Again ... Substitution Treatment More Effective than Abstinence Programs

This is just a friendly reminder for those who want methadone treatment cut back or stopped - methadone and buprenorphine have once again been shown to be more effective for treating opiate addiction than rehab, detox and 12 steps programs.

Thumbs Up For Methadone and BNX
Pharmacy News
August 2009

Buprenorphine-naloxone and methadone have received endorsement as the most effective opioid replacement therapies.

A paper published in the latest issue of the Medical Journal of Australia (MJA) confirmed that buprenorphine-naloxone (BNX) was less likely than buprenorphine alone to be injected by both opioid replacement therapy patients (ORT) and injecting drug users.

Meanwhile a new Cochrane review confirmed that methadone maintenance therapy (MMT) was more effective than "cold turkey" methods in treating heroin dependence.

The MJA study found that in the year after its introduction in Australia, BNX was injected less frequently and by fewer regular injecting drug users and ORT clients than buprenorphine, particularly when differences in the availability of medications were taken into account.

Some individuals did nonetheless regularly inject BNX.

BNX is a combination of a partial opioid agonist and an opioid antagonist for treating opioid dependence, which was specifically developed to limit injection.

"Given that BNX has not only overtaken market sales of buprenorphine, but is also generally available as takeaway medication (unlike buprenorphine), the deterrent effect of the combination product may be even greater than the comparisons in our study suggest," the study's authors wrote.

"This finding has important implications for public health, given the potential for severe consequences of buprenorphine injection."

The Cochrane reviewers looked at 11 studies and found that MMT retained patients in treatment and decreased heroin use better than treatments that did not use ORT such as detoxification, offer of drug-free rehabilitation, placebo medication and wait-list controls.

However, MMT did not have a statistically significant superior effect on mortality or criminal activity, the reviewers found.

Q & A: Kerry Wolf -Certified Methadone Advocate (USA)

This is the first in a series of Q & As for people who have some relationship or interest in illicit drugs. 

First up is Kerry Wolf, Director for the Texas chapter of Advocates For Recovery Through Medicine Medically Assisted Treatment (ARMMAT). Kerry is well known in cyber space for her active role in promoting and educating people about methadone maintenance treatment(MMT). Using the alias Zenith, Kerry moderates several websites and forums for MMT patients wanting to discuss methadone or seek help regarding treatment. 

Kerry is also a Certified Methadone Advocate(CMA) through the National Alliance of Methadone Advocates (NAMA)

NOTE: You can ask Kerry question via the comments.

Name:  Kerry Wolf

Role: Director of ARMMAT

Date: August 2008

Contact: ARMMAT. A.T. Watchdog NAMA. 

You are currently on MMT? What was your addiction? 

I have been on MMT for almost 4 years now. My primary addiction has always been Rx opiates, particularly a hydrocodone containing cough syrup called Tussionex. I also used IV heroin for about 7 months. 

Do you use drugs(including alcohol) recreationally? 

Not any more. I stopped all recreational drug use when I got on MMT. It was never really "recreational" for me anyhow--it was always severely compulsive and always an attempt to self medicate my depression. I always used alone (except for the heroin episode). I also drank pretty heavily when I could not get opiates. 

Do you consider you live a productive life in comparison to someone not with an addiction? 

Absolutely! As an MMT patient, I hold down a full time white collar job, pay all my bills, care for my family, and pursue my own dreams and goals. I am also able to give back to society. 

I have also known active addicts who were able to maintain fairly normal lives even while using--my husband worked steadily for 26 years while using IV heroin almost daily, and supported his then-family (this was before we met), and was never in any legal trouble. 

Are there obstacles being accepted into society for you as an ex addict on MMT? 

Many. In the USA, we have laws, both Federal and state, preventing those with any type of drug conviction from EVER obtaining housing assistance, food stamps, welfare, or student loans. This does not apply to murderers, rapists or child molesters--just drug convictions. In addition, in my state, my right to vote was removed. All employment applications now ask if you have ever been arrested or convicted and employers all do background checks. I was refused a job at Wal Mart because of this--a minimum wage job. Methadone prejudice is very strong. I used to be an RN, but I can never go back to nursing, because nurses in the USA are not allowed to take methadone--at least, not for addiction treatment. They are, however, allowed to take methadone for pain, so I suppose it only "impairs" the nurse when taken for addiction? Methadone is so heavily judged and frowned upon by every level of society that it just amazes me. 

Do you have difficulty telling people you are on MMT? 

Not really--not anymore. I feel strongly that people NEED to know--they need to see that I--a normal person with whom they interact daily--am a methadone patient, and am not a bum under a bridge somewhere looking to molest their kids and steal their rent money. 

You are a member of Advocates For Recovery Through Medicine Medically Assisted Treatment (ARMMAT). Can you tell us about it? 

As an ARM member I work locally and nationally to assist patients who need help with issues at their clinics and beyond. I work with agencies and help to educate people about methadone treatment, and empower patients by informing them of their rights and how to go about contacting the proper people to help them. 

