article: Ridge G et al. J Subst Ab Treatm 37 (2009) 95-100.

IGNORING EXPERIENCE - REPEATING FAILURE: ILLUSTRATION FROM ITALY:

In 2006 a bill known as the Fini-Giovanardi Law was passed in Italy, “heralding the mass criminalization of drug users in spite of the success of a 1993 referendum to de-penalize the personal use of drugs.” The result: in less than three years prison overcrowding has reached record levels – some 40% above official “capacity”. There has been a 7.45% increase in arrests, and/but “confiscation of drugs has fallen by 10.5%.” The estimate of addicts behind bars in Italy has risen from 8,363 in December 2006, to 14,743 by Jan 30, 2008. When will they ever learn...
Full story (in Italian)

MORE OF THE SAME: “JUST SAYING NO” TO REALITY...

The reality that opiate addiction remains a chronic medical condition for which, at the moment, there is no known “cure.” Thus the following in a UK Press Association article of 20 July referring to opposition party of England and Wales: “Conservatives have called for an ‘abstinence-based’ approach to drug rehabilitation, after uncovering figures showing that fewer than 4% of addicts undergoing treatment become drug-free each year.” Would the Conservatives deny diabetics continued insulin based on the same criterion? Or epileptic patients their anti-seizure medication? Or...?

METHADONE TREATMENT PARADOXES

An article on addiction treatment policies in National Journal April 18 ’09 noted the following: “The treatment protocol demands at patients behave like grownups while they are monitored like children. The clinic is licit but stays semi-underground, fearing that even a sign of the door would stigmatize patients or annoy the neighbors. The medication is one of the safest known to science but is regulated as if it were one of the most dangerous.” Go figure . . .

"YOKELS BREEDING INTOLERANCE":

The headline "Yokels Breeding Intolerance" from a column in the Edmonton (Canada) Sun, 14 July, describes the "fine line between grassroots protest and a lynch mob." It goes on to give an example of each. The "lynch mob" is exemplified by the case of a Calgary methadone clinic that was "literally run out of town" earlier this month in the face of threats to the facility and its staff. The "grass roots" protest that is described involved a concerted effort to ensure "proper processes and protocols are in place to keep everyone safe" in a neighborhood in which a group home for deeply troubled teens is located; two residents of the home had been charged recently with murdering a local couple. The contrast is well written and compelling. click here to read the article

MR HANON: My congratulations on recognizing the distinction, and expressing it so eloquently. As you see, we're taking the liberty of posting a blog referring to your column on our website - www.opiateaddictionrx.info

CALGARY (CANADA) METHADONE CLINIC CLOSURE:

As noted in previous postings a clinic has been forced to give up the battle to continue operations. An editorial 11 July in the Calgary Herald is a voice of reason, though perhaps too late to avoid the therapeutic abandonment facing the more than 500 patients now receiving treatment. Some excerpts:

“The loss of Second Chance Recovery is a blow to both drug addicts seeking treatment and to the city's reputation. The closure of the methadone clinic could have been avoided had aldermen shown a willingness to address residents' concerns with facts, or seek another solution, such as changing the zoning law to allow the clinic in an industrial park.

“Now Calgary looks like a city that would rather deny the existence of social problems than deal with them... The problem is a lack of leadership. The clinic's operators are tired of fighting City Hall, and who can blame them. They've been shut down three times in six years, and have reasonably concluded Calgary will not support the clinic.

“Police say they have never recorded increased crime rates where clinics have been located, and are more concerned about the impact the closure will have on the city.”

For full editorial click here

PUTTING NIMBY INTO PERSPECTIVE:

A letter to the editor appeared on July 11 in the Calgary (Canada) Herald. It is entitled, “Here goes the neighbourhood” – a commentary on an article 2 days earlier reporting that a methadone clinic has been forced to close, leaving the fate of over 500 patients in severe jeopardy. The letter can be found by clicking here.

CONTINUED SHARP DROP IN DRUG-RELATED DEATHS IN BALTIMORE ATTRIBUTED TO TREATMENT AND HARM REDUCTION MEASURES:

The Baltimore Sun 1 July reported that the number of drug-related deaths in the city dropped by a third between 2007 an 2008, from 281 to 176. “'Short and sweet: Treatment works,'" said Gregory Warren, executive director of Baltimore Substance Abuse Systems. 'There are literally hundreds of people alive today because of what's happening.'" He also credited a variety of harm reduction measures, including teaching drug users to reverse opiate overdose by administering Narcan.

