Breaking News:Dangerous Delays: What Washington State (Re)Teaches Us About Cash and Cannabis Store Robberies [REPORT]

Methadone & Other Opiate Maintenance

RSS Feed for this category

Overdose and Other Drug-Related Deaths Now Closing In on Car Wrecks as Leading Accidental Killer in US

In a report released Wednesday, the Centers for Disease Control (CDC) has found that drug-related deaths—the vast majority of them overdoses—increased dramatically between 1999 and 2006, and that drug-related deaths now outpace deaths from motor vehicle accidents in 16 states. That's up from 12 states the previous year and double the eight states in 2003. More people died from drug-related causes than traffic accidents in the following states: Massachusetts, New Hampshire, Rhode Island, Connecticut, New York, New Jersey, Maryland, Pennsylvania, Ohio, Michigan, Illinois, Colorado, Utah, Nevada, Oregon and Washington. According to CDC researchers, who examined death certificate data from around the country, some 45,000 died in traffic accidents in 2006, while 39,000 people suffered drug-related deaths. About 90% of the drug deaths were from overdoses, but researchers also included in that figure people who died of organ damage from long-term drug use. Researchers reported a sharp increase in deaths tied to cocaine and to the opioid analgesics, a class of powerful drug that includes fentanyl, methadone, morphine, and popular pain relievers like Vicodin and Oxycontin. Cocaine-related deaths jumped from about 4,000 in 1999 to more than 7,000 in 2006, but methadone-related deaths increased seven-fold to about 5,000, and other opioid deaths more than doubled from less than 3,000 to more than 6,000. Oddly enough, heroin-related deaths actually declined slightly, hovering just below 2,000 a year throughout the period in question. And despite all the alarums about young people dying of drug overdoses, the 15-24 age group had the lowest drug-related death rate of any group except those over 65. Only about three per 100,000 young people died of drug-related causes in 2006, compared to six per 100,000 among the 25-34 age group, eight per 100,000 in the 35-44 age group, and 10 per 100,000 in the 45-54 age group. CDC researchers did not discuss causes for the increase in overall drug-related deaths or the rate of drug-related deaths, but several plausible (and complementary) explanations come to mind: the introduction and widespread use of Oxycontin, the fentanyl-tainted heroin epidemic that appeared in 2006, the increasing non-medical use of prescription pain relievers, and the increasing use of methadone as a pain reliever.
Localização: 
Atlanta, GA
United States

A Heroin User in Stockholm

Another video from the Hungarian Civil Liberties Union, this time in partnership with the Swedish Drug Users Union. Sweden's government is one of the world's most prohibitionist, but nevertheless has moved toward harm reduction in recent years by expanding needle exchange into a national policy. Previously needle exchange was happening only in two cities in the nation's south. Well, there's still no needle exchange in Stockholm, according to HCLU, it's even hard to get into a methadone maintenance program, and those who do often face negative attitudes from the program's staff. Check out the video below, or here.
Localização: 
Stockholm
Sweden

Feature: Heroin More Effective Than Methadone for Some Addicts, NAOMI Study Reports

In a report that was actually completed last October but not published until this week in the New England Journal of Medicine, researchers from the North American Opiate Medication Initiative (NAOMI) found that giving heroin under supervision to some hard-core drug addicts was more effective than giving them methadone. The study's publication in the prestigious peer-reviewed journal is already leading to calls for experiments with heroin maintenance in the US. To qualify for the study, participants had to have been addicted to heroin, Dilaudid, or another opiate for at least five years, have been injecting for at least the past year, have tried addiction treatment, including methadone maintenance, at least twice, and be at least 25 years of age. While researchers were loathe to generalize their findings, they described heroin maintenance as "a safe and effective treatment" for chronic addicts who have not taken to other forms of treatment.

https://stopthedrugwar.org/files/hastings.jpg
Hastings St., downtown Vancouver (from vandu.org)
In the NAOMI project, researchers monitored 251 heroin addicts in Vancouver and Montreal and provided them with maintenance drugs for a year under the supervision of nurses, doctors, social workers, and psychiatrists. One hundred fifteen received pharmaceutical heroin (diacetylmorphine), 111 received methadone, and 25 received Dilaudid (hydromorphone).