Some people say ex addicts especially those on heavy medication like methadone don’t have a place discussing addiction treatment. Do you feel that being on OMT benefits you with your cause or are they correct. 

My feeling is that recovery has nothing to do with whether or not you take a prescribed medication to stabilize brain chemistry or not. Recovery is measured by the fruits of your life. Are you happy? Are you responsible, dependable? Can your loved ones count on you? Are you working (if able)? Are your bills paid? Do you have goals and dreams that you are working on? Do you give back to others? Do you feel good about yourself? Do your loved ones see the positive changes in your life? If you can answer "yes" to these things, then in my opinion, THAT is recovery. When I was abstinent and following an abstinence based program, I was drug-free, yes. I was also deeply depressed, unemployed, exhausted, had no hopes and dreams, and spent most of my day in bed. THAT was NOT "recovery" in my book. 

The US is infamous for it’s drug policy and opposition to Harm Reduction. Though the US has about 10 times the number of HIV/AIDS sufferers amongst injecting drug users compared to Australia, only recently has federal funding been allowed for needle exchange programs. Does this US approach effect OMT from what you have seen? 

My state (Texas) is the last state in the country to refuse to allow needle exchange programs, something I am deeply ashamed of for them. I also see that whenever a clinic tries to open anywhere in the USA there is an onerous protest with the people all saying the same thing..."It will increase crime, attract addicts to our area, and they will steal, rob and molest our children, nod out in the streets, urinate and defecate on the sidewalks, drive away like drug crazed madmen and kill us all, etc etc". Although it almost always turns out that the clinic is a good neighbor and none of these fears come to pass, this continues to happen with very few defending the patients, and so there are not enough clinics to treat those who need treatment--not even 1/4 of them. 

I have heard some horror stories about MMT clinics in the US. What is your experience? 

My clinic is fantastic! I am truly blessed to have a clinic director who is focused on her patients and on empowering them to speak up for themselves and to NOT buy into the stigma that surrounds MMT. The counsellors there are wonderful as well--some of them are also MMT patients. We have no security guard and no need for one. I have never once been offered drugs there or asked to buy any, nor have I seen anything "suspicious" going on. The clinic believes in adequate dosing, and truly pays attention to their patients. But I know that many clinics are NOT like this, and I am very lucky indeed. 

What is the worst case you know of? 

There is a clinic in Paducah, Kentucky that is just beyond awful. I have dealt with several patients there who have had to fight tooth and nail and wait for many agonizing months just to get to a dose of 50mg, only to be told that no one needs more than 50mg (average adequate dose for most patients in the USA is 80-120mg). Their patients are often told to "pray to God" if they are experiencing withdrawals and cravings from these substandard doses, and are forced to attend NA meetings if they want any takehome doses, despite the fact that NA has a written policy stating that MMT patients are "in active addiction" and are not allowed to speak at meetings. This clinic is directly violating the Best Practices standards that disallow dose capping, and almost seems to be an abstinence based treatment program masquerading as a methadone clinic. 

There has been a huge increase in methadone deaths recently in the US. Why is this? 

Actually, there has been a huge increase in the PRESCRIBING of methadone for pain in the past few years, primarily due to the recent Oxycontin scandals. Doctors turned to methadone because it was cheap, long lasting, and does not produce a strong high. However, many doctors were not aware of the special properties and need to carefully titrate this drug in new patients. In addition, the FDA prescribing insert advised doctors that they could give new patients as much as 80mg a day in divided doses--over twice as much as is prescribed as a starting dose to opiate tolerant patients at a methadone clinic! As a result, patients began dying from methadone overdoses. Often, they were not warned about combining the drug with other meds like benzodiazepines which can be a deadly combination. In addition, due to the increase in prescribing methadone for pain, it was much more readily available on pharmacy shelves and medicine cabinets, and curious teens and young people began experimenting with it. Often they would take more and more hoping to get the high they expected with other opiates, only to die without ever getting there. 

Studies by SAMHSA and other organizations show unequivocally that the majority of this diverted methadone comes NOT from the MMT clinics but from pain management and people who steal from pain management patients, or from higher up the chain. Diversion from clinics DOES occur, but it has been low and stable for the past 45 years, and occurs mainly to other opiate tolerant addicts who cannot get their drug of choice and want to avoid being sick. 

What do you see as the main problems with OMT in the US? 

The clinic system itself. There is no standard of care--rules are applied haphazardly across the board and enforcement of accreditation standards is almost non existent. There is no one to speak for the patients. Methadone is grossly over-regulated, to the point that only 10% of those who need and would benefit from MMT can access treatment. Costs are exorbitant in private pay clinics--often over $400 a month, and this continues even when the patient gets only 5 minutes of unneeded "counseling" per month and no other services besides the medicine itself, which is less than 1/8th the cost of the monthly bill. Patients who have been stable in treatment for years--decades, even--have to continue to attend the clinic and pay for ancillary services they neither need or use, rather than receiving the medication from their own doctors, despite decades of evidence that this works and works well for stable patients. 

What do you want to see changed first and foremost with OMT? 

Office Based Opioid Treatment for stable patients, and required, standardized training for all medical and counseling practitioners in MMT. 

