Tuesday, July 27, 2010

“Methadone Works. Stop the Interfering."

That’s the headline of a 26 July opinion piece in The Guardian, UK, written by a London physician whose practice includes many patients receiving methadone or buprenorphine maintenance. Dr. Chris Ford addressed “…the possibility of returning to the outdated and discredited policy of time-limited methadone prescribing” – a policy change stridently demanded by some UK politicians (and also proposed in a recently introduced bill in the state of Pennsylvania). Dr. Ford states, “As a doctor I use methadone and buprenorphine with many patients alongside a variety of psychosocial and other healthcare interventions. Prescribing can last for one week or it can last for 30 years – it is and should be completely patient-driven and dependent on them as individuals. An arbitrary time frame imposed on any patient's medication regime is unacceptable.”

Friday, July 23, 2010

Portugal's Drug Laws Under "New Scrutiny" According to a Wall St. Journal Headline (20 July)

While most reports of the major liberalization initiated in the country 10 years ago have been decidedly positive, and even though Portugal is now looked on as a model by several other countries who are considering emulating their success, the article refers to the negative data of the past decade. It concludes by quoting a senior member of the EMCDDA staff (based in Lisbon) warning that "Now that the epidemic [of drugs] is under control, people start asking ... what is going to happen next? There is a part of the population who do not have the possibility of leaving the treatment." Precisely the same questioning, of course, has been heard in many countries of the world - none more insistently and harshly than Scotland.

For full story, click here.

Wednesday, July 14, 2010

Police Chief from Saint John, Canada, Also Gives a Strong Endorsement of Methadone

The Chief attributes to the new methadone facility, operating out of necessity with essentially no counseling or other support staff, with the dramatic drop in armed robberies there. "Armed robberies in the city are down by more than half since the methadone clinic opened in the city centre last year," according to Chief Bill Ried. He went on: "It's mighty important that we do not have waiting lists - and waiting lists?

Tuesday, July 13, 2010

A Clear, Compelling Argument in Favor of Establishing Methadone Clinics

A clear, compelling overview of the arguments favoring the establishment of methadone clinics is to be found in an opinion piece published in SalemNews.com, Salem, Mass. Written by columnist Brian Watson, it describes one operating clinic he observed as follows: "I was struck by the diversity of people using the clinic and the universally quiet, focused, businesslike manner with which they arrived, drank their daily dose and left. Young and old, men and women - even people opus hing baby strollers - came to the center." Mr. Watson goes on to ascribe what he heard from the local Police chief: "He said he could not remember so much as a traffic infraction - or any other incident - that stemmed from patients at the clinic or walking in the neighborhoods around it."

For full article click here .

Call for "Audit" of Methadone Maintenance Programs in PA

According to an article in the July 1 issue of the Pittsburgh Tribune-Review, Pennsylvania lawmakers have called for an "audit" of methadone maintenance programs in the state to help them consider a half-dozen proposed laws to restrict the eligibility for, maximum duration of, and a host of other restrictions to be imposed in methadone treatment for opiate dependence. It is always appropriate for government to audit services for which taxpayers provide the funding, but the article reflects a fundamental misunderstanding when it states, “The review will examine . . . whether methadone is used as part of a treatment plan aimed at recovery or as a maintenance plan.”

The concepts and goals of “recovery” and “maintenance” are not mutually exclusive. By analogy: would one consider AA to be geared towards “recovery,” or simply “maintaining” an alcoholic’s dependence on meetings, mutual support, etc.?

Similarly, diabetics are “maintained” with insulin, but that does not mean they or their physicians reject “recovery” from the host of complications that diabetics can have. Like diabetes and alcoholism addiction is a disease that we cannot – as yet – “cure,” but can treat with great effectiveness; methadone maintenance is clearly recognized as the gold standard of the treatment options.

Sunday, July 11, 2010

In Face of a Killer Epidemic, Waiting Lists for Treatment!

A UK headline (The Observer, 11 July) reads: “Anthrax deaths expose addicts' plight …13 deaths in UK since Xmas”. The article quotes a drug treatment worker as saying lives could have been saved "if we could have got people access to methadone or Subutex very quickly … but we were looking at six-month waiting lists and, in some parts of Scotland, a year."

Saturday, July 10, 2010

Wishful Thinking Trumps Incontrovertible Evidence:

A recent contribution to the Journal of Addiction (105:1311-1313, 2010) describes a survey of opiate substitution treatment (OST) policies and practices in prisons that found "...only 55% of prisons in the US provide methadone to inmates in any [emphasis in original] circumstance, and most provide only to pregnant women". Overall the authors conclude "only a minute fraction of the estimated 200,000 incarcerated individuals with opiate dependence have access to OST [and] the overwhelming majority also do not offer referral to OST providers ... upon release..."

And the rationale the authors ascribe to respondents: "These policies reflect a common misconception that opiate dependence is cured when drug use and withdrawal symptoms cease ...". In the face of notoriously high recidivism rates (to say nothing of the well-documented mortality rates during the initial weeks after release), it is truly difficult, even for the most cynical of observers, to accept that this truly is the prevailing belief of prison authorities (or anyone else).

Scottish study: Methadone Prolongs Life; Reaction: "What's the Point"

Difficult to understand the dismissal ("what's the point") of medical treatment that is acknowledged to prolong lives but fails to cure the underlying condition. The same (il)logic would lead one to look with contempt on the management of any chronic malady: diabetes, depression, hypertension, etc. It would result in the same "what's the point" contempt for AA and its universally respected role in assisting alcoholics in recovery (but never ever "curing" them of their alcoholism - just ask any AA advocate). And if it were shown that life could be prolonged by nicotine replacement (!) gum or patches that help long-term smokers cut down from two packs to 5 cigarettes a day - would that lead to criticism that one is simply replacing "a queue of people at the pharmacy ... " with one at the tobacconist? As stated at the outset, difficult to understand!

Full story click here.

See opinion on the Scots paper - and comment (URL above). Insanity, but I fear that will be the most common conclusion- essentially, yeah, helps people live longer, but big deal. "What's the point?????" Pretty depressing.

Friday, July 09, 2010


What’s most noteworthy about the prediction is the source: an op ed piece written by Lee Baca, sheriff of LA County and Charlie Beck, LA chief of police. They say cutting $55 million out of the Medi-Cal methadone program “… is tantamount to destroying the lives of 35,000 people, as well as having them return to addiction. The impacts are significant, and go beyond the patients themselves.” Full story in LA Daily News 6 July http://www.dailynews.com/opinions/ci_15445015