Among participants who received heroin by injection, 88% completed the program compared to 54% of those receiving oral methadone. Similarly, illicit drug use rates dropped by 67% among those receiving heroin, compared to 48% among those receiving methadone.

"Our data show remarkable retention rates and significant improvements in illicit heroin use, illegal activity and health for participants receiving injection assisted therapy, as well as those assigned to optimized methadone maintenance," said Dr. Martin Schechter, principal investigator for the Center for Health Evaluation and Outcome Sciences at the University of British Columbia School of Population and Public Health and NAOMI's lead researcher. "Prior to NAOMI, all of the study participants had not benefited from repeated standard addiction treatments. Society had basically written them off as impossible to treat," he said.

"We now have evidence to show that heroin-assisted therapy is a safe and effective treatment for people with chronic heroin addiction who have not benefited from previous treatments. A combination of optimal therapies -- as delivered in the NAOMI clinics -- can attract those most severely addicted to heroin, keep them in treatment and more importantly, help to improve their social and medical conditions," explained Schechter.

The NAOMI research results mirror similar findings from a number of European countries, a fact noted in a Journal editorial by Virginia Berridge. "The results of this trial may be added to those from Germany, the Netherlands, Spain and Switzerland," Berridge wrote. "Switzerland has 10 years of experience in the prescription of heroin, and in a November 2008 referendum, 68% of voters were in favor of its continued prescription."

The NAOMI findings, along with earlier work from Europe, are relevant to the United States. According to government figures, nearly 700,000 Americans are heroin users, and 15% to 25% of them are heavy users who could benefit from prescription heroin.

But heroin is a Schedule I drug under the US Controlled Substances Act, which means it cannot legally be prescribed. That is unlikely to change anytime soon. Even allowing for a pilot program would require political decisions that are unlikely to be made in the foreseeable future.

That needs to change, said advocates of evidence-based drug policies. "The NAOMI results are clear that prescription heroin reduces crime, and overdose deaths," said Laura Thomas, deputy state director of the Drug Policy Alliance. "The reason this effective treatment isn't available in the United States right now is politics. The science is there."

"The success of NAOMI, combined with similar results in other countries, leaves little question that heroin prescription would reduce crime, and overdose fatalities in the United States as well," added DPA executive director Ethan Nadelmann. "Recent votes in Germany and Switzerland, combined with similar evidence of public support in other countries, show that the public will support even controversial drug policies when they have proven results. There is no question that heroin prescription programs are needed and long overdue in this country. All that stands in the way is ideology and the backward assumption that it can never happen in the United States."

It wasn't just DPA wondering about more effective forms of drug treatment. In a blog post titled Prescription Heroin?, New York Times science columnist John Tierney asked just that: Is it time for prescription heroin in the US? He didn't provide an answer, but the fact that the question is being asked by someone like Tierney is suggestive.

And if not prescription heroin, what about Dilaudid? It is Schedule II and can be prescribed, although not, under current law, for maintenance purposes. Schecter and his fellow researchers found that NAOMI participants could not distinguish it from heroin and that it appeared to be equally effective.

Glorious Kyrgyzstan -- the Best Harm Reduction Program in Central Asia

The Central Asian Republic of Kyrgyzstan sits along a drug trafficking route, and has an estimated 80,000-100,000 drug users, more than half of whom inject drugs. Unlike some countries in the region, Kyrgyzstan has embraced harm reduction strategies such as needle exchange and methadone maintenance. Even prisoners in Kyrgyzstan have access to these programs. By going this route, they have been able to curb the country's HIV epidemic. A new video from the Hungarian Civil Liberties Union -- in Russian, with English subtitles -- tells the story. Check it out:

Europe: British Prisons Install Methadone Vending Machines

In a bid to promote opiate maintenance therapy behind bars, the British government has begun installing methadone vending machines in the country's prisons. Justice Minister Phil Hope told parliament last week that 57 vending machines have been installed so far.

The machines allow prisoners to receive an individualized dose of methadone by giving a fingerprint or an iris scan. The machines are paid for by the Department of Health and will cost about $6.5 million dollars, about 10% of the department's prison drug treatment budget. The target is to have the machines in half of Britain's 140 prisons.

