The Winds of Change (US):

“Swapping Politics for Science on Drug Policy” is the headline of an article in The Nation, 21 Dec 09. It’s an overview that gives cause for optimism that US drug policy may indeed be brought into line with what long-standing evidence shows is effective – and hope that policies that are based entirely on unsupported (disproven!) dogma will finally be dumped. Inevitably there is wording with which some will find misleading - if not downright inaccurate. Overall, however, a comprehensive and well-written and compelling piece.

The concluding quote from Ethan Nadelmann, executive director of Drug Policy Alliance, sums up the cause for optimism: "If you take Obama's commitment, of no longer subordinating science to politics, and if you apply that seriously to drug policy, then there is no legitimate basis whatsoever for the federal government not to be supporting heroin maintenance and safe injection--research, at least--in the way that these other countries have. There's no legitimate basis whatsoever." On the down side: the history of the health "reform" legislation makes it painfully clear that regardless of the commitment of the President and top-level members of the Administration and a significant number of legislators, it's plain old politics that determines what happens - and that is a chilling prospect indeed!

Full article: http://www.thenation.com/doc/20100104/schwartzapfel

Editorial Bemoans “Marginalization of Addicts”

Except where methadone treatment is concerned. Nashua (NH) Telegraph, 27 Dec: In arguing against “a measure that would further restrict new [addiction] treatment centers and could even disrupt or destroy some of the programs currently available,” the editorial seems willing to sacrifice availability of and access to methadone treatment. It states, “There may be a case for some restrictive zoning surrounding methadone clinics, but this legislation affecting all drug and alcohol treatment goes too far".

It is correctly noted that “Medical research has confirmed that addiction is most often a medical condition, not a character flaw.” As such, it should be left to the professionals and to the patients to decide what type of treatment offers the best hope for each individual.

Full story click here

PROGRESS IN NEPAL

a moving story describes the impact in Nepal of methadone maintenance during the past year, thanks to major involvement of GTZ (German Fed. Ministry for Economic Cooperation and Development), a German medical technology company CompWare, and WHO. A patient is quoted: "Methadone has literally saved my life. none of the withdrawals or therapies helped. I always relapsed." Added his wife, "I don't know how methadone works, but I do see that he's not hanging out with the old crowd any more, he now helps out at home and I can rely on him."

NIMBY FEARS VS. REALITY

“After 40-year drug addiction, San Gabriel man has first sober Christmas with his family” is the Dec 24 headline of an article of the Pasadena Star-News. It describes a heroin addict who after almost 40 years “… finally walked into a methadone clinic and has not used heroin since.” While receiving methadone maintenance he has also been attending weekly meetings of a church-sponsored support group called “12 Steps with God”. Imagine if protesters and elected officials had prevented the local methadone clinic from opening - and the impact such rejection would have had on this man, his family, and on their “backyard”!

Full article: http://www.pasadenastarnews.com/ci_14065231

MAN GETS SENTENCED; SOCIETY DESERVES CONDEMNATION:

BBC reports “Homeless man granted prison wish … after pleading with a judge to send him back to prison.” According to the report, “Heroin addict Michael Simons… did not qualify for the methadone treatment programme … after being released [from prison] in November … [and] went on to steal a laptop and break into an empty house in Middlesbrough, the court was told. He said ‘thank you’ to the judge after admitting burglary and criminal damage and being jailed for 18 months.” One can only wonder what “qualifications” this 34 yo long-term heroin addict lacked. And while considering this man’s fate, think also of the estimated 2-3 million Russian opiate addicts who have no access to treatment whatsoever because their government “does not believe in methadone”, and the millions more in countries throughout the world where methadone and buprenorphine treatment either do not exist, or where services are woefully inadequate to meet the need.

For full story click here

CONGRESS VOTES TO RE-CONSIDER "U.S. WAR ON DRUGS":

Eight months after it was introduced, H.R. 2134 unanimously passed the House of Representatives and is now going to be considered by the Senate. It would establish an independent commission “… to review and evaluate United States policy regarding illicit drug supply reduction and interdiction, with particular emphasis on international drug policies and programs directed toward the countries of the Western Hemisphere, along with foreign and domestic demand reduction policies and programs. The Commission shall identify policy and program options to improve existing international and domestic counternarcotics policy.” Allocated funding: $2 million. According to an article distributed by Inter Press Service on 12 Dec., “This is being seen as an acknowledgement that current strategies meant to control illicit drugs are not working – and have not worked for a while.”
(http://www.gop.gov/bill/111/1/hr2134) A summary by JoinTogether states that over the past decades more than $11 billion have been spent on the effort to reduce supply of cocaine alone.

QUOTABLE QUOTE:

From the Times-Tribune (Scranton, Pa.), 19 Dec. 09

"Oftentimes, there are other treatments available," said Robert Lubran, director, Division of Pharmacologic Therapies for the Substance Abuse and Mental Health Services Administration. "But when it comes to heroin and opiate prescription drugs, evidence points to methadone treatment as the most effective treatment … In the absence of treatment, drug use is going to continue."

