REJECTING METHADONE IN SCOTLAND:

A recent headline in Edinburgh Evening News (Mar 23) proclaims: “Methadone: there’s little evidence of any real progress.” The article notes that of Scotland’s 77 million pounds (about $US 112 million) spent on combating drug misuse, about 25 million pounds ($US 37 million) is allocated to methadone treatment for some 20,000 patients. That comes to under $US 2,000 per patient per year. Does anyone suggest the money could be better spent to save lives ... and to protect the community at large? And yet, methadone is rejected because “only 3% of addicts entering the substitute programme emerge drug-free.” One must ask: how many diabetics receiving insulin “emerge drug free”? What proportion of patients receiving treatment for epilepsy, or coronary artery disease, or hypertension, or ...? Until we apply same standards to methadone as to the treatment provided for other chronic ailments, methadone treatment will continue to be rejected. For full story click here.

"LIFE AFTER THE CRISIS"

methadone maintenance comes to First Nation, big time! In Oromocto First Nation, New Brunswick, it was estimated six years ago that the "majority of residents in the small aboriginal community ... were addicted to drugs." Then, four years ago, the community "...opened the first on-reserve methadone clinic" and today nearly half the residents receive maintenance treatment. The news article concludes, "These days, Oromocto First Nation is a community in healing, trying to bolster itself and its inhabitants." Full story in Telegraph Journal 5 March click here.

“Waiting List” for Methadone Maintenance in Baltimore:

A 2009 publication (Am J Drug Alc Ab 35:290-294) reports on 120 applicants for methadone maintenance placed on a “waiting list.” After 4 months only 21% had been admitted, and of the remainder almost 90% had received no “formal drug abuse treatment” of any kind. In discussing these outcomes the authors note that “methadone treatment is a low-cost and highly effective approach … [and] given the even lower cost and proven efficacy of interim methadone, its more widespread use could greatly improve treatment access and outcomes. “ They also note the "requirement tied to states' receipt of [federal] drug treatment block grants ... [to] admit IDUs within 14 days of request, or provide interim services when such timely admission is impossible." Left unsaid is why states appear to ignore this rule - and apparently do so with impunity.

DETOX UNDER SEDATION OR ANESTHESIA:

A Cochrane collaboration publication, while acknowledging that "the diversity and small number of studies limits the strength of conclusions..." found: "The increased risk of clinically significant adverse events associated with withdrawal under heavy sedation or anaesthesia make the value of aneaesthesia-assisted antagonist-induced withdrawal questionable." Cochrane Collaboration, 2010, Issue 1.

IN THEIR BACKYARD:

“Methadone clinic gets ok” reads a headline from Allenwood, Pa. By a vote of 4:1 Township planning commissioners approved a zoning change to allow the establishment of a clinic in a local business park. A welcome decision that will save lives (figuratively and literally) and benefit the entire community. For full story click here .

Addiction Treatment: Abandonment?

What’s worse than 100% abandonment? Answer: 99% abandonment. And according to WHO that’s precisely the situation in Eastern Europe and Central Asia , where there are estimated to be over 3.7 million (!) injecting drug users. The data were presented at the 53rd Commission on Narcotic Drugs conference in Vienna on March 9; http://www.unodc.org/unodc/en/commissions/CND/session/53.html

Obama's "Habit": Washington Post, 28 Feb 10:

"U.S. President Barack Obama is in overall 'excellent health' but still struggles with a smoking habit… Obama uses a ‘nicotine replacement therapy‘ … Last June, when asked if he still smoked cigarettes, Obama said he was '95 percent cured' but added 'there are times when I mess up.'" So . . . why can't the President "just say no"? Are there drug-free treatment advocates who would criticize the President for resorting to "replacement therapy" - not even "substituting one drug for another," but merely the route of administration? Would anyone suggest Obama is a weak man, lacks willpower, or has a "psychiatric illness"? Or that he's lying when her says he wants to quit, and is really driven by sheer hedonism and refusal to give up some great joy he derives from smoking? And whatever leads to acceptance and understanding of Obama's "struggle," why is there so much vitriolic condemnation of "substitution" treatment (with methadone, buprenorphine, slow-release morphine etc.) in the management of opiate dependence?

"Quote of the Day"

"This evidence suggests that the primary global need is not for new interventions to change the behaviour of IDUs, but for effective interventions to change the behaviour of policy makers to make policies and programmes consistent with the evidence base for HIV prevention and care for IDUs" (Des Jarlais/Arasteh/Gwadz, 3/1).

The Reuters article includes comments by several health experts who discuss HIV prevention and treatment efforts among IDUs (3/1).
http://www.alertnet.org/thenews/newsdesk/LDE61P0XM.htm

Cambodia to Introduce Methadone:

Not so sure if this is good news or bad. Basically, if the "pilot" is successful, the "glass" of drug treatment availability will remain 95% empty in Cambodia (target 100 patients, estimated "at least 2,000 drug users in P.P." Far more worrying: the staffing of this pilot that seeks to enroll 100 patients is stated to be: "more than 20 doctors, pharmacists, nurses, case managers and counselors." If wildly successful, it will have demonstrated efficacy of a model that will be totally impossible to replicate other than on a tiny, tiny scale. It might well prove to be by far the most insurmountable of all obstacles facing meaningful availability of methadone treatment in Cambodia - and beyond. Full story (dated 1 March):

http://www.phnompenhpost.com/index.php/2010030132834/National-news/methadone-treatment-on-the-way.html