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1. Effectiveness of Substitution Maintenance in HIV Prevention Reaffirmed An extensive review paper published in Int J Drug Policy (16S(2005) S67-S75 by Michael Farrell and colleagues concludes: "There is evidence that MMT is associated with a significant decrease in injecting drug use and sharing of injecting equipment . . . [T]here is strong evidence that substitution treatment with either methadone or buprenorphine suppresses illicit opioid use. There is also evidence that substitution treatment for HIV-positive IDUs is associated with better compliance with anti-retroviral treatment and improved health outcomes." For full story click here
2. IV Methadone vs. Buprenorphine: No Difference in Subjective Ratings or Reinforcing Effects Comer et al studied subjective ratings of the quality of "high" among in-patients following detox, who were involved in placebo-controlled double-blind study of IV buprenorphine vs. methadone. The conclusion: The peak rating for the two drugs did not differ; "these results demonstrate that under these experimental conditions buprenorphine and methadone were equally effective in producing reinforcing and subjective effects." "Impairment" resulting from the IV administration was also compared: "In contrast to buprenorphine, methadone did not significantly alter performance on any of the tasks."Source: (J Pharmac Exp Therap 2005, 315(3):1320-1330
3. Buprenorphine in Primary Care - Retention at 24 wks 59%; 39% of those admitted transferred from methadone maintenance. Stabilization doses were 12-24 mg/day. It's gratifying to read that "practice policy precluded patient discharges due to continuing drug use." Source:Stein et al. (Rhode Island)
- J Gen Intern Med 2005; 20:1038-1041.
4. Methadone Treatment Upon Release From Incarceration: An Opportunity - Rich and colleagues note that recently released inmates with a history of opioid dependence "are at particularly high risk for overdose and disease transmission" and argue that "helping people to begin or maintain their methadone treatment upon release" is an opportunity that should be seized.
Source:J Addict Dis 24(3), 2005
5. Lifetime Benefits of Methadone Maintenance 38 Times
Greater than the Cost - A study by Zarkin and colleagues found a benefit-cost ratio of treatment with methadone maintenance of 38:1. The model used "captures the notion of heroin use as a chronic recurring condition." Source:(Health Economics, 14:1133-1150, 2005)
6. MINSK, BELARUS: All in the Perspective: Methadone Seized Coming Into Prison -
An attempt to deliver methadone to "correctional colony 19" prisoners was thwarted with the arrest of a police senior lieutenant. Who wins? Clearly, those who will continue to smuggle in heroin. No one claims smuggling drugs is an easy or competitive-free enterprise. Not much difference between economic realities in prison and in "the free world." Source:BBC Monitoring Kiev Unit, Dec. 6
7. CHINA: More than 500 “Hole in the head" Operations Performed as an Alleged Cure for Addiction. NO COMMENT NEEDED - The Vancouver Sun (Nov 20) reports that more than 500 "hole in the head" operations were performed in China since 2000 as an alleged cure for addiction. "A thin surgical needle is slowly inserted deep into the brain, where it is heated to a temperature of up to 80 deg. C and kept inside for 7 days . . . " Whatever one thinks of this procedure, it's easy to understand why there are doctors willing to perform it (one, in Xian, claims to have done 262): "Chinese drug addicts and their desperate families ha[ve] been willing to pay thousands of dollars for the treatment . . . " Source: Vancouver Sun (Nov 20, 2005)
8. CHINA: HIV task: Keep cases down- China must keep its number of HIV-infected people under 1.5 million
in the next five years or risk social instability and a possible economic downturn, the country's top health official said Wednesday.
Read the full story at CNN.com
9. ENGLAND: Methadone Maintenance & Pregnancy - A UK National Addiction Centre study concludes: "general practitioners and hospital doctors should recognize the significant benefits of prescribing methadone for heroin-dependent women during pregnancy." The frequent need to adjust dosage (upwards!) during pregnancy is also stressed. Source: (Eur J Clin Pharmac 2005 Nov; 61(10):763-768)
10.SINGAPORE: 100TH Execution in 6 Years for Drug Trafficking - The latest hanging, like all the rest, is justified by the Singaporean government as "an effective deterrent against a crime that ruins lives . . . " There's no place in the world that execution of criminals has been demonstrated to be a deterrent, and Singapore's own record proves this. If one hanging does not deter, nor 10, nor 100 . . . how many could one possibly expect would do the trick? Meanwhile, the US reliance on capital punishment also continues unabated; since the restoration of the death penalty, 1000 people have been executed. Some might applaud the policy based on a thirst for vengeance, or quest for votes, or . . . ; but as a deterrent? The old saying applies: Insanity is doing the same thing over and over and expecting different results.
11. FRANCE: Comparison of Illicit Drug Use and Injection Practices Among Methadone-and Buprenorphine Maintenance Patients - N=197 methadone, 142 buprenorphine. Summary: roughly 35% of each group "had used at least one illicit drug" during the past month . . . Injection was more common among buprenorphine-maintained individuals" (40% vs. 15% of methadone maintenance patients). Surprisingly, "the risk of injection increased with buprenorphine dosage" - an association not found with methadone. Source: Guichard et al, 2003 Addiction 98:1585-1597. (NOTE DATE)
12. FRANCE: Harm Reduction Associated with Great Benefits - From 1996 to 2003 heroin-related arrests in France declined from 17,328 to 4,025 (77%), and overdose deaths dropped 465-89 (81%)! During the same time cocaine-related arrests more than doubled, from 1,184 to 2,511. During these years SEP-distributed syringes remained stable at 1.5million, and those sold in pharmacies initially increased (from 13,180,000 in 1996 to 16,230,000 in 1999), but then decreased to 9,400,000 in 2003. "Replacement therapy," however, increased steadily and dramatically: 24,000 to 101,300 recipients of buprenorphine or methadone. Source: (Emmannuelli and Desenclos, Addiction 100,1690-1700, 2005)
13. FRANCE: Recent Increase in Methadone and Buprenorphine Treatment - Buprenorphine can be obtained by prescription from any GP in France, while methadone can only be received in "drug dependence clinics" at least until the patient is deemed to be "stable. And yet, between 2000 and 2003 methadone recipients in France increased 67% (9,600 to 16,000), while buprenorphine patients increased 22% (70,000 to 85,300). Under thee disparate rules of access, one would imagine the preference for buprenorphine would be overwhelming - but it's not, and the proportion of methadone patients actually is increasing, from 12% in 2000 to 17% in 2003. Source: (Addiction, vol. 100, 1690-1700, 2005)
14. USA: Study Assesses Methadone Dosages After Two Weeks - Noting, critically, that 2/3 of patients received less than 60mg it failed to acknowledge that safety concerns might lead providers to achieve more optimal levels over a longer period of time. Retention rates showed no consistent association with dosages at two weeks. Source: (Brady et al. J Addict Diseases, 24(3):2005)
15. UKRAINE: Clinton promotes care for HIV-positive drug users and methadone substitution therapy- Former U.S. President Bill Clinton signed an agreement with Ukraine's Health Minister for the Clinton Foundation to provide antiretroviral medications for the treatment of AIDS and methadone for the treatment of opioid addiction. To read more about this landmark agreement to help HIV positive injecting drug users in the Ukraine, go to http://www.ceehrn.org/ .
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