Opiate Addiction

Terminating Patients as Disciplinary Measure:

2010-11-22T21:39:00.003-05:00

The following is an exchange that appeared recently on a international website linking colleagues involved in addiciton treatment:

Initial posting: I was wondering if any of you were aware of, or have come across any data/research/information that discusses how long any period of client exclusion from drug treatment service should last? This is in the context of disciplining a client who has transgressed while in treatment.

Response from USA (Robert Newman): forgive an unsolicited comment from far off New York: I wonder if there is any other field of medicine (let alone one with potentially life and death consequences such as opiate dependence) where patients are "excluded" as a "disciplinary" measure because of "transgressions". What "transgression" would lead a doctor to deny further treatment to a patient with tuberculosis, or severe asthma, or diabetes? Would failure on the part of a diabetic to adhere to a prescribed diet, signaled by "catching" a patient stuffing himself with pavlova and two scoops of vanilla ice cream on the side be a sufficient "transgression" to warrant disciplinary action in the form of therapeutic abandonment?

NOTE: I am very painfully aware that precisely these practices are the norm in most methadone "programs" in the USA. I've never heard of any program pursuing this policy being sanctioned by the federal or state regulatory authorities or by the agencies charged with setting and enforcing standards. But for sure that doesn't make any of this right.

Stigmatization Inherent in Addiction Treatment:

2010-10-31T22:31:00.000-04:00

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):

2010-10-31T22:29:00.002-04:00

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.

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

2010-10-24T20:06:00.002-04:00

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: http://www.ncbi.nlm.nih.gov/pubmed/20824183

Mother Faces Life in Prison Due to Accidental Overdose

2010-10-20T22:11:00.003-04:00

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.

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

2010-10-13T21:29:00.003-04:00

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)

Authoritative voice from the distant past - Sir Humphrey Rolleston:

2010-10-11T21:34:00.000-04:00

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.

Pervasive misunderstanding of methadone maintenance:

2010-10-07T20:26:00.000-04:00

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:

2010-10-07T20:20:00.001-04:00

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: http://reason.com/blog/2010/10/06/cameron-government-shouldnt-gi

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

2010-10-05T21:04:00.001-04:00

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.

url: http://www.pittsburghlive.com/x/valleyindependent/news/s_702185.html

"Acadia Healthcare Corp. Cuts Free Methadone to Uninsured"

2010-09-14T22:42:00.001-04:00

"Feetox": a Sept. 2 news report is headlined "Acadia [Healthcare Corp.] cuts free methadone to uninsured" and states some 100 patients will b affected. The Corporation's chief of clinical services is quoted as saying, "... earlier assumptions about methadone are being challenged, including the idea that it is in most cases a lifelong therapy." Let him tell that to a parent whose child has been doing well with methadone treatment and dies of an overdose after being “terminated” from the program because of inability to pay.

Even under the very best of circumstances relapse after treatment ends is the rule rather than the exception, and being poor and without insurance are not likely to improve the likelihood of favorable outcome.

There absolutely has to be a better way, and the hospital and the relevant government agencies have an obligation to find it!
For full article click here.

Alcohol and Methadone

2010-09-14T22:41:00.000-04:00

US state opioid treatment authorities were surveyed as to their policies and guidelines (Harris et al. J Subst Ab Treatm 2010, 39:58-64). Eight states “stipulate patient discharge for continued alcohol abuse and … four states mandate or recommend patient discharge for continued failure of alcohol tests.”

Two critical questions are left unanswered. First, what is the evidence that methadone given in constant daily doses (at whatever level) – i.e., medication to whose agonistic effects the patient is presumably tolerant – potentiate the sedative effects of alcohol and thus pose a risk that warrants termination of treatment? And secondly, whatever one may consider to be the danger of continued methadone maintenance in these patients, and on whatever theoretical or empirical basis, is there reason to believe that therapeutic abandonment will be associated with less risk? It would seem imperative for state authorities and methadone treatment providers to ascertain compelling answers to both questions before suggesting or demanding patients be refused methadone treatment for their opiate dependence.

Addressing the Fears Underlying NIMBY:

2010-09-14T22:40:00.000-04:00

A physician in Windsor, Ontario, has written about the problem of opioid addiction and the very positive role that methadone maintenance treatment can and does play in addressing it. He describes and corrects some of the major misconceptions that cause so many communities to fight against the establishment and continued operation of methadone treatment services.
See: "A look at the role of methadone clinics - re: Location of methadone clinics".
Click here for article

In Support of NIMBY, Let the Facts Be Damned.

2010-09-14T22:37:00.001-04:00

A headline (12 Sept) in the Windsor (Ca.) Star reads: “Meth clinic unwelcome in Somers Point”. The lead paragraph: “Fear gripped West Cedar Avenue residents recently after an 89-year-old homeowner was attacked and sexually assaulted in her home.” The next paragraph: “While a 27-year-old Vineland man, Marvin Sherwood, has been arrested and charged in connection with that particular incident, residents are fed up with problems in their neighborhood and are placing blame for recurring issues on a methadone clinic directly across from their homes.” And then the third paragraoph: “The latest incident is not believed to be related to the clinic, but the clinic’s continuing presence angers residents and is prompting city officials to explore ways to force the clinic from the neighborhood.”

The Press of Atlantic City,
Click for the full story

The Military Troops and Opiates

2010-09-09T16:00:00.003-04:00

Unfortunate that methadone is said to “top the list” of killers in contributing to military deaths, without reference to the fact that it remains the gold standard most effective treatment of dependence. Of course, the fact that until recently FDA was recommending analgesic doses that can be lethal is also not mentioned. Anyway...

