CHINA'S HOPES FOR BUPRENORPHINE:

An article in Xinhua English Service News (Mar 15) was headlined: "China to use new medicine for drug addicts. ", and stated "China's Ministry of Health will use a new type of medicine [Suboxone] to replace methadone in the treatment of some drug addicts . . . " This would be unfortunate in the extreme. Nowhere in the world where Suboxone has been introduced was the purpose to "replace" methadone; rather it has been to supplement it and offer an additional option for providers and recipients of care.

The fact is that both medications are effective and safe, though there are no cure-alls and individual patients will do better on one or another - or with a different treatment modality altogether. Both medications produce dependence (which is not necessarily a pejorative observation - consider the diabetic's "dependence" on insulin), both can be misused, and neither produces allergic reactions. There is, however, one very major distinction, and that is cost. In most parts of the world (including the United States), the average daily dose of Suboxone is some 25 times (!) more expensive than that of methadone - not an insigificant difference when one is talking about almost half a million (registered!) drug addicts!

METHADONE ADOPTED IN CENTER, SHELBY CITY, EAST TEXAS (population 5,900):

Daily Sentinel (March 8, 2007) reports on new "methadone clinic in Center to help painkiller addiction." At a time of very widespread (and usually effective) efforts to prevent methadone treatment from being provided in local communities, this is a welcome exception. A physician from nearby Lousiana State University, Lisa Schrott, summed up the impact one can observe with effective methadone maintenance: "You would be surprised how fast it can make a difference. I've seen people come in haggard and worn out. But once they are stable (on methadone), which usually takes two to three weeks, they come back neatly dressed and smiling. They can go to work, take care of their families and claim their lives back."

full article war on drugs .

WHAT'S WRONG WITH "FOR PROFIT"?

An article in the Bangor (Maine) Daily News on 6 March is headline, ”Ellsworth eyes methadone moratorium.” It is disheartening to read the view attributed in the article to Sheriff Clark that methadone treatment is “just substituting one drug for another.” More than 40 years of consistent reports from around the world have documented the efficacy of methadone in the treatment of opiate dependence; it reduces crime, enhances productive and healthy living, benefits the general community and saves lives. It has been endorsed for decades by the US government, the World Health Organization and countless governmental, academic and clinical authorities.

The report states that the Sheriff also had “another problem,” the fact that many methadone providers are “for-profit operations.” Similar attacks on methadone facilities - especially those still in the proposal/application process - have been heard for decades across the United States. One can only respond: Welcome to America! We enjoy some of the very best health services anywhere, and of course the entire foundation – from insurance to providers of care – is overwhelmingly “for-profit.” Is it possible that the Sheriff and others who voice similar objections really have a problem with this defining characteristic of the American way?

IF WE MUST DEPEND ON ALLIES LIKE THESE...

An AP story on March 2 (Sun-Sentinel.com) reports that the US is disappointed "...that top anti-terrorism allies Afghanistan, Pakistan and Colombia had fallen short in the war on drugs . . . and criticized perennial foes Iran, North Korea and Venezuela for not cooperating." I'm sure the latter three "perennial foes" will be greatly chastened by the American criticism, and that our anti-terror allies will ensure that no stone be left unturned in the effort to find ways to help us in our anti-drug struggle. Those who are less optimistic, however, might wonder whether an american war whose victory depends on unstinting support of collaborators such as these is one that really should be pursued.

AGONIST EFFECTS OF METHADONE IN PATIENTS ON STABLE MAINTENANCE DOSES – TIME TO BALANCE ANECDOTE WITH EVIDENCE

Much has been written over the past four decades regarding alleged opioid agonist effects of methadone on maintenance patients. “Zombies” was a term applied early on and still heard today, along with statements that methadone “gives a buzz,” “clouds the mind,” etc. Such comments have been particularly frequent in the past few years in comparisons that are made between methadone and buprenorphine, which purportedly leaves patients “more clear-headed” and without euphoria.

As far as we know these notions are contradicted by controlled studies. Thus, a paper by Dole and Nyswanbder in 1966 (“Rehabilitation of heroin addicts after blockade with methadone,” NY State J of Med, 66(15):2011-2017) stated, “… the absence of any drug sensation at all [in stable methadone maintained subjects] was verified by tests in which the usual medication (dl-methadone) was replaced by the pharmacologically inactive isomer (d-methadone). … The patients given d-methadone in a double-blind test were unaware of the fact that the medication had been changed until they began to feel vague grippe-like sensations twenty-four to thirty-six hours later, and even then some patients did not suspect that the active medication had been omitted …”

The same year a study was published by Dole, Nyswander and Kreek (Arch Int Med 118:304-309) reporting tests for evidence of “blockade” – i.e., tolerance to the agonist effects of narcotics – when methadone-maintained patients were administered various intravenous doses of heroin or hydromorphone (dilaudid). Methadone-maintained patients experienced “little or no euphoria” even when heroin was injected “in massive doses.” This paper also noted: “An incidental finding of practical interest was the absence of euphoria or other drug effects on intravenous injection of methadone, 40 mg, into patients who were receiving daily oral doses of methadone, 40 mg or more.”

If there are studies subsequent to these that came up with contrary results, references would be most welcome. Otherwise, it would seem good to reconsider the assumptions reflected in the increasingly frequent comments about the effects of maintenance doses of methadone – in absolute terms and/or contrasted to buprenorphine..

VICTORY IN WAR ON DRUGS IS AS CLOSE AS THE NEXT CONGRESSIONAL VOTE

US Fed News reported on March 1 that a new bill has been introduced by Congressman Keller (Rep., Florida) entitled "Drug Trafficking Elimination Act." My goodness, why didn't someone in Congress think of this sooner? Once there's a law to eliminate drug trafficking the war on drugs will finally have been won, and another mission accomplished. Hooray.