Thursday, April 24, 2008


Beware of generalizations. Thus, the chair of the police union for the Netherlands has recently stated, "It is pointless to fight against the supply of cannabis." He went on to say that "...he would much rather see soft drugs legalized in The Netherlands ... [and he] is in favour of letting long time addicts use hard drugs under supervision." The thinking of this experienced, senior police official is clear: "In his opinion this is the only way to effectively fight drug related crime."

For full story

Thursday, April 17, 2008


South China Morning Post (HK) reported on April 10th that the government Auditor is urging that existing treatment services be “shaken up.” Sometimes one loses sight of the forest for the trees; local Audit staff seem unaware that Hong Kong’s response to the problem of heroin addiction, and most particularly its methadone programme, have for over three decades been acknowledged by countries throughout the world to be a model of effectiveness, and one that many have sought to emulate. The extremely low HIV infection rate among drug users in Hong Kong is dramatic testimony to that effectiveness. Among the Audit Director's recommendations: reallocation of funds from methadone to other forms of treatment, and “…stepped up efforts to encourage more methadone patients to undergo detoxification . . . “

Success on the narcotic addiction front is exceedingly rare; Hong Kong must not jeopardize what it has achieved. For full Audit report (which was released March 2008) on Treatment and Rehabilitation Programmes in Hong Kong, click here

Wednesday, April 16, 2008


From Johnson City Press (Tenn.), 16 April, a report of community outrage over a "clinic" where buprenorphine is prescribed for opiate dependence. The article notes that City Code restrictions have long governed establishment and operation of programs treating patients with methadone, but "Suboxone is an especially difficult narcotic for municipalities to regulate, as any licensed physician may prescribe it." Obviously, the fear and loathing that NIMBY reflects are directed at the patients receiving care; the particular medication that's provided is irrelevant!

Monday, April 14, 2008


A successful outcome has just been described in a 31 year old long-time addict who had failed to respond favorably to methadone maintenance. Eur Addict Res. 2008;14(2):113-4. Ultimately, therapeutic decisions require weighing of the alternatives, and whatever reservations one might have about clinical prescribing of heroin to pregnant women, for those whom methadone does not help and who reject other forms of care, the alternative is probably abandonment!

THANKS TO COLLEAGUE HANS-GUENTER MEYER-THOMPSON for calling our attention to this article.

Thursday, April 10, 2008


A good example of the insane policies that people have to fight off - seemingly constantly - in many places in this country, matched by some comprehensive, thoughtful and determined advocacy that has kept the outcome from being much worse. For full first-hand report, click . . . .

Thursday, April 03, 2008


"I am a patient in a clinic in ______ state and have been for 6 plus years. This is the only clinic I have ever been to so I have nothing to compare it with, but things have gotten progressively worse. It seems as though now there is an UNWRITTEN rule that is being enforced clinic wide that is you are 10 years or more on the clinic, and doing well patients are being forced into a detox and being told that "You have reached a point where you cannot benefit from the clinic anymore". We are talking about people that have a good amount of clean time, have take homes and attend all appointments and groups.

There is definitely a trend of prodding, if not forcing clients that would like to stay on Methadone Long Term off of the clinic. I am wondering if this is a practice used by other clinics or perhaps new regulations causing this drastic change in policy? This isn't the first time this clinic has changed their philosophy regarding Methadone Maintenance Treatment. Over the past 3 years they have changed from the "Harm Reduction" model which allowed much more room for relapse, to the "total abstinence" model which is VERY strict regarding dirty urines. I know of dozens of clients kicked off over the past 2 years for frequent relapse... which for quite some time we were told that relapse was "part of the disease".... Is this change of philosophy common among other clinics of is the one I am going to just really bad? "

ANSWER from ICAAT: It's terrible! Bottom line: whatever the circumstances - duration of treatment, excellence of response, stability of work/home, age, etc etc etc - I believe there's no evidence anywhere that contradicts the assumption that relapse remains the rule rather than the exception when treatment is stopped. There is absolutely no justification for encouraging detox, and as for terminating people because they don't achieve complete "abstinence from drug use while in treatment" - the question that's critical is: what's the basis for concluding that the patient will be at less risk of illness, incarceration and death if I discontinue treatment rather than continue to try to afford help to her/him in the program.

The problem is: what can a patient do in fighting a policy/practice of the clinic which has the ultimate say in everything, including dosage, take-home "privileges," and even termination. Some suggestions: expressing concern to the accreditation body - either anonymously or with an assurance upfront that confidentiality will be assured. And/or express concern to state drug authority. Beyond that, I fear that a patient who fights a clinic will ultimately lose, one way or the other.

If the patient needs an advocate with accrediting or regulatory bodies, We are happy to assist in whatever way possible.


An extensive systematic review by Srivastava and colleagues found 15 major studies that reported on clinical experience. Of these, 3 reported that after admission patients increased their consumption while receiving methadone, 3 reported a decrease, and 9 found no significant change. we had to wonder if perhaps the same distribution might be found if one studied alcohol consumption patterns after enrollment in a clinic treating diabetes, or hypertension, or any other chronic medical condition. Publication was in J Subst Ab Treat (2008). 34:215-223.