Headline in Navy Times Sept 3 “Rx for death: Troop deaths soar with prescriptions for war wounded.” The article describes the dramatic increase in drug deaths in recent years, which in large measure is attributed to the widespread use of opiate analgesics (it reports that “about one in seven soldiers is currently prescribed some form of opiate”). The article does not mention the fact that Defense Dept and VA medical insurance continues to refuse payment for the gold standard treatment of opiate dependence: maintenance with methadone or buprenorphine. Get the full article by clicking here

Getting Priorities Straight - Germany

2010-09-09T16:00:00.001-04:00

"Parents of addicts call for acceptance" is the headline of a piece in the Aug 2010 issue of Drogenkurier, which bills itself as "the magazine of JES - Junkies, former junkies and those receiving substitution treatment". The head of one of the leading parent groups in Germany is quoted: "Of course we'd prefer to have our children clean. But the first goal must be to secure their survival, not their abstinence." Difficult to comprehend how anyone, regardless of therapeutic philosophy, could argue with that sentiment. The man who is quoted lost a son to "the politics of drugs" 18 years ago, a suicide by hanging after a long period of desperate and unsuccessful attempt to get help.

A Voice of Reason in the Drug Discussion:

2010-09-03T11:49:00.001-04:00

A voice of reason in the drugs discussion: Those who expect yet another diatribe against "maintenance" treatment will be pleasantly surprised by a 1 Sept. article in The Guardian headlined, "Is abstinence the best policy for addiction?". The focus is on an "award-winning advocate of an abstinence-based approach to [drug] rehab," Noreen Oliver, who "... refuses to be drawn into a dispute that, she says, is not only divisive, but misses the point." More specifically, she states that "Any limits on the prescribing of methadone would be the 'antithesis of individualized care and may actually put lives at risk'. There is no need for a fissure in drugs policy, she argues." Complete article: CLICK HERE

Providers Ignoring the Evidence - Difficult to Comprehend!

2010-08-29T18:16:00.000-04:00

An article just published in J subst Ab Treatm (2010, vol. 39, pp22-31) discusses "trends in methadone maintenance treatment ... in British Columbia, Canada. It was found that compliance with "minimally effective dose guidelines" dropped from 2001 to 2006, and that this decline was mirrored in the decline of 12-month retention data. Another "... troubling finding was the low rate of compliance to guidelines on starting doses and dose titration" despite the fact that the risk of fatal methadone overdose during the first two weeks of treatment is estimated to be 6.7 times higher than that of heroin-dependent patients not in treatment and 98 times higher than that of patients on maintenance doses of methadone". Specifically, 47% of patients were started on a daily dose greater than 40 mg.

What could the clinicians possibly be thinking, and how many lives have been lost as a result of their refusal to comply with guidelines? When patients are non-compliant they generally are threatened with a host of sanctions, including termination of care. Providers of treatment seem to be immune to sanctions of any kind. Tough to figure!

Opioid Dependence Remains an Incurable Condition

2010-08-29T18:14:00.001-04:00

This reality seems to have been overlooked by authors of a paper that appeared recently (J Psychoact Drugs, 42(2):161-175, 2010). They state: "For reasons not adequately understood, some patients find discontinuation of buprenorphine following long-term use difficult." Indeed, this understates the case! Notwithstanding such claims as "buprenorphine is less addicting," once treatment of addiction ends relapse is the rule rather than the exception, and this applies to buprenorphine no less than to treatment with methadone or various drug-free approaches.

UK Government Determined to “Push Ahead With 'Cold Turkey' Drug Policy”:

2010-08-23T20:14:00.001-04:00

According to a 23 Aug article in The Telegraph “The Coalition is working on proposals to stop the widespread prescription of methadone for heroin users and instead increase the use of ‘cold turkey’ residential treatment programmes.” It is difficult to comprehend, even for the most cynical of observers! Are "cold turkey residential" programmes effective for some? Sure: among the relatively very small percentage of the heroin addicts who seek and enter such programmes there is a small proportion who "graduate" - and of these another small proportion have achieved and will maintain abstinence. Great. But to propose this as national policy in lieu of "widespread prescription of methadone" can only be described as madness. Aside from the (huge!) question of efficacy, a massive residential option could never be implemented for a host of reasons - starting with the financial requirement. Severely curtailing methadone treatment, alas, is possible - and the costs will be high for those dependent on opiates as well as for the general community. Before anyone recognizes what many decades of experience have consistently shown - there's no "cure" for addiction - the damage will have been done, many lives lost, more illness, more incarcerations, greater demand for (and thus inevitably supply of) illicit opiates, etc.

For full story click here

Plus ça change - Ambulatory Clinics Providing Opiate Agonists:

2010-08-23T20:12:00.002-04:00

A 1971 paper by Gay and colleagues discuss the US opiate dispensing clinics operating from 1919 to 1923 (there were 44 of them!). they conclude: Today, some 47years later, the time is long overdue to ... reconsider the efficacy of outpatient treatment of addiciton. It seems cler now that (1) institutional programs have failed to establish a broad base of effective treatment, and (2) law enforcement has failed either to stop the flow of drugs or to incarceration all users. We are left with a medical and social problem of staggering dimension." (Int J Addictions 6(2):241-264, June 1971)

And where are we almost 40 years after that assessment? Russia refusing to offer opiate agonist treatment to its estimated 2-3 million addicts; long waiting oists for methadone programs in most of the country where it is legal to provide it; a UK government whose stated aim it is "to stop the widespread prescribing of methadone" and to rely instead on "the use of ‘cold turkey’ residential treatment programmes".

