PODCASTS FOCUS ON DRUG ADDICTION TREATMENT

In September, we began podcasting - taping interviews and editing lectures/workshops we thought might be of interest. We would welcome your opinions on future topics and whether you are interested in this particular way of delivering content.

Topics so far...
The Methadone Market
(Alex Wodak, MD) Oct 26th MP3(19.20 minutes)

Drug Testing & Screening
(Robert Newman,MD & Peter Vanderkloot) Oct 10th MP3(16.35 minutes)

Treating Opiate Addiction with Buprenorphine Therapy in a Local Physician's Office
(Melinda Campopiano, MD) Sept 14th MP3(19.15 minutes)

A Family Physician Discusses Treating Her First Opiate Addicted Patient
(Melinda Campopiano, MD) Sept 10th MP3(5.55 minutes)

Tribute to the late Dr. Vincent Dole
(The BBC) MP3Aug 10th(4.32 minutes)

For those of you who are wondering what podcasting is, well it allows us to share audio and video that you can listen and watch at your convenience on your computer or your mp3 device. You can select interviews and recordings individually or you can use a RSS services to subscribe and you will receive updated content automatically when there is a new offering.

MISUNDERTANDING AND MISREPRESENTING INSTITUTE OF MEDICINE REPORT ON IVDU TREATMENT

The very distinguished and respected journal Lancet editorialized on Sept. 30 (vol 368): “Intravenous drug use and HIV: evidence for action now.” First, Lancet incorrectly described methadone and buprenorphine as “opioid antagonists,” which they obviously are not. Of more substantive importance, however, is that the body of the editorial seems to water down the message embodied in its own title: “Evidence for action now”. Thus, it states that “…there is some evidence that continuous drug-dependence treatment protects against seroconversion … ”, while the IOM clearly and unequivocally concluded: ”Strong and consistent evidence from a number of well-designed, randomized controlled trials shows that opioid agonist maintenance treatment – including methadone and buprenorphine – is effective in reducing illicit opioid use … There is also strong evidence that this treatment reduces drug-related risk behavior.”

Furthermore, the unambiguous recommendations that flow from the IOM’s review are not consistent with Lancet’s call for “more robust studies” while nations “devise and implement multicomponent programmes that reflect their specific economic, cultural, and social circumstances.” The IOM conclusion reads very differently indeed; without mincing words, it states, “We do not end [the report] with ‘More research is needed.’ … We say instead, ‘Action is needed.’” Yes, indeed! How could Lancet have missed this clarion call?

DRUGS AND THE FUTURE OF AFGHANISTAN:

Financial Times (London), Asia edition, 11 Oct., reports on narco-trade in Central Asia under the headline, " Pakistan sees rise in flow of Afghan narcotics." It notes, "Afghanistan receives $US 3.1 billion in annual revenue from opiates. Of that, $US 600 million is estimated to go to farmers while $US 2.5 billion goes to traffickers, often outside the country. Some of that money makes its way back in the form of smuggled goods, such as home appliances. Direct involvement in the drugs trade allows the Taliban to pay its fighters $US 8-10 a day, about 10 times what they could earn from legal activity."

The article concludes with the following: "Hamid Karzai, the Afghan president, has warned that either Afghanistan destroys its opium or opium will destroy Afghanistan." ANYONE WILLING TO TAKE BETS ON THE OUTCOME?

DRUG WAR IN COLOMBIA - Time to Cut and Run?

Concerning the drug war in Colombia , the Los Angeles Times reported on (Sept. 29 that the United Nations has determined that “five years of effort and $4.7 billion had not put much of a dent in overall coca-leaf cultivation.” It also noted that in May “[Colombian] army units allegedly did the bidding of narco-traffickers” in killing 10 US-trained anti-narcotics police and an informant, and that three months later other army units were accused of carrying out six “drug-gang killings.”

And yet, it’s predicted that Congress will maintain business as usual, with an even higher appropriation than the $728 million spent on the Colombian drug war in the current fiscal year. At this stage, wouldn’t it be reasonable to consider an alternative? Specifically - to coin a phrase – to “cut and run”?

METHADONE MAINTENANCE: the non-pharmacological impediments to functioning

A highly respected long-term (30-plus years) researcher in the field of addiction and its treatment with methadone, Dr. Philip Appel, made the following observation recently in email correspondence with colleagues:

"Having been in the addiction treatment-health policy research area for quite some time, my view is that the principal impediments to the functioning of methadone maintenance patients have little if anything to do with subtle neuropsychological deficits, if they exist. Mostly, they have to do with poverty and destitution, punitive welfare reform mandates, employment discrimination, tight-fisted treatment financing, over-regulation of MMT clinics and ubiquitous anti-methadone prejudice, not only among the public, major institutions, and employers, but also, among addiction treatment and research professionals."