Monday, June 26, 2006


Recently there was a proposal to oblige women receiving methadone treatment for addiction to get it in combination form with contraceptive medication. Now there's a proposal to "send electric pulses through the skull to help stabilize the brain after quitting 'cold turkey' and help to control the body's craving." See:


Financial Times 20 June: "Marketing forces unite to fight stigma of Aids." The media initiative was launched by Kofi Annan in 2004 and now involves 130 companies in 69 countries. So . . . why not apply the same approach to addiction, harm reduction and "substitution" treatment? God knows stigma pervades that field as well.

Tuesday, June 20, 2006


There appears to be no other area of medicine where limits are imposed by fiat on the number of patents a physician can treat. And the rationale for limiting the number of patients who may be accepted for life-and-death treatment with buprenorphine of opiate addiction: fear of creating "buprenorphine mills." How come no one worries about "well-baby care mills," or "diagnostic radiology mills," or "epilepsy mills", or "mills" serving patients with AIDS, schizophrenia, tuberculosis, etc.? It seems clear that government is displaying overt prejudice against the medical problem of addiction and those who provide and receive treatment for it. No wonder, then, that stigma against exists throughout society, and presents an enormous obstacle to those who so desperately want to leave behind a life of illicit drug use and all with which it is associated.

Monday, June 12, 2006


According to the Charleston (WVa) Gazette, the package insert for methadone tablets dispensed for analgesia give dosage instructions advising up to 10 mg every three to four hours. That's a potential total of 80mg on day one for a presumably nontolerant individual.- a dosage that unequivocally has lethal potential.

What could the company be thinking? Where's the FDA? .

Tuesday, June 06, 2006


There's a UN convention against use of children as soldiers, but this seems one of those international edicts (like the Geneva Convention) that some countries choose to ignore. Thus, the following headline and first sentence of an article in Environmental News Service

Afghanistan: Schoolchildren Used to Eradicate Opium Poppies
MAZAR-e-SHARIF, Afghanistan, June 2, 2006 (ENS) - It's a day out in the country for Noor Mohammad, as he stands in the middle of a field with a stick, beating energetically at the opium poppy plants around him.

Of course, whether we use adult soldiers with high-powered weapons such as tanks and planes, or kids swinging sticks at poppies, the only thing that counts is the likelihood of winning the war. So who's taking bets on the outcome of this battle?

... click on link above for full story

Sunday, June 04, 2006


From San Joaquin (Cal) News Service, June 3.
Local officials are proposing to terminate the only remaining public methadone program in the County because it's contributing to the budget deficit. Patients would be transferred to one of several private programs in the area.
QUESTION: why/how can private programs not only operate on a break-even basis, but presumably make a profit for their owners - while government programs have to be closed because they add to the county's deficit?

Saturday, June 03, 2006

BUPRENORPHINE - get facts straight

The Boston Globe on June 3 discusses rally of doctors and addicts for better buprenorphine access. Sure, it's good to see demand for greater access to treatment - in this case buprenorphine. BUT the article refers to claims that do not seem supported by evidence. For example, it states that buprenorphine "unlike methadone doesn't make patients groggy..." That buprenorphine "has the potential to wipe out at least 50% of the national demand for heroin." Further, the article is not all good news for buprenorphine: it notes that "the US Justice Dept reports a black market" for buprenorphine. Ultimately, misinformation and unsupported claims will be counter-productive of the stated aim of buprenorphine advocates - to increase treatment availability.

Thursday, June 01, 2006


A bit bewildering to this yank! Govt wants to scrap private methaodne CLINICS but permit any GP to prescirbe for up to 10 pts? The latter I have no reason to criticize, since I have always maintained that methadone prescirbing should be subject to same general rules that govern prescirbing of any other medicine, even potent and potentially medicines, for any other chronic illness. But why ban private "clinics"? Far as I know there's no comparison that usggests they have poorer outocmes than any other provider. And if indeed there are one year waits for receiving treatment - that's just crazy, isnce under those circumstances `the relevant comparison is not between private and public, but between private and zippo treatment - i.e., abandonment. So what's up down under?

A RESPONSE TO MY QUESTION from a distinguished and respected colleague from australia: "The GPs prescribing to less than 10 patients cannot initiate, but can continue treatment. The ban on private clinics is because they account for more than their fair share of complaints. It's true that patients are better off getting bad methadone maintenance treatment than street heroin from an excellent criminal or corrupt police officer. But bad methadone treatment gets a lot of bad press and really does jeopardise the whole programme. We have had a spate of young children dying from methadone recently, I don't like that and the public and the Minister like it even less".