Retrospective Study of Substance Abuse During Pregnancy Concludes:

2010-08-20T15:12:00.000-04:00

"Despite multidisciplinary coordinated antenatal care, women with substance abuse during pregnancy are at significant risk of adverse obstetrical and perinatal outcome ..." Two comments: among the "substance abuse" cohort 66% smoked compared to 2.4% of the controls. Secondly, in the facilities studied "women are always encouraged to reduce their overall drug use (prescribed and illicit) during the pregnancy ..." And indeed this policy - which runs counter to all the evidence on treating opiate dependence with methadone during pregnancy - resulted in an average daily dose at the time of delivery of 35 mg. When providing grossly suboptimal dosages of medication it is hardly surprising that patients (and in this case their offspring) have suboptimal outcomes. It's difficult to comprehend how this practice could be rationalized by the clinicians, and perhaps even more difficult to understand how the investigators could fail to mention this detail in their report. Study: Pinto et al; Eur J ObGyn and Reproductive Biol, 150 (2010) 137-141.

This blog was sent to the senior author of the paper who asked that the following reponse be added:

We note the rather unsubstantiated comment above. There are a wide range of management options for methadone maintenance during pregnancy and for the management of illicit drugs during pregnancy, as we assume the author of the blog entry is aware. These even include withdrawal therapy. The inference that higher doses of methadone plus allowing unrestricted and unadvised illicit use of any drug during pregnancy could lead to better outcomes needs no real rebuttal, as it is self evidently wrong. Most would regard such an approach as poor care.

In our population women are stabilised on methadone if necessary and incremental dosage reduction attempted where feasible. This is a well recognised practice. Removing the risks of illicit drug use is a priority in most services.'
Pinto Shanthi (RBT) Mid Cheshire Tr

Ignoring Populations Most at Risk When Estimating Prevalence of Drug Use Disorders:

2010-08-16T10:38:00.004-04:00

The July 12 CESAR FAX (vol. 19, issue 26) of CSAT reports on a letter to editor of Am J Psych 167(4):473-475, 2010). The authors, Wilson Compton and colleagues, observe that "High rates of DSM-IV substance use disorders among inmates combined with a large inmate population mean that many persons with alcohol and drug use disorders are missed by major US national general population surveys." Hardly anything surprising in that observation - except the fact that this deeply flawed process for making estimates persists. Furthermore, surveys based on "household sampling" miss as well the very sizable population of Americans who are homeless - whose numbers in the US on any given night are estimated at "anywhere from 700,000 to 2 million" (attributed to National Law Center on Homelessness and poverty). When it comes to substance use/misuse, one has to wonder about the relevance of data based on household survey techniques, and worry about the the governmental policy decisions that are based on their findings.

To read more click here.

Methadone Possession Results in 40 Year Sentence:

2010-08-16T10:33:00.003-04:00

In a nutshell: a man is stopped for a traffic violation, consents (!) to have his car searched. Is found to have a baggie and a scale with trace amounts of amphetamine/cocaine - and also a bottle with "three wafers of methadone" said to weight 5.14 grams (yes, grams). The "wafers" were in a bottle with a label indicating they had been prescribed for an acquaintance - the named acquaintance testified she dropped the medication in defendant's car and forgot to take it with her when she left; this is same story defendant told. Appeal based (as far as I can tell) entirely on the admissability of the trace amts amphetamine/cocaine to indicate to jury defendant's "character" and likelihood that the methadone "contraband" was there knowingly and with criminal intent. Conviction and resulting sentence are for the methadone possession - not the presence of trace amounts amphetamie/cocaine. .

First: no way in hell three "wafers" in one medication bottle can weight 5.14 grams -that's 5,140 mg, or roughly 100 days' of average dose medication. Presumably they made mistake - off 1000-fold on weight.

Second, the reason the medication was in car was perfectly reasonable according to defendant and corroborated by the person to whom the medication was legitimately given.

Third, bolstering with the finding of "trace amounts" of amphetamine/cocaine the preposterous notion that - in the face of the evidence - these three wafers were "contraband" and thus merited a prison sentence seems incredible.

And finally, even if the methadone were indeed "contraband" and had been acquired illegally for some nefarious purpose, and even if one gives great significance to the finding of "trace amounts" of other substances and what it might say about the defendant, and even assuming presence of that trace amount (which resulted in no criminal charge) was/is admissable...a 40 year prison sentence??? For three "wafers" of methadone - i.e., three days' supply?

Anything anyone can do for this poor guy? It seems absolutely outrageous - and the people of Texas will be paying for the man's incarceration for many decades. What a disgraceful indictment of our "war" on drugs...(and anyone wanna bet on the defendant's race?) Suggestions.

To read this story click here

Swiss Parliamentarian Wants Drug Legalization - Everywhere:

2010-08-16T10:30:00.003-04:00

(Tages Anzeiger, Switzerland, 12 Aug):
According to Dick Marty prohibition has been a total failure and "... has lead to high prices and big profits for the drug mafia, without lessening availability." Marty, who is known for having exposed the secret CIA prison camps, was involved with the drug war as prosecutor for 15 years. He explained his new orientation by noting it was always the small-time dealers that were prosecuted - and that it's never been easier to obtain illicit drugs.

Marty wants to see the money now spent on enforcement to be used for prevention instead, and have drug use controlled in future through taxation as in the case of alcohol and tobacco. However, he acknowledged skepticism regarding his own proposal, saying legalization could only be achieved on an international basis and that this probably would not be achieved during his lifetime. On the other hand, "Mafia states" such as in Latin America could expedite reconsideration of current policies, pointing to former Mexican President Vicente Fox who, with 28,000 drug-related deaths in a single year, has called for legalization.

For full story in German click here.