According to the latest available prison population statistics, in 2007, nearly 6,400 of Britain's 81,000 prisoners were there on drug charges, with slightly more than half of them charged with simple drug possession or possession with intent to distribute. The official statistics provide no breakdown of which drugs were involved.

"Methadone dispensers are a safe and secure method for providing a prescribed treatment," said a health department spokesman. "They can only be accessed by the person who has been clinically assessed as needing methadone and that person is recognized by a biometric marker, such as their iris."

Providing methadone to addicted prisoners allows them to manage their habits without resorting to illicit heroin supplies within the prisons. But the opposition Conservatives were quick to try to score political points, claiming that the Labor government would rather "manage offenders' addiction" than end it.

"The public will be shocked that Ministers are spending more on methadone vending machines than the entire budget for abstinence based treatments," said Dominic Grieve, the Conservative shadow justice secretary. "Getting prisoners clean of drugs is one of the keys to getting them to go straight. We need to get prisoners off all drug addiction -- not substitute one dependency for another. The government's approach of trying to 'manage' addiction is an admission of failure."

The Conservatives are hammering away at Labor any way they can as they prepare for national elections sometime in the coming months. Attacking enlightened approaches to inmate drug addiction is just another arrow in their "tough on crime" quiver.

Canada: New Heroin Maintenance Pilot Program to Get Underway Later This Year

Despite fighting in the courts to shut down Insite, Canada's only safe injection site, Canada's conservative federal government is providing funding for a heroin prescription pilot program in Vancouver and Montreal. The program will begin providing heroin to some 200 hard-core users later this year.

Known as SALOME (the Study to Assess Longer-term Opioid Medication Effectiveness), the program builds on a similar multi-year program in Vancouver that ended last summer. That program, NAOMI (the North American Opiate Medication Initiative), was funded with $8 million from the Canadian Institutes of Health Research with the approval of Health Canada, but the government of Prime Minister Steven Harper has refused to publicly acknowledge research findings that participants' physical and mental health improved and that they committed fewer crimes.

Still, the Institutes of Health Research are quietly throwing in $1 million for SALOME. Josee Bellemare, press secretary to Health Minister Leona Aglukkaq, told the Toronto Globe & Mail: "Our government recognizes that injection drug users need assistance. That's why we are investing in prevention and treatment, to help people recover from their drug addictions."

The three-year trial will offer heroin in both pill and injectable forms, and will also offer hydromorphone to see if it could be used as a substitute. The trial will seek to assess whether prescription heroin is a safe and effective treatment and whether users will accept the drug in pill form. Researchers are currently recruiting hard-core users who have not responded to conventional treatments and say they expect to have clinics operating in the two cities by this fall.

Canada joins Britain, Denmark, the Netherlands, Spain, and Switzerland as countries where heroin prescription programs are in place either permanently or on a trial basis. The German parliament voted last week to join the club, too.

Europe: German Parliament Approves Heroin Maintenance

The German parliament has voted to allow the prescription of heroin to addicts who have not responded to other treatments. The lower house of parliament approved the measure May 28.

Under the new law, heroin users who have been using for at least five years, are at least 23 years old, and who have failed to stop in other treatment programs will be able to receive pharmaceutical heroin in designated treatment centers. The law follows a German pilot program conducted in seven cities between 2002 and 2006 that showed impressive results in reducing crime, overdose fatalities, and HIV among hard-core users.

Similar results have been reported in Britain, Canada, the Netherlands, Spain, and Switzerland. Last year, Swiss voters legalized prescription heroin in a public referendum.

The news was welcomed by drug reformers around the planet. "The success of the German heroin prescription projects, combined with similar results in other countries, leaves little question that heroin prescription could reduce crime, HIV and overdose fatalities in the United States as well," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "And [the May 28] vote in Germany, combined with similar evidence of public support in other countries shows that the public will support even controversial drug policies when they are given a chance to prove themselves. There is no question that heroin prescription programs are needed and long overdue in this country. All that stands in the way is politics and the backward assumption that it can never happen in the United States."

