TO THOSE WHO WOULD CRITICIZE SEMANTICS...

Especially in the US, advocates of methadone (and buprenorphine) maintenance treatment express outrage over the word “substitution”! It would seem more productive if they focused their attention on acts, rather than on words. Thus, one of the oldest and most effective self-help and advocacy groups in Germany calls itself (itself!) JES...“Junkies, ex-junkies, and those being substituted.” And what have they and allies accomplished? First, there are over 70,000 patients receiving “substitution” with methadone in Germany - hardly 20 years earlier there were none; no one group or individual can claim the credit, but JES has been a critical voice. Also, this year on July 21 the 11th national “memorial day in tribute to the victims of the drug war” was marked in dozens of cities, large and small, throughout the country. A journal (cover image shown here) put out jointly by JES, parents’ groups and “German-AIDS Help” gave the highlights of the day for many of these cities. A case in point: Recklinghausen – “the 60th largest city in Germany”, describes its treatment efforts as follows: SUBSTITUTE FOR DRUGS - dependent patients participate in the substitution program and thereby avoid the possibility of death.”

Critics, and especially American critics, of the label German drug users and former users adopt for themselves should reflect on the situation at home: can anyone imagine a large public demonstration in America honoring the memory of victims of the drug war? Let alone dozens of such demonstrations coordinated throughout the US? Would anyone deign to condemn a group as courageous and effective as JES because of the name it uses - proudly and unapologetically - to define itself and its members?

ADDICTION TO NICOTINE - SOME PARALLELS TO NARCOTIC ADDICTION:

An article in the current issue of Lancet by JD Pollack and colleagues notes that of the estimated 45 million American smokers, over 43% had tried to quit during the past 12 months. Of those who tried to quit on their own, 80% relapsed within one month and only 3% were abstinent at 6 months. The results were better with pharmacotherapy, but "only 15-35% ... were able to remain abstinent for more than a year." Interestingly, there is no mention of anything less than total smoking abstinence - smokers who cut down from, say, two packs a day to five cigarettes apparently were not distinguished from those who never cut down consumption at all.

SCOTLAND DISCOVERS ADDICTION CAN BE FATAL:

An Aug 12 article in the Guardian headlined: "Scottish drug deaths reach record levels." It would almost appear that Scotland has just now discovered what the world has known for decades: addiction is a chronic, notoriously relapsing, medical condition that often has a tragic, deadly end. What it seems not to have understood is that addiction is eminently treatable but – to date – incurable. Failure to accept this reality with regard to drug dependence is surprising, since “treatable but incurable” has for well over a half-century been the near-universal axiom governing the approach to the related condition of alcoholism.

And yet, critics rail against what they see as "excessive" numbers of patients receiving methadone treatment in Scotland, and damn methadone providers because reportedly only 3% manage to achieve a lasting abstinence. The article quotes the Torie view that “…the SNP are losing the battle against illegal drugs;” to the extent this is the case, it would reflect the fact that there are too few addicts in treatment, and not too many!

HEROIN TRIAL RESULTS - SO MUCH FOR THE IMPACT OF EVIDENCE:

The Globe and Mail ( Canada ) of August 22: “The Quebec government's decision to cut $600,000 in funding from a study that would give heroin to hard-core drug addicts jeopardizes research into the controversial treatment that would have been a worldwide first. Doctors involved say they're baffled by the decision, which came to light the same week research from a separate study was published that said giving heroin to people with entrenched addictions was far more effective than administering methadone. . . . The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) would have been the first in the world to compare the effectiveness of medically prescribed heroin against Hydromorphone, a licensed narcotic and whether users will accept the drug in pill form instead of injecting it.” Full story click here.

PROFIT AND MMT

An article in the Chicago Tribune (August 16, 2009) quoted a Drug Enforcement Administration official expressing concern "... when the motive for treatment is profit," with no evidence to suggest any difference in quality of care. And this at a time when many Americans are expressing their fear and fury over proposals to include a government option for health insurance, to be available alongside those offered by a host of (extremely profitable!) insurance companies!

When it comes to treatment of addiction private facilities are helping to fill the unconscionable void resulting from woefully inadequate services of the Government and voluntary sectors. Their role in lessening demand for illicit drugs is an indispensable component of the nation's efforts to address the problem of drugs in America. No one should know this better than law enforcement officials.

MARIJUANA IN NYC: TWO FACTS

Fact 1: In NYC marijuana possession has been decriminalized since 1977; one can be given a ticket and fined $100, but no fingerprinting and no jail.

Fact 2: Since 1997 430,000 arrests have been made by the NYPD for possession of small amounts of marijuana; in 2008 alone there were 40,300 such arrests – over 100 a day, every day.

To understand what explains this apparent dichotomy check out an
article by Harry Levine, posted Aug 10 on AlterNet.

MASS EXECUTIONS IN IRAN:

That's the headline of a joint report of Austrian Presse Agentur and Agence France Presse based on a story in the "reform newspaper", Etemad. It is stated that on 30 July there were 24 hangings for alleged "drug trafficking" in a single day in a prison near the capital. The same prison was the site of 20 hangings earlier in the month, and since the beginning of the year the number of executions in Iran is said to be 219, though Amnesty International puts the total at 246. Human rights activists say that opponents of the regime are being charged with drugs offenses and sentenced to death.
Full APA/AFP report (in German) click here.
(Thanks to our colleague Prof. G. Fischer in Vienna for forwarding this article.)

FROM LONG ISLAND TO IRELAND EXPANSION OF TREATMENT IS NEEDED

The following Letters to the Editor by Dr. Newman was recently published

Addiction treatment delays are deplorable (Irish Examiner, August 4, 2009)

It is simply irrational to force those wanting to give up their illicit opiate habits to wait two years or more for treatment proven in Ireland and around the world to be enormously effective. Countries as divergent as Germany , Hong Kong, the US and, most recently, Iran and China have been able to achieve massive expansion of services almost from one year to the next.

The only prerequisite has been commitment.

It reflects a perverted sense of priorities when government agencies and committees debate strategies for increasing the "monitoring" of patients who, as you report, may have been in treatment 10 years or more, while continuing to ignore those who are being abandoned by shortsighted policies and practices that tolerate - indeed, ensure - multi-year waiting lists. Not only drug-users but the nation as a whole deserve better.

Robert Newman MD, MPH


Newsday --Letters to the editor, August 2, 2009

Get help for heroin Newsday reported in separate articles on July 24: "Drug deaths up in Nassau " and "Heroin fight: It's just 'everywhere'; 110 nabbed in coordinated raids over 4 months in Suffolk ."

Law enforcement efforts have never made a significant impact on use of heroin or the death rate with which it is associated. For decades it's been documented that heroin addiction is a medical condition that can be treated.

When is the last time anyone heard a public service announcement in Nassau or Suffolk urging those who desperately need help to get it? It is irresponsible - and inexcusable - that treatment services either are unavailable, or are being kept secret.

Robert Newman