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1. USA: American Academy of Pediatrics Strengthens Policy Statement and Supports Needle Exchange Programs to Reduce Spread of HIV
“Pediatricians should speak out in support of needle exchange programs to reduce the spread of HIV among injection drug users”, the American Academy of Pediatrics says in a toughened policy statement. The previous version of the policy stated clean needle programs should be "encouraged and expanded." Now the policy goes further,"Pediatricians should advocate for unencumbered access to sterile syringes and improved knowledge about decontamination of injection equipment."
2. HONG KONG: Favorable Trends in Drug User Statistics Continue
Some highlights from the most recent Central Registry of Drug Abuse Report in 2004: reports were the lowest in ten years for total individuals reported (14,714) and for people under 21 years old (2,121). Newly reported users reached a ten-year peak of 5,644 in 2001 but dropped to 3,634 in 2004. Heroin was the primary drug for slightly over 70% of those reported. The complete Report can be requested from sb_@sb.gov.hk
3. GERMANY: Drug Czar’s Positive Assessment of Opiate Agonist Treatment of Addiction In a press release dated 3 Feb., the top German government official charged with drug control, Sabine Baetzing, estimated that roughly 50% of the estimated 120,000-150,000 opiate dependent individuals in the country are receiving "substitution" treatment, primarily with methadone. In her assessment she specifically mentions the steady decline in overdose deaths in recent years, from 2,030 in 2000 to 1,385 in 2004.
"Substitution treatment is an indispensable part of the foundation for care of addicts. It is our goal to retain as many patients in substitution treatment as possible." For the full release in German contact by email: drogenbeauftagte@bmg.bund.de
4. CHINA: Pragmatic Approach to IV Drug Use: Hold the Applause
Translated from German article in the Berliner Zeitung on Feb. 21, 2006
Encouraging news of ambitious targets for methadone maintenance and needle exchange services have been welcome indications of a fundamental change in China's approach to opiate addiction. But there's a gloomier side also making news click for full story
5. BRITISH COLUMBIA: Retention in Community-Based Methadone Program 1996-1999
A comprehensive analysis was done of a community-based methadone program. Of all patients who entered treatment 52% were retained after one year, and half those who left the program subsequently returned. Age at enrollment and dosage were key predictors of retention; program expansion did not affect results. NOTE: "In British Columbia methadone is prescribed almost exclusively by community physicians and dispensed by community pharmacists."
6. AUSTRALIA: Prejudice Against Methadone Treatment. Experience Indicates These Can Exist with “Office-Based” Treatment in the Community as Well (The Mercury, Feb. 9 – Nationwide News Pty Ltd)
Most advocates of “mainstreaming” addiction treatment with methadone have favoured the community-based generalist practitioner, supported by community pharmacists, because that arrangement seems far less likely to dehumanize and to stigmatize the services, the illness and the patients. Alas – it ain’t necessarily so. From Tasmania “an advocate for people with drug problems spoke out against pharmacies [that] left methadone users to wait outside or in a special corner for long periods.” Currently, some 600 patients receive care from 26 prescribers and 43 pharmacies.
Given the near-universal NIMBY reaction that has stifled development of “clinics,” it’s sobering to see a methadone patient advocate refer longingly to “ the former program [that] was free to users and kept them out of the public eye”!
7. AUSTRIA: Double Blind Buprenorphine-Methadone Treatment in Pregnancy (Summarized by: Dr Andrew Byrne MB, BS, FAChAM (RACP), Dependency Medicine, New South Wales, Australia )
This small but meaningful study from Vienna gives us more confidence in the safety and effectiveness of (pure) buprenorphine in pregnancy when compared with traditional methadone treatment. These authors performed a randomised, double dummy trial using flexible dosing, daily attendance and psychosocial supports for 18 patients. Click for more
8.INDIA: Methadone Suggested by UNAIDS as a “New Drug to Fight Heroin Addiction” in India
Under the headline, “new drug to fight heroin addiction” (Indian Express, Feb 7), UNAIDS has recommended to Ministries of Health and of Social Justice urging METHADONE be introduced in India. It was noted that, “there is strong evidence from research that substitution therapy with methadone is effective in reducing illicit drug use, mortality and risk of HIV spreading. It has been shown that even crime is reduced.”
The article mentions in passing one possible hurdle: methadone is not manufactured in India. On the other hand, Buprenorphine, which is used in the treatment of tens of thousands, is produced (and heavily marketed) by an Indian pharmaceutical firm.
9.Acute Pain Management for Opiate-Agonist Maintenance Patients
A paper by Alfrod and colleagues (Ann Int Med 2006; 144:127-134) describes "common misconceptions resulting in suboptimal treatment of acute pain" in maintenance patients and presents clinical recommendations, concluding that "although challenging, acute pain in patients receiving [maintenance] treatment can effectively be managed."
10.Reporting and Perpetuating Anti-Methadone Sentiments
Daily Star ( UK), Feb. 5 ,
The headline read "Cold turkey on menu for junkies; drug cure bill cut." Of course, neither methadone maintenance nor any other treatment of narcotic addiction - medication-based or drug-free - has ever justified the label of "cure." While it continues, today, to defy cure, addiction is a chronic medical condition that can be treated, and treated with great effectiveness. The proposal to legislatively require termination of methadone prescribing, which is the heart of this story, is as irrational and counter-therapeutic as would be a demand to curtail treatment utilizing insulin, or anti-hypertensives or anti-seizure drugs. more
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