DRUG CONSUMPTION ROOMS

An "independent working group" in UK reviewed drug consumption room experience in various countries over the course of 20 months. Main conclusions: they "are a rational and overdue extenson to the harm reduciton policy ... [They} offer a unique and promising way to work with the most problematic users..." Available online at: http://www.jrf.org.uk/bookshop/details.asp?pubID=785

One has to wonder what the ojections mght be in locales where needle/syringe exchange is already a reality - e.g., in New York and elsewhere in the USA. Active heroin users come to a site and are given sterile needles and syringes, and then depart to use heroin off premises. What could possibly be the argument against allowing them to stay in the exchange facilities (assuming there is space available) and using there? And yet, no such proposal seems to have been made - or at least, pursued. Why not?

TEST TARGETS ADDICTION GENE

As reported in the Daily News back in Feb (06) Tests that target addiction gene, may be of academic interest, but the real-life application of a genetic test for predisposition to addiction would be useless at best, and a likely catastrophe for many. Would parents be more or less emphatic, depending on test results, in warning their kids against underage drinking and narcotics use? Obviously not! On the other hand, the enthusiastic researchers quoted as urging mass testing even of babies seem oblivious to the lifelong stigmatization that would inevitably be associated with positive results, and the impact on applicants for jobs, schooling and all the other opportunities that society has to offer.

FENCES AND SCREENS CAN'T HIDE THE SHAME OF THIS COMMUNITY!

An article dated May 18 in "Village Soup - Our Community on the line", Waldo County, Maine, is headlined, "Methadone case settled, clinic clear to build." The approval reflects a settlement reached with the city's code enforcement officer - clearly reflecting a judgment by the city that its refusal to issue a permit would not stand up in court.

The bad news: part of the agreement requires the operator to "fence and screen the property to limit public view and ensure patient security." Say what? How sad that the price of opening a life-and-death treatment facility without further legal battle requires acceptance (and implicit endorsement!) of the uniquely pejorative view of patients who receive medical care for their opiate dependence.

CONFLICT BETWEEN POLICE PRACTICES AND HEALTH POLICIES

Previous postings have noted the disparity between the Chinese Health Ministry's commitment to harm reduction and the reluctance of the Security Department to give up its long-standing focus on harassing and prosecuting drug users. Alas, the same dichotomy in policies and practices exists in the US as well, as a NY Times article on 14 May 06 demonstrates: "A federal judge expects to rule by the end of the month on whether the Bridgeport [Connecticut] police violated her 2001 court order prohibiting officers from harassing addicts participating in the city's needle exchange program. 'My order may well have been written in invisible ink.'"

MISCONCEPTIONS AND MISINFORMATION RE METHADONE AND BUPRENORPHINE (click for full article)

An article in the Gazette (Jamesville, Wi, 7 May) is of interest because while its readership may be limited, it epitomizes the misinformation regarding opiate agonist treatment.

The article is based on an interview with Dr. Adedapo Oduwole, “who specializes in addiction psychiatry” and is said to have “headed a pilot program for Suboxone . . . in New York.” Dr. Oduwole’s enthusiasm for buprenorphine is unbridled: he is quoted as saying “…buprenorphine is performing miracles.” Among the more notable misleading and/or incorrect statements:

Methadone “is a substitute narcotic drug . . . “ - with the clear inference that this is a rubric that does not apply to buprenorphine. “With methadone, patients essentially trade one narcotic for another. They go through withdrawal if the supply is interrupted.“ The statement above is followed by: “But buprenorphine squashes [sic!] the opiate craving in a person’s brain. . . “

Buprenorphine “ takes away the craving for the opiate. And it reduces or even eliminates withdrawal symptoms.” The fact that these are precisely the actions attributed for more than 40 years to methadone is not mentioned – leaving the reader to conclude that they are unique to buprenorphine.

The bottom line message is unequivocal: buprenorphine, unlike methadone, is not an opiate, and it is less “addicting” and more effective (by whatever parameters) than methadone.

How to explain such comments attributed to someone who “specializes in addiction psychiatry”? It is perhaps not excessively cynical to consider the possibility that the answer lies, at least in part, in the fact that the doctor is “on an advocate panel for Suboxone through Reckitt-Benckiser, the manufacturer.”

It should be stressed that these critical comments do not in any way imply criticism of buprenorphine as an additional medication in the armamentarium of treatments available to those dependent on opiates who want and need help.

NIH RECOMMENDATION -WHAT'S BEEN DONE?

In 1998 an NIH Consensus Development Panel published a report entitled "Effective Medical Treatment of Opiate Addiction" (JAMA 1998; 280(22): 1936-1943). The key conclusion: "All persons dependent on opiates should have access to methadone hydrochloride maintenance therapy under legal supervision, and the US Office of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation." If any government official has done anything to suggest acceptance of this Consensus Panel conclusion, it does not seem reflected in any press statements, published articles, news reports, etc. Meanwhile, the EMCDDA 2005 annual report stated that the number of individuals receiving methadone and buprenorphine treatment in the European Community increased seven-fold in the past ten years. It does not appear unreasonable or overly harsh to suggest that US Federal officials have been and continue to be irresponsible in carrying out the mission that they are paid to pursue. One can only guess at the number of Americans whose li=ves have been destroyed - and lost - as a result.

NY TIMES ON ADDICITON AND ABSTINENCE

NY Times News of the Week in Review, 7 May, discusses "abstinence" as a treatment goal, and contrasts it with what is described - but not named - as "harm reduction." It clearly denigrates methadone and buprenorphine by labeling each of them "a substitute drug . . . replacing one habit with another." Furthermore, prescribing these medications seems to be equated to "moderation" as a technique and a goal in treating alcoholism. In other words, the author appears to affirm the long-held myth that clinically prescribed methadone for the heroin-dependent person is analogous to "vodka for gin" for the alcoholic. Obviously, this is nonsense.

The article goes on to state, "When studying these pharmaceutical crutches and prescribing them, doctors tend to emphasize improvement over abstinence . . . " What is not stressed here is the reality, confirmed by over 40 years experience worldwide, that the former - "improvement" - is achievable for the majority of dependent individuals receiving opiate agonist treatment, while long-term "abstinence" is overwhelmingly not achievable. And "not achievable" is translated for a tragically large proportion of individuals not only as relapse per se, but criminality, arrest, incarceration, infection (with HIV or a host of other viral or bacterial agents), and death.

Finally, the author fails to make the analogy that really is on target: addiction is a chronic medical condition like diabetes, epilepsy, hypertension, coronary artery disease, hypercholesterolemia, etc. - and "improvement" rather than cure is the near-universal objective in the treatment of all of them.