Advocating Heroin Treatment by Villifying Methadone

A supporter of heroin maintenance in UK is quoted (Telegraph, UK, 28 April) as bolstering his argument by stating, "..many opioid addicts can’t stand methadone, the current preferred treatment. It rots teeth ..." All approaches for which there's evidence of help and hope for those dependent on opiates should be endorsed. How terribly sad, however, that advocates of one therapeutic regimen so very commonly feel the need to vilify others. Heroin because "many can't stand methadone ... and it rots teeth." Buprenorphine enthusiasm of many supporters based on the notion that it's "less addicting" than methadone - whatever that might mean. And of course that only drug-free management can be considered "real treatment" and that medically assisted modalities reflect resignation, tossing in the towel, "parking people on methadone" and rendering them zombies easily controlled by the state.

Ophthalmic findings in babies of mothers prescribed methadone during pregnancy:

recent dramatic headlines in lay and professional media worldwide have focused on an article from the UK , whose findings are interpreted as attributing visual problems in children to pre-natal exposure to methadone. In fact, the article, which describes 20 children referred to specialists because of concerns over visual function, is very conservative in its conclusions. Specifically, “Infants born to drug-misusing mothers prescribed methadone in pregnancy are at risk of a range of visual problems, the underlying causes of which are not clear” (emphasis added). Even this seems to understate the tenuousness of the possible relationship between prenatal exposure to methadone and the eye problems noted here. Thus, the mothers may have received methadone for one day before delivery, or for the entire period of gestation; to the extent methadone maintenance had been provided for an extended period of time, no clue is given as to dosages – and whether they were adjusted individually based on clinical outcomes. In light of this lack of information, it's not clear how one should interpret the unqualified generalization that these were children born to “drug-misusing mothers”; one must hope this does not reflect the authors' view that all patients receiving prescribed methadone should be characterized as "misusing" drugs. The disquietude in this regard is heightened, however, by the reference to “children who had been exposed to substitute methadone and other drugs of misuse” (emphasis added).

As in the case of any therapeutic regimen, all possible risks should be assessed and considered both by the provider and recipient of methadone treatment, and weighed against the likelihood of success or failure of other management options. In this regard, the bottom line is that there is no treatment of opioid dependence that is as effective as methadone maintenance – for the pregnant patient and her unborn child as well as for all others who want and need help for their addiction.

Original article: R Hamilton et al. downloaded from bjo.bmj.com 22 April 2010

Tolerating waiting lists – why?

In Anchorage, Alaska, it’s being proposed that the budget allocation for methadone treatment be increased to permit the “patient capacity” in a local clinic to be raised from 75 to 100. But . . . there are today 23 people on the waiting list for that program, and surely many times that number would seek help if it were available. The depth of the tragic inadequacy of care is illustrated by the comment attributed to State Senator Johnny Ellis: “We heard of at least two women who got pregnant on purpose so that they could get treatment at the methadone clinic. But they were so short of treatment that even pregnant women were having a hard time getting in.” How can that be? Imagine a pre-natal clinic turning away pregnant women (with or without drug dependency) and placing them on waiting lists because they were “all filled up”! There seems to be a lack of outrage – and not only in Anchorage! News report 20 April click here

Managing Alcohol Use Disorders in OTP [methadone maintenance] Patients"

Policies regarding "managing alcohol use disorders in OTP [methadone maintenance] patients" is the lead story in current Addiction Treatment Forum (vol. 20, no. 2, spring 2010). An example is cited: "A patient arrives [at the methadone clinic] obviously inebriated, but docile. Some OTPs send the patient home in a taxi without dosing. Others keep the patient in the waiting room until breathalyzer scores are low enough for at least a partial dose ... "Question is: is there a basis for either practice? Any evidence that a constant daily dose of methadone to which, by definition, the patient is presumed to be tolerant), would be risky if the patient is intoxicated - and/or the breathalyzer "score" is above a certain threshold? And if there is basis for considering usual - or reduced - dose of methadone to be risky, how does the danger compare to that which might be expected if the patient resorts to illicit opiates to prevent or treat withdrawal symptoms before the methadone is available from the clinic the next day? Comments (and references) welcomed!

ASHES FROM ICELAND, PAY-FOR-STERILIZATION FROM US:

For some years an organization in the US has paid pregnant women dependent on opiates $300 to be sterilized. This program has now been brought to the United Kingdom, thanks to a $20,000 gift from an "anonymous supporter". See Story at: http://www.jointogether.org

Israel Indicates Favorable Impact of Methadone Maintenance Treatment

Consistent with the experience from around the world for over 40 years comes a report from Israel indicating the favorable impact of methadone maintenance on reducing injection drug use and Hepatitis C (HCV) infection among individuals in methadone maintenance treatment. Specifically, regarding Hepatitis C, the behavior that puts people at risk is ongoing drug use... Full story click here

METHADONE MAINTENANCE COMES TO CAMBODIA:

The glass remains 95% empty, and seems certain to leak badly! Cambodian government officials approved a long-delayed plan to open the first methadone treatment programme there, and it should be up and running "within months". The bad news: cost of the project, which will serve a maximum of 100 patients, is US$350,000 for one year, and will employ "a staff of more than 20 doctors, pharmacists, nurses, case managers and counsellors [who].. will have to be trained in an intensive six-week course." Under these circumstances, even the most spectacular success would seem to offer no prospect of significant expansion; indeed, success under these conditions might well be the definitive rationale for refusing to expand maintenance treatment at all. The donors, consultants, providers and officials involved undoubtedly have the very best intentions, but the rationale for this "pilot" is difficult for a far-removed outsider to understand. Click here for the full article.