GAUGING PATIENT SATISFACTION:

A study from Australia assessed satisfaction among maintenance patients receiving either methadone (78%) or buprenorphine (22%) maintenance. Extremely stringent limits on “take-homes” were the major cause of dissatisfaction. Only 41% knew the “complaint procedure” for clinic patients. The results are interesting, but what is perhaps most thought-provoking for providers in US and elsewhere is that the study was done. While some “programs” do study patient satisfaction, most don’t; significantly, this report is of a special investigational study, rather than the results of routine satisfaction monitoring procedures. Full report: Madden et al. Drug Alc Rev Nov. 2008, vol 27, 671-678.

Absolutely Horrible Toll from Battle Among Drug Cartels in Mexico

On Dec. 22 USA Today had an article detailing the absolutely horrible toll taken by the battle amnong drug csartels in Mexico - a battle that is entirely a function of the demand for illicit drugs here in America. Nine beheadings over this past weekend, 1,530 murders in the border town of Ciudad Juarez since January, elementary school attendance down to one or two students per class ... the toll is almost beyond comprehension. What is perhaps most disheartening, however, for Mexicans and Americans alike, is that the US drug Czar wrote an OP ED piece published by the Wall Street Journal barely two weeks earlier, on Dec. 5, with the headline: “Our drug policy is a success.” It certainly is high time for a change!

HEROIN TREATMENT SAVES HEAVILY ADDICTED

Story in Die Welt, 18 Dec. 2008, headlined: Heroin treatment saves heavily addicted; controversial trial in Hannover is a success - addicts become able to work again - criminality sinks to nothing.

The article reports only positive outcomes for patients and the community. Absolutely nothing negative. The only downside: the cost for 35 patients in Hannover is 620,000 Euro per year - or about 17,700 Euros - some $25000 per patient per year. It's difficult to imagine this will allow expansion to 50,000 nationwide, which is a goal mentioned at the conclusion of the article.

Den Artikel können Sie hier lesen (article is to be found here - in German):

FOR A CHANGE, A POSITIVE HEADLINE RE METHADONE TREATMENT:

From the Wilkes-Barre (Pennsylvania) Times Leader, an article whose title says it all: "Treating heroin users effective; decline in addicts seeking agency help attributed to methadone clinic opening" (Dec 15). According to the administrator of a (non-methadone) county social services program that has seen a dramatic drop in heroin addicts seeking assistance, "The introduction of medication--assisted treatments ... has enabled some to stop illegal drug use and stabilize their lives. ... They’ve been able to get jobs, take care of their families and in turn no longer rely on social and human service agencies for help."

DRUG ADDICTS WIN HUMAN RIGHTS COMPENSATION

A UK news headline (Telegraph, 3 Dec) reads: "Drug addicts win human rights compensation" and describes a successful lawsuit brought by 7 former heroin dependent prisoners denied methadone during incarceration. The article includes a number of quotes vehemently denouncing the ruling. One "leading MP" found it "disgusting;" a spokesperson for "Taxpayers' Alliance" denounced prisoners who were "turning over a tidy profit;" another MP described the lawsuit as "a shameless cashing in on this country's compensation culture."

In fact, of course, the reward is based on the refusal of prison authorities to provide effective treatment that has been endorsed for decades by academic and governmental authorities and that is based on the reality that addiction is a medical condition and must be treated as such. Would one refuse insulin to a diabetic whose condition is acknowledged to be grievously exacerbated by injudicious diet? Or bronchodilators to ease the plight of asthmatics whose condition is seriously aggravated by smoking?

Denial of needed medication indeed is a "breach of human rights." The Court is to be complimented.

ELIMINATING METHADONE TREATMENT:

The Michigan Citizen (Dec 13) reports that a city-funded methadone maintenance program will be closed in another month, abandoning 400-500 patients. Responsibility for balancing budgets in these tough times is horrendous - for individuals and for governments. But a move that inevitably will lead many hundreds back into a life of heroin use - and all the health and social problems associated with it - will cost many lives and harm the entire community. There's has to be a better way.

CHINESE POLICIES/PRACTICES RE DRUG USE – A "REALITY CHECK":

China has received much praise for a seemingly pragmatic, enlightened, evidence-based response to drug use – particularly its very rapid expansion of needle/syringe exchange and methadone maintenance facilities. Alas, there’s a darker side to the picture: more “detoxification” and “re-education” centres, a goal of locking up ever more drug users, and more police surveillance and harassment of those seeking the public health services. Findings of a recent study by Human Rights Watch are summarized as “… a sobering reality check to reports heralding China's 'bold steps to scale up' HIV prevention and treatment. They remind us … that seemingly progressive public health policies cannot fully be effective when carried out within a context of punishment and fear." See: China's paradoxical policies on HIV and drug use threaten health at
http://www.eurekalert.org/pub_releases/2008-12/plos-cpp120208.php

REJECTION OF EVIDENCE-BASED MEDICINE: THE TRAGIC CONSEQUENCES :

A Harvard team has concluded that some 365,000 lives were needlessly lost during the many years that South Africa's former Health Minister established a policy rejecting anti-retrovirals and recommending, instead, a regimen of "garlic and beetlenut juice." (NY Times 26 Nov). Unfortunately, other countries persist in denial that also kills hundreds of thousands of its ciitzens. The Russian Federation is a case in point: Russia continues to forbid methadone as treatment for opiate dependence, even after 40 years of overwhelming worldwide evidence of the medication's efficacy for most patients. What is offered instead: essentially nothing!

SWISS HEROIN AND POT VOTES DISCUSSED:

The recent Swiss vote was discussed in a perceptive opinion piece in The Times (London), Dec. 1. The subtitle says it all: "The Swiss Are Ahead Of Us Again - This Time On Drug Reform" - and to the extent the Swiss are ahead of the Brits, they are light-years ahead of many other countries, including the US, the Russian Federation, etc.
For full article click here