But there’s also a decidedly negative side to the story: “Some 74,000 people needed substance abuse treatment last year, according to state estimates, but Warren's organization was only able to reach 16,000 of them …” Full story

TREATMENT ON DEMAND: AN OLD CRY, STILL UNANSWERED

In 1988 the Presidential Commission on the Human Immunodeficiency Virus issued its report. Among other things it called for “…greatly expanded [addiction] treatment capacity, with the goal of treatment on demand...“ (page XVIII). So...how does one measure the adequacy of the treatment capacity for opiate-dependent individuals? Very simply: by the ability to publicize that treatment on demand exists, and by doing everything possible to encourage those who need help to seek it. And where in the United States does one see public service announcements to this effect? Cynics might well conclude that no one gives a damn. Meanwhile the common-sense conclusion of the Commission more than two decades ago continues to be ignored.

PATIENT BELIEFS ABOUT METHADONE MAINTENANCE:

A study that is 7 years old but still of vital importance describes the results of a survey of patient beliefs about methadone maintenance – which, on average, the 315 respondents had been receiving for seven years in a public clinic in NYC. Among the findings:

. although 79% agreed that “methadone has helped me change my life in a good way,”
the negative beliefs that were expressed were distressing.
. 47% believed methadone “is bad for your health (additional 32% “not sure”)
. 39% believed higher doses “are less healthy than lower doses” (30% unsure)
. 71% (!) believed “methadone gets into your bones” (19% unsure)
. 80% believed “people should try to get off methadone” (11% unsure)

There is no reason to believe that in the intervening years since this study was done much has changed (certainly the public’s perception does not seem to have become more favorable, so there’s presumably no cause for optimism regarding a change among recipients of care). The responses can be interpreted in only one way: the clinic staff have been woefully ineffective at educating their patients about the medication that is fundamental to the care provided. Even more distressing is the possibility that many patients may be mirroring the attitudes and beliefs of staff members.

It is difficult to imagine that treatment will be optimally effective when patients believe the medication they receive is injurious to their health and should be given in doses that may be inadequate. Patients who believe one should aim to discontinue treatment will be likely to do so - notwithstanding the high rate of recidivism and all the concomitant risks (including, very specifically, the risk of death).

Surely patient knowledge about their treatment is a most important parameter of quality care. Is anyone aware of programs that focus on this treatment imperative? Do the accreditation bodies assess the process and outcome of this aspect of care?

Comments welcomed.
Citation: Stancliff S, Myers JE, Steiner S and Drucker. Beliefs about methadone in an inner city methadone clinic. 2002. Bull NY Acad Med. 79(4):571-578.

NIMBY SUCCEEDED BY "BANANA" (BUILD ABSOLUTELY NOTHING ANYWHERE NEAR ANYTHING):

That could be the conclusion drawn from an article in the Herald-Citizen (Tennessee) on 28 June. The headline: "Methadone clinic denied in Spencer." The 2007 population of Spencer, Tenn, was 1685. the reason the State denied approval for a proposed methadone clinic: "the rural status of Spencer." Go figure....!

DRUG PROBLEMS OF IRAQ/AFGHAN VETS COULD DWARF THOSE OF VIETNAM ERA:

That is the alarming (but not surprising) headline of a news story in JoinTogether. And yet, when it comes to vets dependent on opiates (whether illicit drugs or prescribed painkillers), the DoD not only erects barriers but has an absolute bar against provision of the "gold standard" of care, "maintenance" with methadone or buprenorphine. TRICARE, the insurance policy for vets and their dependents, simply denies coverage for such treatment, without qualification or explanation. The article notes that only 1/4 to 1/3 of vets choose to get medical care through the VA - the only option for most of the others is TRICARE, but not if they need and want medication-based treatment for opiate dependence. And yet, US taxpayers fund methadone programs around the world - e.g., in Vietnam. Go figure! Full story click here>

PARENTS INITIATIVE FOR TOLERANT DRUG POLICY (GERMANY):

An article in June 09 Die Strasse presents an interview with Juergen Heimchen, head of the organization for almost 16 years. The fundamental goal of the "Initiative" - which is both a self-help and advocacy group - is to do everything possible to allow drug users to survive. Heimchen describes the advances made in the last 2 decades; initially, methadone in Germany was only available to addicts who had a terminal illness! It is very largely the effort of parents of addicts that turned the tide in Germany; today an estimated 70,000 patients receive methadone maintenance.