What are your views on other OMT’s in use or on trial in Europe like slow release morphine, injectable hydromorphone and prescription heroin? 

I feel that these are needed therapies. No one treatment works for everyone. As with diabetes, some patients are able to control their disease with exercise and diet, others require oral medications, others need injectable insulin, and still others are extremely brittle diabetics and may not do well even on insulin, yet it does improve their outcome to some degree. With opioid addiction, some may do well with abstinence based treatment. Others may need an oral partial agonist like Suboxone. Still others may need a full agonist like methadone. And there are those who do not do well even on methadone, yet who are able to maintain a more stable life on controlled doses of heroin or morphine. My feeling is that opiates are a naturally occurring chemical in our brains (endorphins) and seeing them as some type of evil substance is erroneous. In a sense, we are all "opiate addicts" in that we need a normal level of natural opiates to be able to feel pleasure and enjoy life. When that level is depleted, whether genetically or by long term drug usage, supplementing it with exogenous opiates simply restores the patient to normal function. Giving the same amount of opiates to a patient who already has normal endorphin function will simply cause the "cup to run over" so to speak, but for those who need it it simply stabilizes them. I feel there is a place in addiction treatment for these therapies for carefully selected patients. 

"War on Drugs" and prohibition has been a huge failure. Do you support legalising drugs in anyway? 

Yes, I do. I feel that legalizing drugs would remove the criminal element from it, stop the black market trade, provide a purer and less deadly form of drugs for those who use them, and would not, as many fear, increase the addiction rate. I don't think there are tons of people out there who are holding back from using drugs simply because they are illegal and who would run out tomorrow and shoot up heroin were it to be legalized. I think our prisons and jails are full to bursting with petty drug offenders whose lives have been ruined forever, and this costs taxpayers an incredible amount of money. 

I do not think people should be able to do things which impact others, however, such as driving while intoxicated, using drugs in the presence of children, ignoring responsibilities, etc. 

In 1999, John McCain proposed a plan to remove most methadone programs for abstinence based treatment. Do you feel Barack Obama follows the same ideology as McCain or will he support a more evidence based drug policy if he wins office? 

I hope that Obama will have a more open minded drug policy, but I don't think it will be as open as I hope for. However, it will surely be an improvement over what we just had or over McCain's closed minded ideas. 

Finally, if you were President Zenith and you could change one law relating to drugs or drug treatment, what would it be?

I would decriminalize all drug possession for personal use, while making it clear that the person is responsible for their behavior while taking the drug. 

RELATED ARTILCES:

Q and A: Dr. James Rowe - Lecturer at RMIT, School of Global Studies, Social Science and Planning
Q and A: Gino Vumbaca - Executive Director of the Australian National Council on Drugs
Q and A: Sandra Kanck - Former South Australian MLC. South Australia spokesperson for Families and Friends for Drug Law Reform (FFDLR)
Q and A: Tony Trimingham - Chief Executive Officer, Family Drug Support

Prescription Heroin - Lifesaving Medication?

As the results from Canada and Britain’s heroin trials approach, findings.org.uk have written an article about the positive outcomes of prescription heroin. A little known fact is that in Britain, heroin can already be prescribed for addiction under certain circumstances. The reality though is that because of the US’s obsession with prohibition and the pressure from the International Narcotics Control Board (INCB), heroin is rarely prescribed anymore, if at all.

Here is an extract from that article.

Role Reversal

By Mike Aston & John Witton

finding.org.uk

Controversial, expensive, yet promising so much, interest is increasing in prescribing heroin to heroin addicts. It’s the drug field’s ultimate role reversal from killer drug to lifesaving medication. Just five studies hold the answers to whether it can work. 

Led by government ministers frustrated at slow progress in the fight against serious drug problems, Britain is about to revive its acquaintance with heroin not as a drug of abuse, but as a treatment for drug abuse. Heroin prescribing has traditionally been the main distinguishing feature of what was seen as the “British system” for responding to heroin addiction. It rested on the unique legal leeway afforded doctors in Britain, until recently the only nation which allowed heroin (in its pharmaceutical form called diamorphine) to be prescribed for the treatment of addiction. Before 1968, any doctor could exercise this prerogative. Since then the treatment has been restricted to specialists who hold the requisite Home Office licence, nearly all of whom work in NHS drug dependence clinics. 

At first the dominant response to the 1960s UK heroin outbreak, soon diamorphine prescribing waned to be replaced by injectable and then oral methadone. Of the 70 or more licensed doctors today, perhaps 50 prescribe diamorphine (almost entirely in injectable form) to just 450 patients. An increase in these numbers can be expected to flow from the commitment in the UK

Why consider diamorphine?

The “Why bother?” question is the main one diamorphine has to answer. After all, Britain has spent the last 30 years moving away from diamorphine and towards oral methadone, a treatment with substantial research backing and which benefits many thousands of patients. Only if there are substantial extra benefits compared to oral methadone might the extra costs and risks be justified. Even then there would remain the issue of whether injectable methadone might provide the same benefits yet permit a less drug-dominated lifestyle - injecting once rather than three times a day and less pronounced mood swings. 