The Australian group Families and Friends for Drug Law Reform likewise used the German vote to agitate for similar policies Down Under. "The German decision challenges Australia to remove John Howard's veto of this medical treatment and put humanity and social well-being first," said Brian McConnell, President of Families and Friends for Drug Law Reform. "The veto of the decision of the Australian Health Ministers in 1997 for a heroin trial must be reviewed in the light of the rising number of overdose deaths and the threat of a renewed flood of Afghan heroin," he said

"Excuses for not introducing it have become baseless given the overwhelming evidence that now exists in support of the measures," McConnell added. "Attracting the severely addicted into treatment, away from recruiting and selling to new users to support their habit, will surely allay parents' and governments' concerns about the provision of this treatment. It can undermine organized crime's profit from heroin, which is critical at a time when world production of heroin is increasing. Much is to be gained with this common sense measure: there are lives to be saved, individuals' health to improve and a huge potential for reduced crime and trafficking in illegal heroin."

Heroin Maintenance: Study Suggests Baltimore Could Be Ripe for a Pilot Program

Baltimore is home to one of the nation's most intractable heroin-using populations, and now a study done for the city's Abell Foundation is suggesting it could be time to try something new, at least in this country: heroin maintenance. The idea is not so much to push for such a program now, but to open the door for discussion -- a worthy idea given that decades of repression and, more recently, conventional drug treatment have done little to stem the tide of addicts.

Authored by University of Maryland drug policy expert Peter Reuter, the study, Can Heroin Maintenance Help Baltimore?, examined existing heroin maintenance programs in Switzerland and Germany as well as the now-ended North American Opiate Maintenance Initiative (NAOMI) program in Vancouver, and examined the Baltimore heroin scene. His review of results so far found decreases in criminality, increases in employment, and health improvements for participants.

But Reuter also noted that those existing programs are expensive (more expensive than methadone treatment), serve relatively small numbers, and would be politically controversial in the US setting. In fact, the US National Institute on Drug Abuse, offered a chance to participate in the NAOMI program, declined. In addition, Reuter wrote that significant differences between hard core heroin users in Baltimore and in European cities made predictions of success difficult.

Can heroin maintenance help Baltimore? Here's how Reuter answered his own question:

At best there is a case only for an experiment. There are too many potential differences between Baltimore City and the other sites in which HAT [heroin-assisted therapy] has been tried to allow confident predictions of the outcomes. Visits to facilities in other countries hardly provide an inspiring model. The client population in Baltimore City is highly troubled so even if HAT leads to better outcomes for the group as a whole, many of the clients will remain unemployed, marginalized, and in poor health conditions. There will be some poster children but not many.

The potential for gain, however, is substantial. Even in the aging heroin-addict population, there are many who are heavily involved in crime and return frequently to the criminal justice system. Their continued involvement in street markets imposes a large burden on the community in the form of civil disorder that helps keep investment and jobs out. If heroin maintenance could remove 10 percent of Baltimore's most troubled heroin addicts from the streets, the result could be substantial reductions in crime and various other problems that greatly trouble the city. That is enough to make a debate on the matter worthwhile.

"It is a sensible innovation to consider," Reuter told the Baltimore Sun. "I am not a passionate advocate for it, but I do think someone should try it in the US. It has enough plausibility that it's worth trying."

But Baltimore officials are not convinced. "I think it would be a mistake to pursue an expensive and unproven idea when we need more resources for effective drug treatment," said Dr. Joshua Sharfstein, the city health commissioner, who apparently did not actually read the report. "There's nothing that persuades me to invest in something that is so expensive and without evidence."

Former Baltimore health commissioner Dr. Peter Beilenson worried that the notion was too radical to fly in the US and could undercut more plausible reforms. "It's not like everything has been tried and everything has failed and you just throw up your hands," said Beilenson, who is now Howard County's top health official. "The problem is if you are going to do any reasonable drug policy reform, this heroin thing is such a red flag that it takes all the attention away. It makes it look like anyone who is interested in drug policy reform is crazy." [Ed: Beilenson should know -- he tried it in 1998.]

But some addiction specialists said there should at least be a clinical trial. "Do I think it would be interesting? In a controlled clinical trial setting, yes," said Susan Sherman, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health "To me, it's also important to have a public dialogue, regardless of the outcome. It forces people to deal with really hard issues about drug use and drug users."