Candid Comments on AA and “Rehab”

2010-08-11T22:31:00.005-04:00

Candid comments on AA and “rehab” - an article in Washington Post 8 Aug is headlined, “We're addicted to rehab. It doesn't even work”. The author, Dr. B. A. Johnson, is chairman of psychiatry and neurobehavioral sciences at the University of Virginia. Dr. Johnson concludes as follows: “When any other illness causes great suffering, our society devotes time and money and effort to studying it and to developing treatments that are empirically found to work. Alcoholism and drug addiction should be no exception. Recent advances in neuroscience have led to a greater understanding of how alcohol and other drugs affect the brain. They have, in turn, allowed medical researchers, myself included, to begin to approach alcohol dependence as we would any other disease: by searching for effective medicine.”

For the full story click here

(Dr. Johnson states by way of disclosure that he has "served as a paid consultant to pharmaceutical companies developing medications to treat alcoholism")

This is a thought-provoking (and courageous!) article. Alas, it is sobering (!) to note that even when “effective medicine” for dependence has been identified it is all too often rejected by medical professionals and the general society alike. Methadone for the maintenance treatment of opiate dependence is a case in point.

UK Prime Minister Cameron "... wants to shift the focus away from the use of methadone as a substitute drug..."

2010-08-09T22:07:00.002-04:00

UK prime minister Cameron "... wants to shift the focus away from the use of methadone as a substitute drug.... [and] press ahead with an expensive shift in treatment for drug addicts, towards residential programmes and away from the use of methadone as a substitute licensed drug." Cameron described methadone as " ... a government authorised form of opium ..." There are today an estimated 150,000 patients in England receiving methadone maintenance treatment. Full story click here (Guardian, 6 Aug)

A DEA Manager's View: Diversion a Consequence of Too Many Staff in OTPs

2010-08-09T22:06:00.001-04:00

DEA "diversion program manager" for 5 mid-western states worries about the danger of diversion of methadone posed by the "multiple employees" working in OTPs. "The more people involved, the more it increases the chance for diversion." Wow - that's a new one! Suppose it's time for FDA to demand OTPs get rid of those docs, nurses, counselors and other potential diverters that it currently requires as a sine qua non for approval to operate. The context: praising suboxone as "...a safer option to methadone." Even the manufacturers of buprenorphine couldn't have come up with this "benefit". For full story click here.

“Methadone Works. Stop the Interfering."

2010-07-27T08:52:00.001-04:00

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.”

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

2010-07-23T15:15:00.002-04:00

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.

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

2010-07-14T19:32:00.007-04:00

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?

A Clear, Compelling Argument in Favor of Establishing Methadone Clinics

2010-07-13T23:08:00.002-04:00

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

2010-07-13T23:05:00.001-04:00

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.

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

2010-07-11T09:13:00.001-04:00

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."

Wishful Thinking Trumps Incontrovertible Evidence:

2010-07-10T20:31:00.003-04:00

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"

2010-07-10T20:28:00.003-04:00

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.

DISASTROUS CONSEQUENCES PREDICTED IF CAL. ENDS METHADONE FUNDING:

2010-07-09T20:24:00.000-04:00

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

Legislative attempt to usurp medical authority - Pennsylvania:

2010-06-29T23:14:00.001-04:00

In a series of half dozen proposed bills, the PA. Senate is seeking to assume the role of physicians. For example: Sen. Bill 1293 would estaboish a "methadone death and incident review team" - what a label for those who desperately need help to contemplate! The team (mainly non-physicians would be charged with "determining the role that methadone played in each death ..." Isn't that the traditional responsibility of the trained/certified medical examiner? Sen. Bill 1294 would establish "eligibility criteria" (ever hear of eligibility" for a medical treatment ordered by medical doctors?), to include: "inability [of applicant] to stay drug free after at least two substantial attempts at appropriate treatment in drug-free programs." Like telling severely depressed and suicidal patients they must first have two unsuccessful suicide attempts before being "eligible" for anti-depressant medication. And the same bill demands a specific plan to achieve abstinence," imposes urine testing every two weeks forever, and prohibits patients from driving during the first two weeks treatment with methadone (but only if the methadone is given for treatment of dependence - patients getting methadone for pain would be under no constraint whatever).

Do these proposed bills reflect appalling ignorance, or merely self-serving demagoguery intended to gain votes in the next election? And which of these explanations would be more shameful for these elected officials?

ONDCP (office of national drug control) DIRECTOR: Over Half of Drug Treatment Program Patients "Are There Because of a Law Enforcement Intervention."

2010-06-25T07:43:00.002-04:00

(Statement of Office of the Director, ONDCP (office of national drug control policy), May 18, 2010) What a sad reflection on our country's policies, priorities and practices! In NYC at the height of the tuberculosis epidemic a few years ago, roughly 3% of all patients were under legal mandate to receive directly observed treatment (source: email correspondence with NYC Health Dept Bureau of Tuberculosis).

What's being done to attract voluntary admission of those who need care? When's the last time there was a government public service message (federal, state or city) advising drug dependent individuals that treatment was available promptly, and urging them to apply? And the illogic of CJS-mandated care: judges and prosecutors determine that a defendant has a medical problem needing treatment - and generally dictate what that treatment shall (and shall not!!) be. And when the treatment is less than optimally effective - i.e., when the defendant-patient shows continuing evidence of the condition being treated (drug dependence!) - that defendant-patient faces jail, while the treatment providers merely fill the newly vacated "slot" with another court referred individual.

What a system!

Strong Support for Methadone Maintenance - from "LA's Top Law Officials"

2010-06-19T22:19:00.002-04:00

At a news conference 16 June LA Police Chief Beck and Sheriff Baca "decried the proposal ... to eliminate state funding for treating heroin addicts [with methadone]". Those against methadone treatment, as well as those who don't care one way or the other as long as it's provided in someone else's backyard, take note! What do top cops know that you might not? Full article: http://www.mercurynews.com/breaking-news/ci_15311225?nclick_check=1

Does Stigma Play a Role as a Barrier to Methadone in Treating Pain?