The potential advantages of diamorphine derive from its anticipated pulling power for heroin addicts, defined traditionally and legally in Britain as having an “overpowering desire” for the chemical. Those who find methadone unappealing or for whom it fails to curtail heroin use might be attracted and retained by diamorphine, extending the benefits of maintenance therapy - social stabilisation, risk and crime reduction, health improvements - to yet more patients. 

The same pulling power is the source of diamorphine’s potential drawbacks. Once known to be an option, new patients who would have been satisfied with and done well on oral methadone may demand diamorphine. They may even deliberately fail on methadone to “qualify” for the drug. Once in diamorphine treatment, relatively safe, hassle-free and cash-free access to their drug of choice might prolong patients’ careers as addicts and as patients. Injectable diamorphine maintains the frequency of injecting with its associated risks. As in the 1960s, addicts may sell all or part of their diamorphine, spreading addiction and risking the purchasers’ lives, yet preventing this by requiring thrice daily attendance for supervised injection is costly and unpopular with patients. 

Establishing the validity of these hopes and fears sets the agenda for this review.

Read the entire article:

http://findings.org.uk/count/downloads/download.php?file=Ashton_M_22.pdf

Methadone Saves More Lives Than Abstinence / Detox.

People who are opiate dependent like heroin addicts, will die at a rate of 13 -1 compared to non addicts of the same age/sex. Mind blowing stuff. But there are still many out there who object to substitution treatment despite it being the single most effective treatment for opiate addiction. What would happen though if abstinence based treatment like detox was found to have a higher mortality rate than opioid maintenance treatment (OMT)?

The Boston University has recently released several reports that should make many anti-methadone proponents reassess their ignorant and often arrogant views. Not only do they indicate that methadone and buprenorphine save lives but choosing abstinence/detox over OMT increases the chance of patients dying. The anti Harm Minimisation stooges will undoubtedly still push their naive, ‘drug free’ ideology but the fact is, those on methadone or buprenorphine have a hugely reduced risk of being a mortality statistic. 

Isn’t this the goal, to save lives? It’s becoming increasingly obvious that’s not the case for some of the so-called “Tough Love” advocates. Extremist, Salvation Army Major and INCB member, Brian Watters suggested that heroin addiction was a fate worse then death. He also said that addiction was a sin. For the record, Watters is also a DFA director, ex chairman of the Australian National Council on Drugs (ANCD) and one of the 12 members of the UN’s International Narcotics Control Board (INCB) which has come into major criticism for breaching human rights and being a stooge for US drug policy. Many opponents of methadone use Sweden as an example of a successful drug policy which includes a strong preference for abstinence based programs and severe restrictions on how long someone can stay on methadone. What they leave out is the high mortality rate in Sweden compared to countries that endorse methadone.

This report is very specific about what needs to be done to prevent harm—not just to reduce it or minimise it but to prevent it, with the ultimate aim of always making the individual drug free and not sentenced to a lifetime of methadone, which will probably take 46 years off your life expectancy, and not turned into a hag with their teeth falling out. If you think the mouth of a tobacco-smoking person is hideous, look at the mouth of a methadone user.

Bronwyn Bishop - Inquiry Chair: The impact of illicit drug use on families. The winnable war on drugs.

There are many who object to substitution treatment as being a ‘cop out’ for addicts or as a grand plan of industry ‘elitists’ who want full drug legalisation. The claims are varied from an ‘Orwellian addiction swap’ to ‘the federal government trades places with the street dealer, swapping heroin for methadone and feeding the addiction with taxpayer dollars’. Even politicians who have access to vast amounts of research either choose to ignore the evidence and lie to the public or are incapable of separating their personal views from facts. What is worse ... an elected official blatantly deceiving us or an elected official being so obviously clueless and incapable yet still left to manage important issues for us?

Do we want to follow the example of the many US OMT clinics that place restrictions on the period of treatment or set unrealistic dosage levels out of misconceived ideas on how OMT works? OMT was never meant to be a short term treatment but through a haze of Zero Tolerance claptrap, the guidelines have been misinterpreted by many health care providers. It seems logical to end OMT as quickly as possible because of the temptation to have a cured addict, free of physical addiction. Unfortunately, it’s not that simple and the usual consequences are the unnecessary deaths of addicts pushed into a dangerous treatment plan by ignorant and self righteous care providers.

Opioid Maintenance Therapy Saves Lives

http://www.bu.edu/aodhealth/issues/issue_may08/friedmann_gibson.html

Opioid-dependent patients are 13 times more likely to die than their age- and sex-matched peers in the general population. To examine predictors of long-term mortality, Australian researchers conducted a 10-year follow-up study of 405 heroin-dependent patients who had participated in a randomized trial comparing methadone and buprenorphine.

Overall mortality was 8.8 deaths per 1000 person-years of follow-up (0.66 during opioid maintenance treatment and 14.3 while out of treatment).

Each additional opioid maintenance treatment episode lasting more than 7 days decreased mortality by 28%.

Subjects who were using more heroin at baseline had a 12% lower mortality rate overall, likely because they spent more time in opioid maintenance treatment.

