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