2010-06-14T20:39:00.002-04:00

That is the question posed by a recent article in Pain Physician (13:289-293, 2010), and not surprisingly, the answer is an emphatic "yes"! The authors note that "the most socially stigmatized patients are those treated with chronic methadone." While it "is an excellent drug" for pain management, "... the lack of depth of knowledge by pain care providers about the benefits of the medication and societal stigma still play a role as a barrier to treatment." Sadly, of course, precisely the same can be said about methadone in the care of opiate dependence - even after 45 years of consistent evidence of efficacy.

NIMBY at a New High (or Rather, Low!)

2010-06-14T20:35:00.002-04:00

A June 10 Riverdale (NY) Press article reported that for some time now 45 residents of a health care facility for elderly and disabled in the Bronx have been obliged to travel by special bus, most on a daily basis, to obtain their methadone from a maintenance facility in the neighboring town of Yonkers. It has obviously been a great inconvenience to the patients - as well as costly and disruptive (an estimated taxpayer cost of $150,000 yearly, and "loading and unloading the patients, some of whom are in wheelchairs, on the buses backs up traffic..."). So . . .the facility has proposed operating a methadone program on-site under terms that would involve a maximum of four non-facility residents receiving methadone there.

The reaction: outrage of the local residents who "just say no to methadone." There is worry over "what kind of people" would be attracted to the proposed program . . .[and] the possibility of a different breed [sic!] coming around here... "

Even with stories about NIMBY appearing from cities and towns around the nation, this one really is beyond the pale. How terribly sad!

Article can be accessed by clicking here.

Views on Proposed Limitation of Addiciton Treatment Duration

2010-06-12T10:59:00.002-04:00

A blog from UK on 10 June endorsed the view that it's dead wrong for government to impose limits on the duration of methadone treatment for opiate dependence. The blog is to be found at http://northerndoctor.com/2010/06/10/nutt-on-methadone-and-the-tories/. The comment below was submitted in response to this posting.

Dr. Lawson - and Prof. Nutt - are absolutely correct. It would be unprecedented and irrational to impose a time limit on medical treatment for a condition that - to date - is incurable but eminently treatable. It would be just as absurd to demand that alcoholics be urged or somehow forbidden to attend more than a given number of AA meetings. Or that diabetics be given six weeks to adapt to a rigid regimen of diet, exercise, etc. - and then be cut off from further insulin prescriptions.

We're talking about a treatment that very literally can spell the difference between life and death for those who need it. We're also talking of a treatment that yields enormous benefits to the community at large. Imposing arbitrary limits to override the judgment of doctors and needs of patients would be a catastrophe.

More Criticism of the Cost of UK Jail Methadone Treatment.

2010-06-03T15:26:00.000-04:00

More press coverage of criticism of the cost of UK jail methadone treatment. Once again, totally missing the underlying source of the problem: the continuing incarceration of so many drug users and the reality that drug dependence and its consequences do not end with incarceration or upon release.

http://www.dailyexpress.co.uk/posts/view/178372/Jails-44m-scandal-of-junkies

Protecting Patient Confidentiality:

2010-05-20T10:36:00.001-04:00

Protecting patient confidentiality - in the interest of the public as well. A May 5th editorial entitled "Patient safety first, doctor" in the Southland Times (New Zealand) commends a physician for reporting one of his methadone patients, who worked in a nursing home, to her employer. What the editors fail to understand is that inability to guarantee strict adherence to privacy will be a powerful disincentive for those who want and need help for their dependency - and particularly those who are employed in "sensitive" settings. Discouraging those needing help from getting it poses an enormous threat to the entire community.

Quotable Quote, and Just As Relevant 13 years Later:

2010-05-13T12:01:00.000-04:00

"Although recent scientific research supports our understanding of opioid dependence as a chronic disease, methadone maintenance treatment has not yet gained universal acceptance as a normal therapy for a bonafide medical condition ... [and] its effectiveness in improving quality of life is limited by the continuing stigmatization and social disengagement of patients." (emphasis in original, Can Med Assoc J 1997; 157:395-398)

Dramatic Efficacy of Methadone Treatment in Maine:

2010-05-11T07:34:00.002-04:00

a state of Maine study of more than 1000 patients has found an “astronomical” drop in use of of pre-treatment drug of choice, with “broad impact not only on patients, but on their families as well.” Story appeared 7 May and can be found by clicking here,

Proposed Cap on Duration Methadone Treatment in Wisconsin

2010-05-03T14:59:00.001-04:00

It is reported (Wisconsin State Journal May 1) that Deborah Powers, who regulates methadone clinics for the state of Wisconsin, has suggested “limits on how long people can be in [methadone] treatment” as a response to substantially increased need and demand for care. This makes as much sense as a demand that those lucky enough to cram into one of the Titanic lifeboats be required to give up their places every few minutes to unfortunate survivors still in the water. Or to use a medical analogy: to proclaim a pre-natal clinic is “at capacity” and thus limiting each pregnant woman’s care to no more than three months.

Opiate dependence is a chronic, notoriously relapsing, potentially fatal medical condition. Many different treatment approaches exist and all deserve support. None, however - whether long-term or short-term, with medication or without, in-patient or ambulatory – has ever been able to make a credible claim that it is a cure. As for methadone maintenance in particular, no treatment has been shown to be more effective in attracting and retaining patients and in helping them resume healthy, productive lives. Furthermore, experience throughout the world for more than four decades has demonstrated that it can be expanded rapidly and at a modest cost, with enormous benefits not only to patients but to the community as a whole.

Wisconsin, and every other state in the nation, should focus on providing prompt care for all opiate dependent people who want and need it – and with tragic frequency die without it. No public officials should be more committed to this goal than those who, like Ms. Powers, are given the authority and responsibility to “regulate” treatment services.