TREND TO FOR - PROFIT ADDICTION TREATMENT

A study just published in J Subst Ab Treatm (vol 36, 355-365) found that in 2005, 34%of outpatient substance abuse treatment recipients obtained care in for-profit facilities compared to less than 10% ten years earlier. The bad news: not unexpectedly, for-profit services were more likely than others to refuse admission – and to terminate prematurely - based on inability to pay. The disparity was particularly great among methadone treatment programs. Of course, unequal access to care based on financial considerations is the norm in all areas of medicine in this, the wealthiest nation on earth.

HEROIN AND/OR COCAINE NOT GOOD IN PREGNANCY

This conclusion was reached by a Swiss laboratory study on placentas from mothers who received methadone treatment during pregnancy. Hardly surprising: risk of adverse consequences of heroin and cocaine obviously is not limited to the placenta, or to pregnant women, or to women or men who are not receiving methadone treatment. The study did not compare the harm of the illicit substances in placentas from women who did and who did not receive methadone treatment during pregnancy.

News summary available at http://news.bbc.co.uk/go/em/-/2/hi/health/8092732.stm

COMPARED TO WHAT:

A commentary in the Albany (NY) Times Union on June 4 begins, "Rarely has there been a prouder moment in the history of our state Legislature than when Democrats and Republicans came together earlier this year to reform the Rockefeller Drug Laws, which over more than three decades wreaked havoc on thousands of people whose addictions should have been treated by health care professionals -- not by the criminal justice system." Seems to set a mighty low threshold for pride - and of course even this break through of common sense, fairness and community self-interest is currently stymied by political wrangling.

NY SEEKS TO IMPROVE ADDICTION STRATEGIES - DON'T HOLD YOUR BREATH:

A "collaborative council" was established by Executive Order on April 15, 2009, with the lofty goal of "identifying ways in which statutes, regulations, rules and policies may be revised in order to promote addiction prevention, treatment and recovery efforts" (click here ). The timetable hardly suggests a sense of urgency: an "interim report is due in 18 months, and a final report a year after that - by October 31, 2011! Also to be noted is the statement that "involvement of non-governmental stakeholders, including community based organizations and business entities, is essential to the development of strategies to address the devastating effects of addiction" - but membership on the council is limited to 20 State agency heads.

GOVERNMENT PRIORITIES IN SPENDING - AND IN CUTS

A CNN report June 5th, states that Michigan is closing 8 prisons - allowing 1000 employees to be fired and saving $120 million; three facilities were closed earlier this year. The State has assured voters that no inmate will be released early as a result - i.e., displaced prisoners will be squeezed into other facilities. Currently 22% of the State's general fund budget is allocated to the Corrections Department (the amounts for cops, prosecutors, courts etc are not given - nor is the proportion of inmates incarcerated on drug-related charges).

EXCHANGE WITH NEWS EDITOR – PRISON FOR METHADONE POSSESSION

From Nevada: The article prompting the exchange can be found by clicking here.

LTE: Re "Methadone tablet earns prison term" (June 2) - for someone dependent on heroin one methadone tablet can prevent withdrawal symptoms and craving - and multiple injections of heroin - for 24 hours. Strictly from the perspective of the community's self-interest, punishing this with a 2-1/2 year prison term seems just plain dumb. He should instead have been referred to a methadone maintenance clinic where his dependence could be treated.

EDITOR’S RESPONSE: I don't know about New York City, but there is a point here in Nevada at which someone who continually breaks the law deserves a time-out to think about it. Mr. Jenkins is lucky he only got 2 and a half years. While being in possession of a single methadone tablet might not seem like much, in fact it was something else he stole from someone else, who might have needed it. No matter what the charge, Mr. Jenkins went to prison because he is a thief. No one would have even known he had the tablet if he hadn't been shoplifting, again. I believe people can be rehabilitated, but I also believe that the worst thing that can happen to a person is a lack of consequences as a result of their actions. Thanks for writing, Kurt Hildebrand editor

US DRUG POLICY: ARE THE TIMES A'CHANGING?

From JoinTogetherDirect (www.jointogether.org) June 1 - Obama's First Drug Budget Fails to Shift Priorities The chairman of a House oversight committee last week chided the Obama administration for failing to live up to its rhetoric about ending the war on drugs and taking a new approach to preventing drug use, challenging the composition of President Obama's first drug budget during new drug czar Gil Kerlikowske's first appearance as director of the Office of National Drug Control Policy (ONDCP).