Dr. Newman, Director of the International Center of Advancement of Addiction Treatment, provides an overview of the challenges facing opiate addiction treatment to an audience in India. The podcast is accompanied by a PDF.

Our Australian colleague, Dr. Alex Wodak, an internationally recognized expert in the field of addiction treatment comments: "This is an important milestone. It took 11 months to go through the elaborate WHO process. But now that process has been completed and this is the outcome. Had the decision gone the other way, regulation would have increased and availability decreased. This was a win for public health, HIV prevention and science." for details

This is the headline on Feb 20, 2007 in the Frankfurter Allgemeine Zeitung. Heroin availability had been set to terminate on June 30. Regarding the outcome of the "heroin trial," it's noted that for the society as a whole the benefits have been modest, but for the participating patients very great!

March et al. J Subst Ab Treatm 31 (2006) 203- 211 From Granada (Spain) comes a report of favorable results with heroin prescribing PLUS methadone compared to methadone prescribing alone. AS IN OTHER STUDIES (Switzerland, Germany, Canada), the subjects were individuals for whom "previous available treatments have failed"; at least two prior unsuccessful methadone maintenance enrollments were prerequisite for participation. Of 176 individuals "assessed for eligibility" 114 were excluded for one reason or another. The ultimate conclusion: "The prescription of intravenous diacetylmorphine-based opiates ... does provide a viable alternative treatment that should be made available to patients who, throughout their addiction, have not improved with other approaches."

To learn more about the journal and download the current edition, go to: http://atfor um.com/SiteRoot/pages/addiction_resources/addictio n_resources.shtml#Europad

The following (unedited) appeal was received by a colleague in Germany. Does anyone have any suggestions as to how to respond? It is difficult to comprehend a government's abandonment of those who want and need help - and who we know can be helped with effective medical care. Of course, Norway is not unique in this respect . . . "Hello We are in desperate need for a doctor who can help us with Subutex treatment, do you know about doctors in germany who we can travel to and get subutex from, we used to go to denmark every month for the last 2 years ,and got medicin for 1 month , but their are closed now. And in Norway we dont get the medicin legally. We gonna pay all expencivs, medicin,doctor appointment etc. all help are wanted, best regards"

A study by Correia et al (Psychopharmacology (2006) 189:297-306) assessed "effects associated with double-blind omission of buprenorphine/naloxone over a 98-hour period." Results are said to "suggest that under chronic daily dosing conditions the omission of several days of buprenorphine/naloxone will result in minimal subjective discomfort . . . [T]hey also suggest that patients may skip daily doses (or even several days of dosing) with minimal discomfort." These findings raise concern over the potential for diversion of medication by patients (motivated by venality or friendship/compassion). Whether such diversion and associated misuse/abuse are cause for reasonable concern is open to debate, as is true of diversion of methadone - particularly in circumstances of demand that vastly outstrips legitimate availability. The political consequences, however, could be devastating - and already there are worrisome threats to the continued largely unfettered access to buprenorphine to many tens of thousands of patients in France.

(Arch Int Med, 167:166-173) There's the seemingly encouraging finding that "the mean age of injection drug users has increased substantially" over the years, but it's tough to put too much credence in any data on illicit drug use that come from a survey that EXCLUDES anyone who is institutionalized - a term that applies to over 2.2 million Americans who are behind bars, a great many of whom are there for drug offenses.

Three Pennsylvania County Prisons are setting up methadone maintenance programs for inmates who were in treatment before they were incarcerated. Full news story

This heroin trial is in Belgium, in Liege to be precise. Hopefully the growing evidence of efficacy of heroin treatment will lead countries henceforth to accept it without having to repeat the studies yet again. We are indebted to our colleagues at CRAN for first bringing this to our attention.
FOR FULL STORY (in French)