| HUNGARY: Methadone Treatment - A Long Way to Go |
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The journal Psychiatric Services (June 2006) has an
article by Gerevich et al on “degrees of sociocultural
resistance” to methadone. It concludes with the
hope that the country’s admission to the European
Union will “have a favorable influence on the
governmental resistance to opioid substitution
treatment and to the professional legitimization of
methadone maintenance . . . “ Clearly there’s a long
way to go. The article notes that in 2005 roughly 400
health care organizations were treating drug users,
but 88% do not deal with methadone at all and 8%
use it only for detoxification. A mere 4% of all
addiction treatment providers in Hungary offer
methadone maintenance.
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| ISRAEL: Retention in Methadone Maintenance (MM) 74.4% After One Year |
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A report of 10 years of experience with MM in Israel
indicates very high retention, cessation of heroin use
by 66% over the course of the first 12 months, and a
net decrease in cocaine use of over 60%. (Peles et
al. Drug and Alc Dep 82(2006) 211-217)
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| IRAN: Methadone Manufacturing to Launch |
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The Islamic Republic News Agency (July 29) reports
that methadone production is about to be launched
by two private pharmaceutical companies. Noting
that "...treatment of addiction by methadone is a
globally-accepted and effective method," the deputy
health minister for food and drugs stated that the
country needs "four to five times more than the
amount currently imported."
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| USA: NIDA- Drug Addiction “a Brain Disease" |
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Medicines such as methadone and buprenorphine,
shown to help normalize brain functions and should be
made available”(July, 2006). These key principles
are the underpinnings of what has been described
(Seattle Times, July 25), as NIDA’s “first report aimed
at improving how the criminal justice system deals
with drug addicts.”
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| USA:"Methadone Clinic Wins" |
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The above is the headline of Baltimore Sun news
story that ran Aug 9th. In this field,
and specifically when it comes to NIMBY, headlines
don't get much better than that!
After a four year legal battle in federal court against
the government of Baltimore County, MD (different
than Baltimore City), a Fourth Circuit U.S. District
Court and jury found that the County discriminated
against A Helping Hand methadone program and its
patients when it made a zoning ordinance that would
have restricted the (already licensed) methadone
clinic from operating.
The County was found to have violated the
Americans With Disabilities Act (ADA) and the Due
Process Clause of the 14th Amendment of the U.S.
Constitution when it enacted and tried to enforce a
law prohibiting the methadone clinic from operating
within 750 feet of a residence.
The owner of the clinic, Joel Prell, and three patients
brought the lawsuit to federal court and testified.
ICAAT's director, Dr. Robert Newman, was their
expert witness. They were represented by a
Washington DC law firm, Steptoe and Johnson, and
the American Civil Liberties Union joined the case; the
attorneys as well as Dr. Newman acted pro bono.
ICAAT congratulates Mr. Prell and the patients who
showed great strength in standing up for the right to
get methadone maintenance treatment where it was
needed, and all those who helped them win this legal
victory.
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| CHINA, HONG KONG, INDONESIA, IRAN, LITHUANIA, POLAND: Substitution Treatment Update |
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Summary (in German) was prepared by Ingo Michels
ingoiljamichels@gmails.com
CHINA (Prof. Q. Lu): first 8 MMT clinics
opened at the beginning 0f 2004; end of March 2006
there were about 128 and the goal is 300 by the end
of the year. “The results of methadone treatment are
compelling.” Health and quality of life both improved
markedly; depression decreased; HIV and hepatitis
rates stabilized. Risky sexual behaviour increased, but
criminality essentially stopped and the employment
rate rose from 25% to 31% [not clear what time
period]. Three-month retention rate was 97% [!!]
and at the end of 6 months 85%. Average methadone
dosage after 6 months was 49mg/day.
HONG KONG (Prof. Char-Nie C
Hen): 30 year history of substitution treatment,
whose objective is to ensure an easily accessible,
legal, medically safe alternative to illegal opiate use,
to maintain contact with patients, reduce anti-social
and criminal activity and assist patients to lead
normal and productive lives. Patient visits to HK
methadone clinics have averaged about 2.5 million
per year for the past 15 years. Approximately 2/3 of
the estimated 14,000 addicts are in treatment. Harm
reduction outcomes improved markedly when
methadone dosages were raised. HIV rates among
addicts in HK have consistently been extremely low.
INDONESIA (Dr. Mardiati): Estimated
total heroin addicted population 120,000 to 196,000.