Comments:

Often overlooked in the controversy over opioid substitution therapy is the reality that opioid dependence has a high fatality rate. The current study highlights that opioid maintenance treatment saves lives. The selection of the treatment episode as greater than 7 days strongly suggests that opioid maintenance, not detoxification, reduces mortality. The time is right to promulgate opioid maintenance therapy with either buprenorphine or methadone as the standard-of-care, first-line treatment for opioid dependence.

Peter D. Friedmann, MD, MPH

Reference: Gibson A, Degenhardt L, Mattick RP, et al. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction. 2008;103(3):462–468.

Death Before, During, and After Opioid Maintenance Treatment

http://www.bu.edu/aodhealth/issues/issue_apr08/samet_clausen.html

To what extent does opioid maintenance therapy (OMT) reduce mortality in patients with dependence? To answer this question, Norwegian researchers linked data from a national death registry to a national database of people who were on a waiting list for OMT, receiving OMT (predominantly methadone), or discontinued OMT. Researchers then compared the risk of death during treatment with the risk before and after treatment among 3789 patients. In some cases, data from the death registry were confirmed with death certificates and autopsy results.

Over 7 years, 213 patients died.

Seventy-nine percent of deaths in the waiting-list group, 27% of deaths in the treatment group, and 61% of deaths in the discontinued-treatment group were attributed to overdose.

Mortality risk (from overdose and other causes) was significantly lower in patients receiving treatment than in patients on the waiting list (relative risk [RR], 0.5; death rates of 1.4 versus 2.4 per 100 person years, respectively).

Risk was highest among men who discontinued treatment (RR, 1.8 compared with men on the waiting list).

Comments:

With impressive methodological rigor, these investigators provide further strong evidence that OMT lowers the risk of death. Because of the increasing cases of overdose death attributed to physician-prescribed methadone for pain and the potential negative public backlash towards this treatment, these data may play an important role in policy efforts that support the continued use of OMT to reduce mortality risk in people with opioid dependence.

Jeffrey A. Samet, MD, MA, MPH

Reference: Clausen T, Anchersen K, Waal H. Mortality prior to, during, and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1-3):151-157.

Related Links:

What are the benefits of Methadone Maintenance Treatment

Advocates For Recovery Through Medicine

Ideological Influence in Addiction Treatment

Naltrexone Implant Data: Dangerous - MJA

Diary: Is My Pharmacist Committed?

DIARY: Some chemists are notorious for the treatment of methadone patients. And I have had my share of run ins with arrogant pharmacists who feel methadone patients are somehow less important than other customers. But the switch to another medication meant I was a normal customer again, away from the stigma of being just another junkie on methadone. Well, I was wrong...

I am guessing most methadone patients have had the frustrating experience of waiting in line for service only to be overlooked when a regular customer comes to the counter. I am also guessing that many methadone patients have found themselves at odds with the pharmacist on at least one occasion. If you happen to pick the wrong chemist, it can cause methadone patients much, unneeded grief which often erupts into an outburst of frustration and anger. The chemist gladly informs their 2nd rate customer that they are off the program. The ex customer has to then find another chemist, which is usually for the best in the long run.

That all changed for me when I switched to SROM ... well I thought it did. Not having to go to the special counter for methadone patients was a big bonus and I was treated as regular customer who was just receiving a normal prescription. So I thought at first.

My script is presented monthly and I pick up weekly. I had some extra medication at the start so I could come in a few days late if I was unable to get to the chemist on time. I usually pick up Thursday evenings for the following week but sometimes I would leave it until Friday or Saturday and I would just receive a week’s worth of medication. One day that all changed with a different pharmacist. The pharmacist decided that my weekly pick up started on the day I came in and since I was one day late, I would be short a day. She explained the script said “pickup dose every 7 days”. She knew it was a technicality and since my doctor was on holidays, she couldn’t ring him. I finally sorted it out with the owner and I agreed to come in every Thursday to keep it simple. My doctor also changed my script to say “weekly pickup” so I could come in any day within the week.

I stuck to the Thursday agreement but this week I was at a funeral and I forgot to pick up my dose. I came in the next morning as soon as the chemist opened but agian was told that my week now started on Friday instead of Thursday. I was furious and stormed out. I came back to point out the new script but the pharmacist just casually flopped over to the counter sucking on a lollipop and slapped the prescription down without saying a word. I showed her the new wording but she didn’t even respond. I was a customer for fuck’s sake but a junkie is a junkie and I wasn’t worthy of customer status.

I rang the owner but he couldn’t get his head around the days. He said that if i got my medication on Friday, next Thursday would only be 6 days. I said that shouldn’t matter as we had been through this before all I wanted was to pick up my meds on Thursdays like usual. He got mixed up with days and numbers and kept repeating the same illogical outcomes even though he agreed he was wrong only 30 seconds before. His final solution was come in on Thursday as normal and he will just give me 6 days worth to get it back in line. WTF? One mixed up chemist!

