The above title is in headlines of newspapers nationwide (e.g., Seattle Times, 25 July). Reference is to the National Institute on Drug Abuse (NIDA) "...first report aimed at improving how the criminal justice system deals with drug addicts..." The bottom line: "The key is understanding that drug addiction is a brain disease that affects behavior, and that it requires ... treatment, including access to medication such as methadone after the drug offender is released into society." Publication is in press, but available in PDF format below.

GREENS IN AUSTRALIA are advocating legal heroin availability. The Australian (17 July) reports that the Green Party maintains "Current approaches are not working, so it is time to step back from the emotional debate and work to implement programs that will effectively tackle the problems associated with legal and illegal drugs." Specifically, the call is for a trial "for those addicts ... [who] had become resistant to methadone based treatments."

The current pilot program, which has been judged to demonstrate the effectiveness of heroin prescribing for long-term, treatment resistant, narcotic dependent patients, officially ends in December. What's demanded now are the legal changes to make heroin part of the standard German pharmacopoeia. (Hamburger Abendblatt, 14 July)

Although originally determined to reclassify buprenorphine (subutex) as a narcotic, subject to the same very restrictive rules as methadone, the French Ministry of Health has decided instead to temporize the move by the appointment of a "working group" to study the subject.

--that's the headline of a story in The Star Online (Malaysia), July 12, which quotes the Health Ministry as determined to "place 5,000 more heroin addicts under the methadone treatment programme after the pilot programme achieved a 90% success rate." ("Success" is not defined in the article.) The Deputy Minister went on to say that the methadone programme was "in line with the Government's objective of treating heroin addicts like ordinary people who required help."

Bijan Nassirimanesh, head of the first NGO in Iran to provide methadone maintenance, sterile needles/syringes and HIV testing, recently visited Switzerland at the invitation of Ambros Uchtenhagen, Director of the Institute for Addiction Research (Zurich) and the foremost Swiss addiction specialist. Dr. Nassirimanesh concluded that Iran should consider as a model the four-pronged Swiss approach: prevention, treatment, harm reduction (including heroin prescribing) and law enforcement. He noted that the acceptance by the Iranian government of his own program in Tehran, Persepolis, reflects the realization that the prior focus on repressive measures aimed at drug users simply isn't effective. Brought to our attention by our Muenster colleague, Ralf Gerlach.

The addiction treatment authority of the CDU/CSU party, parliamentarian Maria Eichhorn, has rejected an appeal that heroin be approved for treatment of addiction (letter dated 26 June 2006 – available on request from ICAAT). The current Federal “drug czar” – Ms. Sabine Baetzing - endorsed such a move based on positive results of the recent German heroin trials. The major rationale for rejection: complete abstinence must be the goal of all treatment, and there’s no evidence this can be achieved with heroin prescribing.

The methadone program and use of "opt-out" urine- based HIV testing among patients is described by SS Lee and colleagues, in New Topics in Substance Abuse Treatment, LA Bennett, Ed., pp 171-190, 2006. The HK program (in operation since 1975) is credited as having "so far served the purpose of protecting the territory from an explosive spread of HIV among drug users. The key features of its success are its vast coverage, low threshold, and the value-added components of patient education, counseling and more recently, HIV diagnosis and referral."

This was the urgent message of the UNODC South Asia representative Gary Lewis speaking at a recent regional task force meeting in Kuala Lumpur. Specifically, there is a need for "needle exchange programs, and treatment options including substitution - using drugs such as methadone..." As another participant noted: The epidemic is not waiting for us!" (The Australian, 5 July 06)

In Newington, New Hampshire, "Police Chief Jon Tretter said he researched communities that have methadone clinics and talked to police departments, who reported no real problems. He also said there is a need for treatment in the area." (Portsmouth Herald, 7 July 06)

It’s rare for anyone to express concerns about opiate- addicted individuals who desperately want and need treatment but find no help is available. Fewer still make an effort to correct this shameful reality – which has tragic consequences for the entire community. Hopefully Davis’s efforts will prove successful, and officials elsewhere will follow his lead.(Chicago Sun-Times, June 27)

An article in the current issue of European Addiction Research (2006;12:121-127) presents data on almost 30,000 episodes of treatment for opiate addiction in Italy between 1998 and 2001. Among the 6,435 cases involving methadone maintenance, less than one in five "had doses higher than or equal to 60mg/day," and fully half received 40mg or less. It's difficult to comprehend the continued resistance among physicians - in Italy and in many other countries - to provide methadone dosages known for decades to be associated with better results for most patients. But as tough as it is for colleagues to understand, imagine trying to explain it to the poor patients!

The main argument for the proposed re-classification is that this will substantially decrease buprenorphine trafficking. It is accepted that less than 5% of patients in substitution treatment divert their buprenorphine to the black market. Many clinicians involved in providing substitution treatment in France are concerned that the re-classification will discourage physicians and pharmacists (and even some potential patients) from involvement in buprenorphine or methadone maintenance treatment. Even a small decrease in participation by doctors or pharmacists in this treatment will considerably reduce access to drug treatment for the remaining 95% of patients who fully comply with all the requirements of their drug treatment.