David Marsh, MD, Medical Director of INSITE, presents the first three years of experience at this innovative program.

Bangor Daily News Dec. 14, 2006: The article comments on the far more patient-friendly regulations governing buprenorphine compared to methadone, and the recently-passed legislation increasing per-physician patient limits from 30 to 100. It expresses the hope that this will make buprenorphine more available to the estimated 34,000 opioid dependent residents of Maine who are currently receiving no treatment of any kind. They go on to lament the fact that no more than about 60 physicians in the State now provide buprenorphine maintenance, and state: "What a service our rural physicians would perform in our besieged state if they would... take the time to get certified, post their names prominently and open their doors wide to those desperate Mainers trying to reclaim their lives."

15 Dec 06 Die Welt:That’s the headline of an article by D. Maxeiner and M. Miersch in the German on-line news service Die Welt. In sum: “It has never been possible to eradicate drug use. Attempts to suppress it heightens criminality and social suffering. Legalization would drastically reduce crime, deny the Mafia a vital source of income, and strengthen the effectiveness of the police.” The article concludes with the sentence: “Now is a good time to reconsider the error of prohibition.” (Thanks to our colleague Ralf Gerlach of INDRO e.V. for bringing this to our attention) For full story (in German)

Thursday, December 14, 2006, Victoria [B.C.] Times Colonist 12/13/06 (Ed): This headline appeared in the Times Colonist, B.C. Canada, and sums up the message succinctly: "U.S. shows us what not to do: America's hardline approach to battling drug abuse has been a costly disaster." CLICK FOR COMPLETE ARTICLE

Liberation, Dec 1, 2006: This is the headline of an article in Liberation (http://www.liberation.com/actualite/terre/2 20514.FR.php) It cites the estimate of 400,000 Ukrainians infected with HIV and states this is the only country with an epidemic that approaches the magnitude that exists in Africa. While there are now some 300 needle/syringe exchange sites, most drug users hesitate to attend because of fear of police harassment. One drug user is quoted: "As an addict the police don't consider me human; I have no rights." In the entire nation only 200 people are said to have access to methadone. Colleagues knowledgeable about the Ukrainian situation advise that in fact, at the moment no one in that country has access to methadone.

Monday, December 04, 2006: A commitment to methadone was announced by the Minister of Health at a press conference held on International AIDS Day Dec. 1. With over 2,500 cases of HIV infection on the island to date, 40 were identified in October 2006 alone; there are roughly 1.25 million inhabitants. While efforts proceed to expand methadone, some centres are relying on codeine maintenance. Full story (in French)

Monday, December 04, 2006: This is the bottom line in an article by AP dated Nov. 30, 2006. The article goes on to say that the illegal status of methadone in India is "a fact that UNAIDS and other groups are pressing the government to change." For full story

Monday, December 04, 2006;de la Fuente et al (J Epidem Commun Health 2006; 60:537-542): The article compared seropositive prevalence rate in 3 Spanish cities in 1995 and again in 2001-2003. "HIV prevalence in IDUs decreased by half in Barcelona and Seville but remained constant in Madrid. In 1992 Barcelona already had 20 heroin users in methadone maintenance programmes per 10,000 population aged 15-49 years; Seville reached this rate in 1994, and Madrid not until 1998." Conclusion: "all the evidence suggests that Madrid lost an opportunity to prevent the dissemination of HIV among injectors during the first half of the 1990s by not rapidly implementing methadone maintenance programmes while other cities were doing so. A similar situation may currently be taking place in other areas which already have high prevalences of infection, but which in some cases even prohibit methadone maintenance programmes. The description of what has happened in Spain may facilitate decision making in a context of public debate on the effectiveness of certain measures."

Thursday, November 30, 2006: No change in recommended dosage of methadone for pain is mentioned in the FDA "advisory" on methadone for pain management, issued 27 Nov., nor in the manufacturer's "patient information" sheet (see blog post on this topic ) However, the "FDA recently approved new prescribing information", referred to in the Advisory, is an exhaustive,17-page, fine-print summary of methadone (Dolophine) by Roxane Labs; on page 15 it reads, "THE USUAL ORAL METHADONE STARTING DOSE IS 2.5 MG TO 10 MG EVERY 8-12 HOURS" - i.e., UP TO 30 MG over the course of 24 hours. This corresponds to the maximum of 30 mg specified in FDA regs governing starting doses when methadone is used for maintenance. It is a MARKED CHANGE, HOWEVER, FROM THE PREVIOUS "USUAL" STARTING DOSE FOR PAIN PATIENTS OF 2.5-10MG EVERY 3-4 HOURS - i.e., UP TO 80 MG over the course of the first 24 hours. Click here for information on the FDA regs

Thursday, November 30, 2006: After the longest and probably largest trial of heroin maintenance treatment, with therapeutic effectiveness strongly documented, the German Government has decided not to establish heroin as an approved medication for the care of opiate addiction. At most, according to a press release on 27 Nov. from the Federal Ministry of Health, there might be continued availability of heroin for participants in the trial, some 350 at this point. The problem even with that very modest suggestion is that the small number of patients can not justify the cost that's involved.

Monday, November 27, 2006: The deputy chief of Nottingham, England, has proposed at a police officers' conference on drugs that opiate-dependent individuals be given legal heroin instead of continuing to have to commit a variety of offenses to support their habit with illicit drugs. The proposal stated legal heroin would cost about 12,000 UK pounds (roughly $US 23,000) per individual per year. In fact, that price tag seems far, far higher than what the actual cost would be, making the anticipated benefits to society that much greater when compared to the value of property crimes associated with heroin addiction (according to the Deputy Commissioner, about 45,000 UK pounds per year - in addition to dramatically lowering criminal justice system expenditures. Stories in several UK papers: earthtimes.org The Independent TimesOnline Telegraph Daily Mail