It was so simple. I have a one day buffer which means I have my last dose Thursday morning, pickup my script that night and start the next morning, Friday. I have the buffer because I take my dose before 7am so it kicks in by 9am otherwise I am in massive pain and start withdrawal. If I have to wait until the chemist opens at 9am, I am not getting my meds working until 11am-12pm.

I asked them to ring my doctor but somehow this was not an option anymore. Can you picture an insulin patient having to miss a day because they came in a day late? What about someone on medication for a heart attack? A day early is different but this is after the due date. Originally they stated that the script specifically said that medication was every 7 days but when I purposely had the script changed to clear this problem up it wasn’t the issue anymore. They conveniently changed their mind that this was the reason.

Funny enough, I used to come in late one or two days for the first few months and nothing was even mentioned, until I got the pharmacist from hell. Why was I treated with suspicion but they still wouldn’t ring my doctor? I was doing fine coming in every Thursday but one day I come in Friday morning and my medication gets pushed back a day. The pharmacist treated me like shit and this just would not happen with other customers.

I approached another chemist near by and they said they would be happy to treat me as a customer regardless of when I came in. As long as my script said “weekly pickup” and I didn’t come in earlier than the due day, it was up to me when I picked up my medication. I asked them to ring my doctor to make sure but they said it wasn’t necessary because they understood the logic of “weekly pickup”. I wonder what a customer of 10 years has to do to get treated like I was. It all came down to one junior pharmacist and the owner who couldn’t do the maths in his head. One phone call to my doctor would have cleared it all up.

Just as I was getting my life together, I get let down by my doctors and then the chemist. I have enough problems to deal with! It seems that addiction warrants others to put you through extra misery without consideration for being a person with needs and feelings. There are very few positive experiences being an addict with depression and it is extremely upsetting when your only relief, your medication is unnecessarily interfered with. It is easy to become cynical when it happens regularly whilst having the public consider you less than human as well.

Many methadone patients (including myself) have become loud and angry when obvious discrimination occurs and usually it results in punitive action which only inflames the patient even more. I’ve seen it dozens of times at pharmacies especially certain ones that seem to thrive on acting superior to the patient. No one can really understand until they have been through it and I don’t wish it on anyone. I have never heard one single methadone patient ever ask for anything more than being treated the same as everyone else. Is that too much to ask? ... and people wonder why there are relapses.

For more horror stories, visit A.T. Watchdog. If you think we have it bad in Australia, try the US.

Diary: Some Clarification

DIARY: I received a comment from a cyber friend today and decided to publish this article as a few people have asked similar questions or voiced their concern about myself ‘managing’ my addiction. 

Terry, this is a general comment about your site more so than about this topic as such. Specifically about the information in your sidebar actually. Also I say this as someone who has grappled with a number of addictions so, please understand my comments are not intended to be judgemental. Mate, it seems to me, that your experience is possibly somewhat atypical, your claim (and I have no reason to believe you are being dishonest) to be living a more or less "normal" (don't like the word myself, conventional might be a better substitute)life but-for-being-a-heroin-addict seems to me to be a kind of attempt to normalise your addiction. I know I kept drinking and using drugs for many years on the illusion of managability, I believed my addiction was manageable, so I kept using. I had to -like it says in the first step- admit that i was powerless and that my life had become unmanageable. 

While you continue on with the belief that your life is manageable while you continue to use, you will relapse. Obviously this isn't something I usually discuss in a public forum so you can email me if you'd like to respond, obviously you can choose to ignore or take on board what I have to say, it's entirely up to you.

For the record I have been street drug and alcohol free for five years now and I was a daily, round-the-clock abuser of a number of substances. There was a time in my life when I couldn't even imagine going a day without some kind of mind altering chemical.

First of all, I am actually a recovering addict. I am on what’s called, substitution treatment which is the most common form of treatment for heroin addiction. Substitution treatment usually involves methadone or buprenorphine which keeps the patient “stable” by maintaining their addiction with something else apart from street heroin. These substitution drugs are just as addictive as heroin but each dose is much longer lasting and doesn’t get the patient high. The idea behind it is to give the patient time to stabilise their life without worrying about finding money or drugs everyday. Once on methadone, most patients can live a fairly normal life with work and other normal functions of life. After being stable for a period, the patient can then be weaned off methadone slowly until they are free of opiates. 

Due to a pain condition and the problems of depression and some health issues from methadone, I have been switched over to slow release oral morphine (SROM) which works on basically the same principal as methadone. Morphine is not allowed to be prescribed solely for addiction in Australia but is an option for addiction treatment in some other countries. 

Although substitution treatment can get you physically clean from heroin, often the physiological cravings can lead the patient back to heroin. To succeed with substitution treatment, counselling is recommended and it increases the chances of staying clean. Many methadone patients relapse and usually it takes a few attempts. 

A major issue is that often people start on heroin because of a personal problem, particularly deep rooted physiological trauma or mental health issues like depression. When these people get clean, their problem might still persists and the chances of relapsing are high. 