44% of the new HIV positive cases were drug users;
70% of heroin consumers are under age 25. First
methadone clinics opened in Jakarta and Bali in Jan-
Feb 2003; Training has been provided to 312
physicians – mostly in private practice. Only 2% of
the costs of methadone treatment are paid by the
Government. Today there are 330 patients in Jakarta
(300 in one clinic), and 330 in Bali; about 50
elsewhere in the country [NOTE estimated opiate
dependent population, above]. 60% of patients are
HIV positive.
IRAN (Dr. Mokri): Methadone is generally in
tablet form and there is hardly any psychosocial
support; there’s a general sense that methadone
alone is sufficient. Naltrexone is also available, but
retention is very low and relapse after treatment
almost 100%. It’s the experience of the University
clinic in Tehran that methadone is equally effective in
treating heroin-dependent as opium-dependent
patients. Mokri advocates multi-modal treatment
availability – including buprenorphine, which is
provided at the University clinic and has retention of
about 65%; buprenorphine patients come from better
social settings and pay their own way – about $US
15 per month. Mokri also advocates maximum
utilization of private medical care providers.
LITHUANIA (Dr. Subata): HIV prevalence per
100,000 people is 28.1 in Lithuania, 112.9 in Latvia
and 272.2 in Estonia and 470.0 in the Kaliningrad
district. In January 2006 in Lithuania there were 436
patients being treated in 4 specialty centers and 8
public health facilities; by comparison there’s only
one center in Latvia providing substitution treatment
and 2 in Estonia [Russia outlaws substitution
medications]. The methadone in these countries
comes from Denmark and costs about 1 Euro ($US
1.28) per 100 mg.
POLAND (Drs. Habrat and Moskalewicz):
estimated addicts 35,000-40,000, of whom 5-7,000
come into contact with the medical care system each
year. There’s high mortality. “Despite positive
substitution treatment outcomes there are only about
700 clients being treated in 12 facilities.” Admission
criteria are high: at least 18 years old, 3 failed drug-
free treatments or medical indications (e.g.,
HIV/AIDS). Psychosocial support is offered and group
meetings are mandatory.
COMMENTS BY DR. ALEX WODAK (Australia):
two fundamental aspects of a response to the
problem/threat of HIV-AIDS are critical – it has to be
comprehensive and it has to be very rapid! To
achieve this total involvement of private as well as
public health care providers is key.
SUMMARY BY VLADIMIR POZNYAK OF WHO:
short-term plans for methadone treatment that
ensure care for only a few months without
sustainability are unethical. Continued availability
must be guaranteed. Disaster-planning is also
imperative – e.g., in areas subject to frequent natural
catastrophes. Minimal quality standards should be
adhered to. And finally, there must be better
coordination between security and health
authorities: “they must speak the same
language.”
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HEROIN TRIALS & SUPERVISED INJECTION SITES:
- Review of Available Evidence
- Fostering Knowledge, but Also Misunderstanding
- Vancouver’s Supervised Injection Site at at Risk
- Five Years with Medically Supervised Injection in Australia |
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HEROIN “TRIALS” Review of Available
Evidence- First an editorial comment, it should
be noted that certain conclusions are so self-evident
as to merit acceptance without a host of scientific
studies involving randomization, double-blind
technique, etc. We hope sophisticated readers will
forgive this simplistic statement; in our defense we
might point to an analogy: one accepts the life-
saving role of parachutes, even without fancy studies
and "statistically significant" outcomes. Having said
that, it’s obviously essential to be familiar with such
scientific data that do in fact exist and
comprehensive and authoritative reviews of the
evidence are available
HEROIN TRIALS: Fostering Knowledge, but Also
Misunderstanding - The trials of
Switzerland, Netherlands, Germany etc. are to be
applauded for demonstrating that heroin maintenance
is feasible and effective for many. But the
methodology also carries with it a downside (more)
Vancouver’s Supervised Injection Site at
Risk - The Canadian government is about to
make a decision that will affect the future of North
America’s first Supervised Injection Site in
Vancouver. The Vancouver facility, Insite, opened in
Sept. 2003 and Vancouver Coastal Health received a
three-year scientific research exemption under the
Canadian Controlled Drug and Substances Act
allowing it to have illicit drugs in the facility for
research purposes.
Now, that exemption is up for renewal, and the
government’s decision will determine whether this
groundbreaking facility continues to operate.
Right now, that future is very much in doubt. Insite is
seeking your assistance.(click here)
Five Years with Medically Supervised Injection in
Australia-The bottom line, according
to our colleague Andrew Byrne: 200-300 injections
each day, not a single death, strong support from
local residents, businesses and "most police." For
more on the service
click http://www.sydn
eymsic.com/.
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