Advocating Heroin Treatment by Villifying Methadone

2010-04-29T11:14:00.001-04:00

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:

2010-04-28T07:07:00.001-04:00

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?

2010-04-28T07:05:00.000-04:00

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"

2010-04-26T09:59:00.001-04:00

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:

2010-04-26T09:57:00.000-04:00

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

2010-04-23T19:49:00.000-04:00

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:

2010-04-12T12:07:00.001-04:00

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.

REJECTING METHADONE IN SCOTLAND:

2010-03-25T09:19:00.000-04:00

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"

2010-03-24T21:16:00.000-04:00

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:

2010-03-22T10:09:00.000-04:00

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:

2010-03-18T09:49:00.001-04:00

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:

2010-03-17T09:47:00.000-04:00

“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?

2010-03-11T13:43:00.000-05:00

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:

2010-03-03T19:23:00.000-05:00

"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"

2010-03-02T23:43:00.001-05:00

"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:

2010-03-02T23:41:00.001-05:00

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

Crisis and Complacency . . .

2010-02-25T10:01:00.001-05:00

A 22 Feb news report from Scotland is headlined “Waiting list crisis for drug treatments” describes the desperation to obtain methadone treatment so great that some are committing crimes in order to be incarcerated and have easier access to methadone behind bars. The immediate cause of the desperation is attributed to fear of anthrax, which has claimed nine lives recently as a result of contaminated heroin.

"A spokeswoman for the Scottish Government said NHS Scotland targets were in place to ensure that by March 2013, 90% of people who need treatment for their drug problem receive it within three weeks." Three years to be able to offer admission within three weeks? Difficult to comprehend!

For full story click here

“Walking proof that methadone ‘is failing’ after 20 years on treatment”

2010-02-25T10:00:00.001-05:00

A 12 Feb article in News.Scotsman was headlined: “Walking proof that methadone ‘is failing’ after 20 years on treatment”. the article reports the latest harsh criticism of methadone maintenance by "one of Scotland's leading experts on drugs," Prof. McKeganey. The man referred to in the headline has been dependent on opiates since a teenager, and in Scotland – even more than most countries of the world – untreated heroin use with tragic frequency ends in death. It is difficult to imagine anyone positing that the methadone prescribed in this case did not contribute in a major way to survival. And if survival of a frequently fatal condition is not proof positive of a treatment’s efficacy, then what is?

GUEST VIEW: Clinics' 'Red Tape' Not the Problem

2010-02-22T09:27:00.000-05:00

The following comment was prompted in response to “GUEST VIEW: Clinics' 'red tape' not the problem” – by Delia Brennan, 20 Feb 2010, SouthCoastToday.com

Regarding the stated practice: "[Methadone maintenance patients] will be disciplined through a series of contracts, but not discharged. If, for instance, a client has multiple positive drug screens, and misses counseling and groups regularly, then perhaps a discharge hearing will occur." Can one imagine anything remotely similar for clinics treating diabetics, in response to blood sugar levels remaining out of control, patients failing to keep appointments with nutritionist, patients seen eating a Twinkie outside the clinic . . . .? The fact that a patient continues to come to the methadone clinic clearly indicates a need and desire for help. Discharge can mean death.

Clinics with such practices would do well to consider AA and its approach to alcoholics... AA NEVER denies access to those who "slip," who are inconsistent with meeting attendance, etc.

Deterrents to Methadone Treatment Enrollment:

2010-02-16T09:53:00.000-05:00

An important study addresses the question: "Why don't out-of-treatment individuals enter methadone treatment" (Int J Drug Policy 2010; 21(1):36-42). The major reasons given by a small (n=26) cohort of subjects in Baltimore were: waiting lists, financial barriers and requirement to carry photo ID. Another reason given: unwillingness to commit to long-term maintenance, "but would have accepted shorter time-limited methadone treatment". Some of these barriers could, presumably, be removed promptly and at no cost: e.g., accepting driver's licenses or other ID in lieu of "program" ID, and publicizing availability of short-term maintenance or even shorter-term detoxification. We can only hope these research findings will be translated into practice.

Try Substituting Methadone for Aspirin ...

2010-02-14T09:51:00.000-05:00

A recent study published in Substance Withdrawal Syndrome (Eds. Rees and Woodhouse, 2009, pp. 93-112) concluded as follows: "This systematic overview suggests that aspirin withdrawal has ominous prognostic implication in subjects with or at moderate-to-high risk for coronary artery disease. Such information should be borne in mind when advising patients under such treatment, and aspirin discontinuation should be advocated only when the risk of ... adverse effects clearly overwhelms that of cardiovascular atherothrombotic events."

Change a few words and this admonition applies - in spades! - to opiate maintenance treatment of dependence. "Advising patients" of the "ominous prognostic implication" of discontinuing maintenance treatment should be considered absolutely essential before any "tapering" begins. Indeed, ethical medical practice (and logic) would seem to demand that a written informed consent be obtained before beginning withdrawal. Clearly, the risk associated with discontinuing maintenance treatment is vastly greater than that associated with its commencement.

Subutex v. Suboxone Abuse Liability:

2010-02-11T09:12:00.000-05:00

A study by investigators at Columbia University that seems to have received inadequate attention appeared in 2002. Bottom line: “... results demonstrate that both [Subutex and Suboxone] served as re-inforcers … and that they may have similar [intravenous] abuse liability in recently detoxified individuals who abuse heroin.” (Comer and Collins. 2002. J Pharmac Exp Therap 303(2):695-703)

We’re unaware of any data in the USA regarding the actual parenteral misuse of either medication (or, for that matter, misuse by oral consumption), but these findings would suggest that the primary consideration in deciding whether to use Subutex or Suboxone should be price.