Original article click here.

DIFFERENT CONTINENTS, DIFFERENT PERSPECTIVES ON METHADONE TREATMENT

From Canberra (Australia): “Push for more methadone outlets”

Canberra Times, 20 Dec, 2009:
Michael Tedeschi, a senior specialist with the Australian Capital Territory's drug and alcohol program is quoted as follows: "We want patients to stay on programs, we want patients to have normal lives, have babies, get married, get a job."

Michael Moore, chief executive of the Public Health Association of Australia and a former ACT health minister, said that people who change to methadone … do so to try and change their lifestyle.… "The more normal [receiving methadone treatment] can become, the more likely they are to progress beyond heroin.''

Full story click here

And from Scranton, Pennsylvania: “Rep. Smith pushes moratorium on new methadone clinics” The Times-Union, 19 Dec, 2009

“Rep. Ken Smith is calling for an immediate moratorium on new methadone clinics opening in the state. … Mr. Smith also is proposing bills that would prohibit methadone clinics from locating with 500 feet of a school or establishment geared toward children; requiring an individual seeking treatment to undergo random drug testing at least once a week; and requiring methadone patients to be transported to and from a clinic by a driver with a valid Pennsylvania license.”

Full story click here.

METHADONE IN UK PRISONS – ATTACKED AND DEFENDED:

In the past week articles have appeared in several leading UK newspapers that have focused on giving prisoners methadone behind bars. The story was launched by BBC based on an interview with former UK drugs tzar Mike Trace,” who reportedly claimed methadone as over-=utilized, employed more to control rather than treat inmates, and diverted patients from the goal of using prison time to achieve rehabilitation.

The original BBC story (8 Dec 09) click here

Click here for a related column in the Times of London (10 Dec 09)

And a response to the Times columnist (14 Dec 09) by Professor Gerry Stimson, Executive Director. International Harm Reduction Association, can be read by clicking here.

THE US “WAR ON DRUGS” – HOW ARE WE DOING?

The answer seems clear from data provided by the National Institute on Drug Abuse in NIDA Notes, vol 22, no. 5, 2009, p. 19. Among 17 countries in five continents, US reportedly had the highest life-time use of cocaine (16.2% - no other country greater than 4.3%); and cannabis (42.4% - New Zealand had 41.9%, next came Netherlands with 19.8% and France with 19.0%). No other rates for illicit substances are given. For the world’s most rigid and enthusiastic champion of zero tolerance, the data seem to suggest it may be time for a change...

"RISKS OF METHADONE-PRESCRIPTION DRUG INTERACTION"

The lead article in the latest issue of AT Forum discusses "Risks of Methadone-Prescription Drug Interaction." For sure, there is a very widely held belief that methadone "interactions" with other psychoactive medications can be dangerous - and it would seem that precisely the same concerns/questions apply to buprenorphine.

Is there, however, evidence to support this assumption in situations where a constant daily dosage of methadone (or buprenorphine) is being provided and tolerance to that dosage consequently exists? In other words, if a patient has been receiving, let's say, 160 mg of methadone every day, that dosage presumably will not cause sedation, respiratory depression, euphoria or any other narcotic effects with the possible exception of constipation and/or diaphoresis. So...is there any reason to believe that the maintenance dose of methadone, to which tolerance exists and which does not on its own produce any CNS-depressant effects, will potentiate the CNS effects of other substances? And to the extent one can come up with a theoretical basis for concluding this might be the case, is there any research evidence to support it?

The questions are not rhetorical, and we wrote to AT Forum in the hope that it would share them with its readers, along with whatever answers might be available. Alas, no response has been received from AT Forum. Original article referred to click here.

High-level Criticism of Methadone Maintenance as "An Easy Option" (UK):

A BBC headline reads, “Prisoners' heroin addiction treatment 'undermined'; heroin addiction is being tackled using methadone as a substitute. The story attributes to “former drugs czar” Mike Trace the view that “prisoners were being prescribed the addictive heroin substitute methadone instead of being encouraged to get drug free“. It quotes Mr. Trace as follows: "When they (inmates) see the healthcare professionals they are offered, sometimes the only choice they are offered, is a prescription of some type, which means their motivation to try to remain drug-free can be undermined.”

Mr. Trace’s criticism is echoed by shadow home secretary Dominic Grieve, whom the article quotes as stating, “ … what is happening is that effectively the prison service has become content in doling out methadone as an alternative to tackling the underlying problems these people have - it's quite wrong."

One must wonder about the evidence that is the basis for this criticism against methadone treatment – criticism that, of course, applies no more and no less to the prison environment than to the general community. Regardless of setting, relapse to opiate use is the overwhelming rule rather than the exception once abstinence is achieved, regardless what types of services are – and are not – available.