As you can see, addiction is very complex and addicts are usually misrepresented by the MSM and the ignorant as just selfish, hopeless junkies. For the majority, this isn’t true and until addiction is treated entirely as a health instead of a legal issue, the politicians and MSM will continue to use the personal health issues of addicts as publicity fodder. Some other people like myself have major problems kicking opiates and spend years or even decades on methadone. For some, life on methadone is fine and recent research is showing that it might be an appropriate strategy to keep some patients on methadone indefinitely. 

The constant push to lower your dose for the goal of becoming clean is now being questioned as appropriate for everyone. As more is being discovered, alternative treatments for long term patients are being trialled overseas like prescription heroin. 

Addiction was once treated with the drug that addicts were addicted to. Just as methadone is currently used to stabilise then reduce, heroin, cocaine and morphine were once prescribed using the same model of reducing your dose until clean.

Ironically, the real problems of heroin and cocaine started when the US declared the “War on Drugs” in 1971 and forced the UN to enforce it worldwide. The level of drug related crime and the mortality rates were only a fraction of what they are today. Prior to the push from the US/UN to enforce their “War on Drugs” policies, the US were one of only a few countries with major drug problems because they outlawed prescribing these drugs for addiction half a century before anyone else. 

As some countries are reverting back to prescribing heroin, their heroin related problems are decreasing steadily whilst drug related crime and major societal problems continue to infest countries like Australia and the US. Heroin prescription is now an option for long term addicts in Canada, England, Germany, Switzerland, The Netherlands and Spain. It has been extremely successful and many more countries are looking into it.

I used to use heroin up to 500-600 times a year or about twice a day. On methadone I got that down to zero for a while but I kept relapsing. This went on for several years until my back pain got worse, the depression became unbearable and my body was at it’s limits from the methadone. 

My doctor arranged for me to see a pharmacotherapist who arranged with the health department for me to switch to SROM and anti depressants. That treated my back pain, my addiction and my depression (to an extent). I wasn’t going to get off opiates any time soon and my doctor agreed that prescription heroin was suited to my situation if available. I now use heroin 12 times a year or once a month. I don’t crave heroin like I once did but use this method as a safety measure. It’s still very easy to fall into using but once a month is enough for me. If I start to stray, I can reminded myself that my time to use is coming up. It seems to work and keep away from heroin for 344 days a year. If I was in another country, I would be on prescription heroin and the difference is it is not an option in Australia. 

For those who think I am deluding myself as all good junkies do, the use of heroin as a treatment is approved by many doctors but cannot not officially be endorsed. To summarise, my treatment plan is not focussed on being free of opiates. I would love to be clean but the current thinking is that long term addicts have different needs to most heroin addicts. I have the choice to deal with my situation with street heroin or via the medical route ... I have chosen the official medical route. My treatment is long term addiction management, not the “stabilise, then reduce” treatment like most methadone patients. I have no physical need to use heroin because of the morphine (or methadone) but I still have physiological cravings. This is treated via 12 monthly doses of heroin. BTW, my situation is fully implemented and monitored by 3 medical professionals. I should also mention that you can safely take opiates all your life. they are basically non toxic and do no harm physically. Other drugs like amphetamines are a different matter. You can never manage a life of speed or alcohol for too long because of the havoc it causes on your body and brain. 

Some Won’t (Don’t Want To) Get It. 

Tens of thousands were once treated with heroin or morphine with very little problems but that changed when the US/UN enforced their abstinence or nothing approach. Abstinence should always be the first and preferred method but if that doesn’t work, then there should be several options after that like substitution treatment. The problem is that after nearly 40 years of drug hysteria and propaganda from the MSM, politicians, moralists, conservatives and the religious right, there is massive ignorance in the public arena and total abstinence is seen as the only option. 

My whole blog is based on trying to dispel the myths and personal views that dictate how we, as a society treat the drug problem. Some will never change their minds though, choosing to ignore science and medical facts and sticking to their ignorant views. Even when presented with my blog, some choose to skip over the facts and the actual content then construe their own biased views or judgements about myself.

As an unrepentant Junkie Wright, it really is just a matter of time before he cops a shot of some bad smack or before he catches a blood borne disease and goes to the biggest trip of all. I am amazed how the likes of Everett take at face value all of Wrights protestations that he has his habit “under control”. When it is very clear that Wright is in fact a most obedient slave of the poppy and that any suggestions that this addict can control his master, like those made by Wright in his blog, actually border on the delusional as any number of former addicts will testify. In the end the only ways to stay clean are to totally abstain which Wright refuses to even consider. Indeed Wright’s ability to “cope” is predicated upon some rather fragile constructs that are only ever one or two setbacks from irrevocably collapsing in a heap Typical of the left Everett is willing to make any concession to someone who her perceives as a noble “victim” he does it in relation to our Indigenous Australians and he does it with Wright. Personally I don’t care about the fact that Wright is a Junkie it is his obnoxious and belligerent comments directed at me that I object too and I refuse to treat him with kid gloves because he loves the needle more than anything else in the world.

-Iain Hall; Moralist and conservative blogger.

The above comment was made by infamous conservative want-to-be weirdo, Iain Hall. Much of his criticisms are aimed at me personally but you get the feel of the overall ignorance that he displays. 