Memorable and Still Relevant Quotes:

2010-02-08T14:50:00.001-05:00

"The drug treatment field is unusually contentious. the gold standard pharmacological therapy for heroin dependence, methadone maintenance treatment, is attacked relentlessly despite compelling evidence of benefit and safety."
Alex Wodak, 2005
Expert Opinion Drug Saf. 4(5):815-819

"Methadone maintenance is a treatment method that does restore a substantial portion of those treated to socially productive activities. Thus, as community groups fight the establishment of new clinics ... the necessity is to compare the results with what else is available rather than with generally unrealistic expectations."
Oct 1, 1975
NY Times Editorial

Yes, Semantics Clearly Do Seem to Make a Difference

2010-02-04T10:22:00.000-05:00

A study that as yet is available on-line only assessed the impact of two "commonly used terms" applied to individuals with substance-related conditions. The conclusion: "Even among highly trained mental health professionals, exposure to these two commonly used terms ["a substance abuser" and "having a substance use disorder"] evokes systematically different judgments. The commonly used 'substance abuser' term may perpetuate stigmatizing attitudes." Kelly JF and Westerhoff CM. Int J Drug Pol (2009), doi:10.1016/j.drugpo.2009.10.010

"Methadone Maintenance: It Ain't What it Used to Be":

2010-02-04T10:21:00.001-05:00

That was the title of a presentation made in April 1974 (and published 2 years later), lamenting the overwhelming focus on providing the lowest dose of methadone and discontinuing it altogether as soon as possible (or sooner!). Alas, the preoccupation of politicians, the public at large and - tragically - even most providers is at least as great today as it was 36 years ago, in America and throughout the world. Source: Newman RG, Br J Addict 1976, 71:183-186.

In Defense of UK Prison Drug Policies/Practices

2010-02-03T10:18:00.000-05:00

Responding to harsh criticism that methadone is used to "control" prisoners and that "treatment" is denied, the chief executive of the National Treatment Agency for Substance Misuse notes that "... the voices of users are heard - a key driver for making methadone more widely available was the class action taken by almost 200 ex-prisoners a few years ago [who ...said their human rights were breached because they could not access the same treatment in prison that they had outside." The Chief Exec went on to note: "Good clinical practice will either continue the treatment the prisoner had before arrest, or prepare them for the treatment they will receive on the outside. Otherwise individuals would be vulnerable to suicide while they were in custody, and to overdose on release." For the Full story click here

The Guardian ( London ) 3 Feb 2010

Catholicism and Common Sense:

2010-02-01T10:15:00.000-05:00

From Albany, NY, report of a decision by Catholic Charities to provide sterile needles and syringes to all IV drug users. The following quote seems to say it all: "I understand there will be questions, but this is common sense," said Sister Maureen Joyce, CEO of Catholic Charities. "I strongly believe in this. It will save lives." From Albany Times-Union, 29 Jan.

NO HEROIN DEATHS IN 2009 (Lebanon County, PA)

2010-01-25T11:19:00.000-05:00

"First time in recent memory there were no heroin deaths" in Lebanon County, Pa. in 2009. The County Coroner "... credited the decline to the methadone clinic in North Cornwall Township which the county opened in 2006. 'We are giving the people the option and opportunity to quit heroin, and we are very busy at the methadone clinic,' he said. There is no other reason I could give as an explanation.'" Lebanon Daily News 21 Jan.; http://www.ldnews.com/news/ci_14240574

Fredericton (New Brunswick, Canada) Physicians Revoke All Methadone "Carries" (take-home doses) :

2010-01-21T09:33:00.003-05:00

LATEST NEWS (Jan 21, 2010):
Methadone providers rescind ban on take-home doses: "the methadone program will remain unchanged." A fortunate turn of events indeed! Full story in Telegraph-Journal - http://telegraphjournal.canadaeast.com/rss/article/927747

ORIGINAL STORY: Physicians revoke all methadone "carries" (take-home doses) in response to the death of a 23-month old who ingested methadone. News stories to date make no mention of the possible source of the methadone. The physicians' decision means 478 patients who have been eligible for take-home medication will be obliged to take their medication every day in a pharmacy.

Almost 40 years ago Boston City Hospital abruptly terminated take-home privileges of all patients enrolled in its methadone maintenance program. In short order one-third of patients had dropped out and presumably returned to street use of heroin, and of those remaining, one-half lost jobs they had held before the new policy came into force. If the new, ill-advised policy is not rescinded, similar consequences can be predicted in Fredericton, and the costs will be borne by the entire community.

Individualization is generally viewed as imperative in the medical management of any illness. It is difficult to comprehend this across-the-board policy change. Whatever turns out to be the source of the medication in this case, there is absolutely no basis for concluding that every person receiving methadone for dependence must be considered careless, irresponsible, untrustworthy, or worse. That is stereotyping, and stigmatization at its very worst and it comes from the providers of methadone treatment. It is appalling!

Original story click here

Methadone providers rescind ban on take-home doses: "the methadone program will remain unchanged." A fortunate turn of events indeed! Full storyin Telegrpah-Journal 21 Jan - http://telegraphjournal.canadaeast.com/rss/article/927747

“Deepak Chopra Lends Name to Squamish Addiction Centre” (Canada):

2010-01-14T09:50:00.001-05:00

As the saying goes, for those who like that sort of thing – and can afford it - that’s the sort of thing they’d like. According to the article the cost of 4-6 weeks stay is $18-26,000. One of the principals of the Centre is quoted as saying, “If we position this program authentically, we will not attract those people who are looking for a quick fix and substitute methadone for heroin." Clearly, it is easier to speak of “authentic positioning” (whatever that might mean or imply) than of price, affordability and evidence of efficacy. Incidentally, the title is a tiny bit misleading in its reference to "lend its name"; rather, "Chopra Centre is licensing its brand and curriculum to Paradise Valley in return for a percentage of revenues generated."

