Thursday, March 24, 2005

How much longer will America withhold effective treatment from those who want it, need it, and whose lives might be saved with it?

This posting addresses the just-published paper on “Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users.” 1 The authors have provided a valuable, comprehensive summary of the evidence supporting the enormous potential of opiate agonist treatment, and the extent to which this potential is and is not being fulfilled in various regions of the world. In countries that remain resistant to permitting any opiate agonist treatment (e.g., Russian Federation, Ukraine and others), “cautious introduction” may be unavoidable, but it is painful to contemplate the suffering and loss of life that “caution” brings with it.

Here in the US, however, there seems to be no excuse for failure to move forward on a massive scale for all who are willing. We have 40 years experience with methadone, and two+ years with buprenorphine.” And yet, virtually nothing is happening! Four years ago “only 170,000 of the estimated 810,000 opioid-dependent individuals in the US” were able to receive “the most effective medical treatment for opioid dependence – opioid agonist maintenance.”2 And today? Maybe – at best- a few thousand more, though data with respect to incremental patients appear to be unavailable, suggesting no one cares enough to even count!

How much longer will America withhold effective treatment from those who want it, need it, and whose lives might be saved with it? How much longer – and with what associated costs in dollars and illness and lives – will America ignore the proven ability to expand access to opioid agonist therapies for drug users? While pondering these questions – and their staggering implications – we might consider the audacity of America’s “Drug Czar,” John Walters, who reportedly has been on the stump in Europe, extolling our “balanced strategy” on drugs, and damning the efforts of other countries to lessen morbidity and mortality – i.e., to promote harm reduction. Until the U.S. gives some hint that we take seriously the lives and welfare of our own citizens, our government leaders should maintain silence on the international front when it comes to dealing with the drug problem.

1.Sullivan LE, et al. Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction 100:150-158, 2005

2.Fiellen DA et al. Methadone Maintenance in Primary Care: A Randomized Controlled Trial. JAMA 286(14):1724-1731, 2001

3.Watson R. US official preaches benefits of “drug courts” in curbing misuse. BMJ 330:560


At 12:55 PM, Anonymous Anonymous said...

I spent the last 2 months in pains of 8-9#'s on the pain scale before someone finally listened to me. It took a ride to the hospital in an ambulance, called by some friends. After three days in the hospital the pain was brought under control by I.V injections of morphine every two hrs. I never have had a more unbearable two months in my life.
I understand Dr's are wary of drug abuse and diversion, but for those of us who suffer these types of pains there must be a better way of getting the medications we need. One of the reasons I have this pain is because my insurance company refuses to cover the procedure necessary to alleviate my condition. In the mean time I miss work, spend money on office visits 2-3 times a month, copays, not to mention what the cost of the hospital stay will be. Nominal amounts of medication that only keep me from not crying all day long are not enough.
Society has created a new generation of prisoners. It is time we give Dr's the opportunity to prescribe these pain medications to those of us who suffer without the fear they feel from the government and societies watch dogs.
These medications are a tool that is necessay to any physician and their patients.
I not only want to have the pain alleviated but I want to be able to have a functioning life again.Thank you to the physicians who help those of us who suffer this ungodly punishment; a punishment we did nothing to deserve.

At 12:24 PM, Blogger Me said...

For one answer to this question see this NYT editorial from Saturday 3/26.|EnrQ23Q27VAeQ27Q27~Q24rQ24zzxrzfrQ24OrQ27p).)Q27.rQ24OAQ5D~f/C~84

At 7:43 AM, Anonymous Anonymous said...

I agree. There is absolutely NO EXCUSE for anyone in the US to die from opiate addiction. We know too much about effective treatment.
Trying to successfully site new programs is like pulling hen's teeth. It takes way too much money to fight the powers that be - often law enforcement opposition, or, sadly, other providers. Certainly PROVIDERS would know that there are more than enough potential patients that we needn't fight over the current ones!???
Opening new programs should not be a pastime for the overly wealthy. How do we find funding sources that patients or other groups could access for start-ups?

At 1:45 PM, Anonymous Anonymous said...

I believe it's a difficult road ahead, when even the country credited with the most liberal drug policy around (Netherlands) still has physicians with methadone prejudice on the brain.

I'm sorry that my post does not entirely connect to your article, but I am trying to find out whether methadone does in fact cause dilation of the bile duct.

After 30 years of opiate use (only heroin and for the past 17 years methadone), I have always been in excellent health, work as a translator who has translated mountains of info on methadone for various drug research institutes, medical staff in the addiction field, methadone guidelines for physicians, and much more. This means I am familiar with effects, contra-indications and such like, but it seems I have missed a 'problem'.

I've developed a mystery stomach illness which can't be diagnosed. Various blood / urine tests, abdominal ultrasounds come back negative. First angle of course is ‘methadone’… [arrghhhhh].

I had my gallbladder removed some 8-9 years ago, and the ultrasound shows that my bile duct is dilated (ca. 9 mm).

The x-ray technician/physician first considered a gall stone may have remained behind in the bile duct (this was in fact the cause of jaundice and emergency gall bladder removal at the time), but since he now knows that I use methadone, I am being told that methadone use causes dilation of the bile duct. Flat out. My GP repeats the same. Have I missed this fact in all the literature on methadone I’ve read and translated over the years?

Question: is this true; and what's the prevalence?

I am experiencing all over again the short-sightedness of doctors once ''methadone'' is involved, (even if they are the ones prescribing it). I have not taken any other substance for two decades, and am an 'opiate-only' girl. (Now age 50 with astoundingly young looks and a funky-sparkling brain to boot).

It almost seems to me that my GP (who proudly told me that he started out in the addiction field), has developed some animosity in light of the fact that I do not conform to the standard 'methadone/opiate addict' picture he has been taught.

At 9:26 AM, Anonymous Anonymous said...

There are studies that suggest that methadone and other opioids dilate the CBD. Here are a few references (the blog software cuts off my pasted links so I have to just include the refs and a pubmed address):

Firoozi B, Choung R, Diehl DL.
Bile duct dilation with chronic methadone use in asymptomatic patients: ERCP findings in 6 patients.
Gastrointest Endosc. 2003 Jul;58(1):127-30.

Zylberberg H, Fontaine H, Correas JM, Carnot F, Brechot C, Pol S.
Dilated bile duct in patients receiving narcotic substitution: an early report.
J Clin Gastroenterol. 2000 Sep;31(2):159-61.

Sharma SS.
Sphincter of Oddi dysfunction in patients addicted to opium: an unrecognized entity.
Gastrointest Endosc. 2002 Mar;55(3):427-30.


I myself (20 years dependent)had my CBD sphincter opened and a temporary stent put in (which resolved recurrent attacks I'd been suffering for ten years or so...)a few years back. I still have no idea whether the condition is impacted by my opioid dependency or not....but it definitely is worth further research.....Dank u wel!

At 10:56 AM, Anonymous Anonymous said...

Sincere thanks for digging up this information for me.

And .... tulips from Holland. :-)

At 10:21 PM, Blogger Imran said...


I noticed your blog on the Sphincter of Oddi and wanted to invite you and your readers to join a newly formed SOD Support Group.

We can be found at :

Hope to see you there

At 4:22 AM, Blogger ranjini said...

Thanks for sharing, I will bookmark and be back again

Methadone addiction


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