(check out the original story online by clicking here

VETERANS DESERVE BEST TREATMENT FOR ADDICTION

The following Letter to the Editor by Robert Newman Appeared in The Detroit News

U.S. Sen. Carl Levin, chairman of the Senate Armed Services Committee and a Michigan Democrat, has been a leader in expanding the availability of treatment for Americans suffering from heroin addiction. In 2000, he co-sponsored with Sen. Orrin Hatch, R-Utah, the Drug Addiction Treatment Act -- groundbreaking legislation that allows community-based physicians to treat opioid-dependent patients with buprenorphine. Buprenorphine is similar to methadone, which has more than 40 years of proven effectiveness, but which may only be used by comprehensive treatment programs; both medications have a high degree of success in treating dependency on heroin and prescription painkillers such as OxyContin, Percocet and Vicodin.

In 2006, Levin sponsored another bill that substantially increased the number of patients for whom physicians can prescribe buprenorphine. At that time, he noted "the great success of buprenorphine treatment" and continued, "It is tragic if the personal and community benefits of this new anti-addiction medication ... are limited because of artificial limits on its use."

Unfortunately, precisely such "artificial limits" persist, and one of the greatest barriers to care is our Department of Defense. In clear defiance of congressional intent and ignoring decades of proven efficacy of medication-assisted treatment, the Department's TRICARE insurance plan refuses to pay for any maintenance treatment for addiction. And who are the people desperately seeking and needing help, but being denied coverage? American military, veterans and their families, including survivors of those who have made the ultimate sacrifice in defense of their country and been killed in action.

TRICARE is a well-deserved health care benefit for almost 10 million Americans. Its refusal to pay for what has been aptly described as "the gold standard" of care for opioid dependence is outrageous, and the outrage is underscored by the fact that treatment denied to our nation's heroes and their loved ones at home is being offered at U.S. taxpayer expense to opiate-dependent citizens of other countries -- for example, Vietnam.

Meanwhile, tens of thousands of veterans are known to be dependent on opioids, and the numbers keep rising. In May, former Drug Czar Barry McCaffrey told a conference of addiction-treatment providers that serious drug use among U.S. troops in Afghanistan has doubled in the last four years. Furthermore, according to a new report on veterans and addiction released by the Drug Policy Alliance, nearly a third of Iraq and Afghanistan veterans report symptoms of post-traumatic stress disorder. Of these, as many as three-quarters show signs of substance abuse or dependence.

To grasp the impact of the TRICARE tragedy, consider the case of Amanda Dressler of Georgia . In 2006 Amanda, then 23-years-old, married Sgt. Shawn Dressler; two weeks later he was deployed on his second tour to Iraq . In anticipation of Shawn's return, Amanda bought a house and began renovating it when, on June 2, 2007, shortly before their first wedding anniversary, she got word that Shawn had been killed in action.

In her grief, the young widow turned to opiate analgesics and quickly became dependent. With the strong support of her mother, Teresa Bridges, she sought and received in-patient care followed by buprenorphine prescribed by a duly certified community-based physician. Amanda responded extremely well to the treatment, but her recovery was thrown into jeopardy when she received notice that TRICARE would not cover her ongoing "maintenance" treatment.

Amanda's options were bleak. There was no way she could afford to pay out of pocket for continued buprenorphine treatment, but cutting short her care would result in an extremely high likelihood of relapse. Committed to her recovery, Amanda and her mom appealed to TRICARE and reached out to local political leaders, but they just said no!

Fortunately for Amanda, she caught a break; she recently learned that she had been accepted into a pharmaceutical company's "patient assistance program." This aid, however, will only provide treatment for one year, so the fundamental problem will persist for Amanda just as it does for thousands of others in need of opiate maintenance therapy.

Clearly, our leaders must again show compassion and common sense and demand that the TRICARE exclusion of "maintenance treatment" as a covered service be rescinded immediately. (The story online)

DEBATE CONTINUES OVER HEROIN TREATMENT IN ABERDEEN:

According to a report in The Press and Journal Dec 2, the debate continues over a proposal "to offer heroin on the NHS to city [Aberdeen] drug addicts." One city Councilor explained his support as follows: "There is evidence to suggest that weaning people off heroin is much easier than weaning people off methadone," while the Liberal Democrat "group deputy leader" is quoted as saying, "I know methadone is society's way of shifting the responsibility but I would like to take some of the responsibility back and look at options." One can only wonder who is advising the elected officials. For the full story, click here.

GOOD AND BAD NEWS REGARDING THE WAR ON DRUGS:

The Frankfurter Allgemeine on 30 Nov reported the following “good news”: from Afghanistan, for the first time in years production of opium decreased; the bad news: the decrease had nothing to do with the efforts of President Karzai or the US troops, but merely reflected the gout of opium and heroin in the world market, with the result that prices had fallen so sharply to make alternative crops more attractive to some of the Afghan growers.

There was also good news from Brazil: Rio was chosen the site of the 2016 Olympic games; the bad news: a police helicopter wa shot down by drug gangs in Rio, gangs whose arsenal of weapons is estimated to be nine times (!) than that of the entire Brazilian police force.

Surely there’s a more productive approach . . .