His views reflect the usual media driven images of desperate junkies shooting up anything and not caring about sharing needles. 

The idea that any form of treatment except the “abstinence only” method is doomed to fail is typical of conservative values and ignorance. Remember that it was the US and their conservative views that interrupted over a century of treatment with their own “War on Drugs” approach that has given us the massive drug problems we have today. 

The conviction that Hall’s conservative opinions are facts are shown with his claim, “as any number of former addicts will testify”. What former addicts? We just have to take his word for it. Although Hall should never be taken seriously, his views are reflective of those who can’t comprehend that drug addiction is complex. The black and white world of some right wing conservatives will always hinder their ability to see past drug addiction as a law and order issue. Countries that have prescription heroin or safe injecting rooms are always under threat of conservative politicians regardless of the success. There is quite a lot of research now showing the huge benefits from what would have been called radical only ten years ago. You can only ignore facts for so long and the fallacious thinking like that of Hall is luckily becoming less influential on how we approach drug addiction. 

Oh McCain ... You've Done It Again

John McCain who is turning 182 next week, has slipped up again. This time, in an effort to please the GOP conservatives, McCain was making sure that he wasn't going to stumble on any of the moral issue policies. It seems though with all this responsibility that he isn't sure if condoms stop HIV/AIDS. On the "Straight Talk express", a reprise of the bus tours that he used as part of his election campaign back in 2000, McCain stumbled, paused, mumbled and called on help from his advisors. What was his position? Help please...

The transcript: 

Reporter: “Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?”

McCain: “Well I think it’s a combination. The guy I really respect on this is Dr. Coburn. He believes – and I was just reading the thing he wrote– that you should do what you can to encourage abstinence where there is going to be sexual activity. Where that doesn’t succeed, than he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I’m not very wise on it.”

( McCain turns to take a question on Iraq, but a moment later looks back to the reporter who asked him about AIDS.)

McCain: “I haven’t thought about it. Before I give you an answer, let me think about. Let me think about it a little bit because I never got a question about it before. I don’t know if I would use taxpayers’ money for it.”

Q: “What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush’s policy, which is just abstinence?”

McCain: (Long pause) “Ahhh. I think I support the president’s policy.”

Q: “So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?”

McCain: (Long pause) “You’ve stumped me.”

Q: “I mean, I think you’d probably agree it probably does help stop it?”

McCain: (Laughs) “Are we on the Straight Talk express? I’m not informed enough on it. Let me find out. You know, I’m sure I’ve taken a position on it on the past. I have to find out what my position was. Brian(press secretary), would you find out what my position is on contraception – I’m sure I’m opposed to government spending on it, I’m sure I support the president’s policies on it.”

Q: “But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: ‘No, we’re not going to distribute them,’ knowing that?”

McCain: (Twelve-second pause) “Get me Coburn’s thing, ask Weaver(senior adviser) to get me Coburn’s paper that he just gave me in the last couple of days. I’ve never gotten into these issues before.”

This must be scary for a many people. A potential US president who doesn't know if condoms stop HIVAIDS or sexually transmitted disease. Having to ask an aid what his own position is on government funded sex education including the use of condoms is more than just a McCain gaff. It is typical of how the GOP have allowed religion and neocons to overtake their core party ideology. I am sure The Republican party of old would be vastly unhappy with the direction the present day GOP has taken. Apart from minimalist governments, no nation building and personal rights, keeping people safe is another fundamental GOP cornerstone that the current Republican party members in power are happily ignoring.

Another Statistic

Recent surveys found that 79 per cent of adult males detained on property offences tested positive to a drug of some type (excluding tobacco and alcohol) 

- (Source: Australian Institute of Criminology, 2006)

It is more than likely that the 79% mentioned are addicts resorting to theft to feed a drug habit. It must be obvious, even to the most optimistic of us that there is an underlying problem not being addressed here. The current solution to this problem is jail. Not a good place to send someone with a medical condition especially addiction. It grates on me that when you are sick, you are normally sent to hospital unless that sickness is addiction. One growing solution is to treat addicts with the drug they crave. Some countries now take this approach with extremely successful results. England still provided addicts with their drug of addiction up until the 1970s when they fell in line with the US "War on Drugs" and switched patients over to methadone. Some doctors can still legally prescribe morphine, cocaine or heroin to addicts but the UK health department usually don't approve it. There are about 300-400 patients still prescribed heroin in the UK. Recently the British government embarked on a scientific trial with prescription heroin and cocaine to 500 addicts but this time carefully monitoring the success rate. The problem was that those who already received prescription heroin had very little crime activity and had caused no problems at all. It all seemed to be working well but to expand the program they needed scientific evidence and this was undertaken a few years ago. The results are still to come.

I don't endorse just handing out highly addictive drugs to anyone. Abstinence should always be the goal. The problem is that sometimes addicts take longer than expected to get clean and sometimes it just never happens. These are the cases where we should look to the past where drugs like heroin, cocaine & morphine were prescribed to treat addiction and drug related crime was almost unheard of. Interestingly, the addiction rate has not really changed since we first started recording this information over 100 years ago.