Full article, attributed to CanWest News Service, Jan. 9 click here

Liberal Decriminalization Law Now in Effect in Czech Republic

2010-01-13T09:48:00.002-05:00

According to an article published 7 Jan 10, "Since 1 Jan the Czech drug laws have become among the most liberal in all Europe." Some specifics: no penalty for possession of up to 15 grams marijuana, five LSD tablets, one gram of cocaine and one and a half grams of heroin - said to be three times more than allowed in The Netherlands.

Article (in German):
http://www.tagesschau.de/ausland/tschechien186.html

German Hemp Association Sounds the Alarm

2010-01-11T09:46:00.001-05:00

German Hemp Association sounds the alarm over "massively diluted" marijuana. "Millions of Germans are smoking artificial substances, sugar and stuff that's even worse." (Jan 12).

Full report (in German)
http://hanfverband.de/aktuell/meldung_1263333611.html

Swiss drug policies: Change (and lack of change!) over the years:

2010-01-07T13:57:00.002-05:00

An article appeared in the Tages-Anzeiger (Zurich) 31 Dec 09. It describes how Switzerland became the first country in the world - 15 years ago - to introduce heroin for the treatment of opiate addiction, and highlights events culminating in a law that took effect Jan 1 firmly and formally establishing the legality of what has become longstanding practice (there are now 22 heroin-assisted facilities in the country). Particularly fascinating is the fact that for years there had been strong and very widespread support for legalizing heroin - assisted treatment (in a Nov. 2008 referendum 68% of Swiss voters approved) - but passage was repeatedly blocked because the proposed law also had a provision calling for decriminalization of marijuana possession. The article states that parliamentary debate was resumed and the bill quite promptly passed after all reference to cannabis had been removed.

Another interesting (and, to some, no doubt very distressing!)note: the report ends by stating, "Pursuant to the [new] law the goal of [Swiss] drug strategies is abstinence." Go figure!

Article can be accessed in German: by clicking here

Liberal decriminalization law now in effect in Czech Republic:

2010-01-07T13:56:00.000-05:00

According to an article published 7 Jan 10, "Since 1 Jan the Czech drug laws have become among the most liberal in all Europe." Some specifics: no penalty for possession of up to 15 grams marijuana, five LSD tablets, one gram of cocaine and one and a half grams of heroin - said to be three times more than allowed in The Netherlands.

Article (in German): http://www.tagesschau.de/ausland/tschechien186.html

CHINA: ADVANCES IN EXPANSION OF TREATMENT, BUT PERVASIVE HUMAN RIGHTS VIOLATIONS

2010-01-07T13:49:00.001-05:00

Notwithstanding the recent advances made by China with regard to large-scale rapid expansion of methadone treatment and needle exchange services, persistent and pervasive human rights violations targeting drug users are reported. An article in the Seattle Post-Intelligencer 6 Jan is headlined " Group slams China's drug user detention centers." It summarizes a Human Rights Watch report (http://www.hrw.org/node/87467) that describes a system in which "addicts are denied proper treatment in China's state-run rehabilitation centers and are sometimes beaten and forced to work without pay." An idea of just how horrendous the system is can be gleaned from a quote attributed to one observer: "Many drug users, when caught by police, would rather admit that they are trafficking drugs than using drugs because at least there is some kind of legal procedure involved in a drug trafficking charge."

There can never be enough research (or so it seems):

2010-01-06T23:52:00.000-05:00

Yet another paper has been published of a study whose findings confirm what has been known for decades: "High doses of methadone greater than 100 mg daily may provide a better outcome for illicit opiate use among some patients who would not respond to moderate doses." To reach this conclusion seven authors collaborated in a study involving a total of 59 (!) patients in treatment at the Atlanta (Ga.) VA Hospital.

Source: J Addictive Dis 28:399-405, 2009

The Winds of Change (US):

2009-12-28T10:44:00.000-05:00

“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”

2009-12-28T10:42:00.001-05:00

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

2009-12-28T10:41:00.002-05:00

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

2009-12-28T10:40:00.000-05:00

“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:

2009-12-23T22:58:00.000-05:00

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":

2009-12-23T22:53:00.001-05:00

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:

2009-12-23T22:49:00.001-05:00

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

2009-12-23T22:42:00.002-05:00

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:

2009-12-14T12:24:00.000-05:00

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?

2009-12-11T14:35:00.001-05:00

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"

2009-12-11T14:33:00.001-05:00

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):

2009-12-10T14:56:00.001-05:00

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

2009-12-03T11:20:00.002-05:00

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:

2009-12-03T11:18:00.001-05:00

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:

2009-12-02T10:00:00.000-05:00

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 . . .

"NOT ENOUGH HELP FOR THOSE BATTLING DRUG ADDICTION"

2009-11-19T11:35:00.003-05:00

That's the heading of a reader letter to the Kennebec Journal Morning Sentinel (Nov 15). The writer mentions, as an illustration of the inadequacy of services, a three-month wait for admission to the methadone clinic in Waterville, Me., and notes that lack of prompt access to care also is a catastrophe for the community that bears the crime and fear that go along with untreated dependence.

But it need not be this way. There is no reason why applicants for methadone treatment, in particular, must be forced to remain on a waiting list for 3 months - as is said to be the case in Waterville.

Earlier this year, just a few hundred miles to the northeast, in St. John, NB, rapid expansion of methadone treatment was accomplished almost overnight and waiting lists eliminated in a matter of a few months. (SEE POSTING). All that's required is commitment.