Sunday, October 31, 2010

Stigmatization Inherent in Addiction Treatment:

A comment from a long-term, thoughtful provider of "substitution" treatment in Germany, and one that applies in most countries (most particularly the US): "Wherever we fight for a better treatment of addicted patients, our goal should be the same as the ones we apply to the treatment of all other chronic diseases. Three common violations of this principle:

- The considerable centralization/concentration of patients in specialized 'programs' is suboptimal and in many ways counterproductive. Part of the healing process for many involves new relationships and the ability to be integrated into all segments of society - including the medical care system..

- The attitude of many government officials, insurers and clinicians (including, perhaps most of all, addiction treatment providers) that patients should be grateful for what they get, accept the fact that there will be many associated restrictions, and an expectation that all "rules" must be followed, including abstaining from non=prescribed drugs/medicine, and that non-compliance will lead to therapeutic abandonment.

- Policies and practices that reflect mistrust towards all patients, regardless of treatment duration or individual therapeutic response. (In the US the most glaring example may be the demand of the federal government that every methadone maintenance patient, forever, submit no less than 8 urine specimens per year, and the insistence of many programs that urine be provided under the direct observation of staff)."

Court Approves Payment of Travel Expenses Associated with Methadone Maintenance Treatment (Wiesbaden, Germany):

A decision in Oct. 2010 ruled in favor of a patient whose daily travel to a methadone clinic cost approximately $US 220. Note that there has been political furor over costs born by Pennsylvania for transportation of patients to nearest methadone clinics. Summary (in German)click here.

Sunday, October 24, 2010

Buprenorphine Maintenance vs. “Taper” in Chronic Pain Patients “Who also had Opioid Addictions”

Buprenorphine maintenance vs. “taper” in chronic pain patients “who also had opioid addiction”. The stated objective of this study with NIH grant support: to test the hypothesis that “… those given steady doses of buprenorphine would be more likely to adhere to the treatment protocol than those given tapering doses.” We won’t kill the suspense by revealing the outcome.

Abstract at:

Wednesday, October 20, 2010

Mother Faces Life in Prison Due to Accidental Overdose

Mother faces life in prison because of accidental methadone death of 3 year old daughter. In this report from Reno, Nevada, the District Attorney notes that the guilty verdict "should send a strong message to every methadone user ... that if you choose to bring this liquid poison into your home, you better make damn sure it's secure... If you fail to, you may be spending the rest of your life in prison.'

It's a tragic fact that a great many children are harmed (and some die) because they accidentally ingest medication prescribed for parents or other household members. A federal study released just last month Click here for the Dawn Report) estimated over 100,000 children under age 6 were seen in the nation's EDs in 2008 because of accidental poisoning. Over a quarter involved medication for heart or lung disease, and anti-depressants and non-narcotic pain relievers (like motrin and aspirin products) accounted for another 25%. When death is the outcome, is the DA really intent on seeing the parents in these tragic cases spend "the rest of their lives in prison"? Note that narcotic pain relievers (methadone is one of many) accounted for less than 4% of cases, and methadone for treatment of dependence wasn't mentioned at all by the federal report.

Wednesday, October 13, 2010

“Nobel Prize Winner Advocates Legalization of Drugs”: (German: Oct. 10)

The bottom line:
“Mario Vargas Llosa, the Peruvian writer who on Thursday received the Nobel Prize, called for a legalization of all drugs. ‘This is the only solution,’ said the author, who is anything but a revolutionary and considers himself a liberal. ‘Traffic in drugs can’t be overcome with military means. It will persist as long as a demand for narcotics persists’.” For full report click here...(report in German)

Monday, October 11, 2010

Authoritative voice from the distant past - Sir Humphrey Rolleston:

The key conclusions of the Rolleston Committee Report (1926) in UK are worth considering (again, still) today. "[Addiction] in most well-established cases must be regarded as a manifestation of disease and not as a mere form of vicious indulgence. In other words, the drug is taken in such cases not for the purpose obtaining positive pleasure, but in order to relieve a morbid and overpowering craving. ... It is true that there is a certain group who take the drugs in the first instance for the sake of a new and pleasurable sensation ... But even among these a morbid need for the drug is acquired and the use is maintained not so much from the original motive as because of the craving created by its use."
To see the article.

Thursday, October 07, 2010

Pervasive misunderstanding of methadone maintenance:

From a fossil fuel expert comes the following: … the question is, does CNG (compressed natural gas] make sense right now or is it to petroleum based fuels what methadone is to heroine [sic!]” The author’s understanding of methadone treatment is surpassed only by his spelling ability. Sadly, his use of this analogy reflects - and also strengthens further - the bias against methadone maintenance as a treatment of unparalleled efficacy in response to a chronic, often fatal, medical condition. See the full article.

Criticism of Methadone Maintenance Continues Unabated in UK:

Prime Minister Cameron of UK has “suggested taxpayers shouldn’t be paying for drug treatments that don’t really work, especially when they involve the government dispensing even more addictive drugs.” The basis for his conclusion: the very small proportion of patients “able to kick their addictions.” Same criticism, same response: consider applying this orientation to any other chronic illness... Report accessed at:

Tuesday, October 05, 2010

“Methadone clinic a go after suit settled with Fayette County [Pennsylvania]”

The above is the headline of an article in the Tribune-Review of Oct. 1.

The company proposing to establish the clinic had “claimed in its lawsuit that the section of the [zoning] ordinance that prohibits placing a methadone clinic within 1,000 feet of residences, schools, public playgrounds, parks, hospitals or places of worship is unconstitutional and discriminatory.” The court obviously agreed. The County Commissioner “ …said the settlement included a monetary payment [but] … did not disclose the amount and could not be reached yesterday.” Nor, according to the article, could the attorney who represented the County.

While an important victory, the sad reality would seem to be that like the occasional victories of the past, this one will in no way dissuade other counties, in Pennsylvania and elsewhere in the US, from enacting similar ordinances to prevent methadone maintenance from being provided to those who need it. and perhaps understandably, few who propose to establish clinics will spend the time and money to fight.