"Most studies clearly show they help," said Dr. Christopher Welsh, assistant professor of psychiatry at the University of Maryland medical school. "But using public funds to fund something like this would be a whole other level of politics, especially in this economy."

Europe: Danish Heroin Maintenance Program to Commence Next Month

Beginning sometime next month, hard core heroin users in Denmark will be able to receive two doses of heroin a day, courtesy of the Danish health system. They will have to go to one of five drug clinics established around the country, where they will be able to inject pharmaceutical grade heroin under a doctor's supervision.

https://stopthedrugwar.org/files/copenhagen.jpg
downtown Copenhagen
The heroin maintenance initiative was approved a year ago by an overwhelming consensus in the Danish parliament. Only one small far-left party opposed it, and not on principle, but because of funding issues. It even won the support of the rightist Danish People's Party, not normally a bastion of progressive ideas.

Denmark thus joins a small but growing number of European countries, including Switzerland, the Netherlands, and Great Britain that have heroin maintenance programs. The goal is harm reduction.

"The aim is to improve their state of health, help them avoid committing crimes and stabilize their lives," Dr. Anne Mette Doms of the Danish Board of Health told the British newspaperThe Guardian. "Quitting altogether is not a realistic option for most of these patients. For them, this will be a chronic treatment, as if you were treating a chronic disease."

Support for such programs is a welcome change, said Preben Brandt, chairman of the Council for Socially Marginalized People. "Five years ago I decided I would not participate in yet another debate on drugs," he told the Guardian. "It was too emotional, with different groups being very aggressive. The counter-argument was always 'you kill people by giving heroin' or 'with this initiative, you are telling people that taking heroin is OK'," he said. "It is very difficult to have a rational debate when you are arguing against beliefs."

But successes in other European countries experimenting with heroin maintenance helped change the atmosphere, said Mads Uffe Pedersen, head of the Center for Alcohol and Drug Research at the University of Aarhus. "The politicians became convinced that it could help those with the most severe drug problems," he said. "You could not argue against the (positive) findings."

"The debate became more practical," agreed Brandt. "It was about what policies worked and which ones did not. It was no longer about morality."

And changing attitudes toward drug users also helped, Brandt said. "Drug addicts in Denmark are less stigmatized. They are no longer perceived as criminals who are a danger to society. They're seen as patients who have a disease they need help with. The new scapegoats in Denmark are the foreigners."

Europe: Government Must Support Employers in Hiring Drug Users, British Drug Watchdog Group Warns

With drug strategies and welfare reform plans in the British Isles moving toward pushing drug users into treatment and from treatment into the workplace, the British government is going to have to do a lot more to help drug users find jobs, a leading British drug policy think tank said in a report released this week. The report, Working Toward Recovery: Getting Problem Drug Users Into Jobs was published by the UK Drug Policy Commission and contains more than three-dozen recommendations aimed at easing the transition.

The report noted that while holding a job is a key component of drug user rehabilitation and integration into society, about 80% of problem drug users were unemployed. (The report defined "problem drug user" as someone dependent on heroin or crack cocaine.) And while government strategies in England, Scotland, and Wales are to get users off drugs and into jobs, the strategies are undeveloped and, and employer practices sometimes counterproductive.

In particular, the report criticized the informal "two years drug free" rule used by many employers. With the two years of abstinence including abstinence from opiate substitute medications, such as methadone, the practice is unduly harsh and unnecessary, given that many people on the controlled drug regimen have already achieved the stability employers say they want.

Employers are unlikely to want to hire problem drug users, with only 26% saying they would be prepared to hire a former drug user. Employers cited several types of risk associated with drug users -- from continuing drug use, to the firm's reputation, and to the firm's customers and employees -- and about three-quarters of them they needed more government help in developing risk assessments, support for drug using employees, and information about indemnity insurance.

The Labor government's welfare reform proposals will tie money to pay for drug treatment to drug users agreeing to a rehabilitation plan, the study noted. But with employment a big part of rehabilitation, the government is going to have to provide incentives and programmatic support if it is going to force those drug users into the job market.

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, 2015 Drug War Killings, 2016 Drug War Killings, 2017 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, Vaping, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Pill Testing, Safer Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Kratom, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psilocybin / Magic Mushrooms, Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School