Giving Free Drugs to Addicts

What is more important? Stopping; violent crime, theft, robberies, drug overdoses, thousands being murdered in drug wars, the spread of HIV and HCV etc. or trying to stop drug addicts getting high? History has revealed 2 things - you can’t have both and trying to stop society from using drugs simply does not work. So, which would you choose? ... stopping associated crime and violence or stopping users getting high?

I’m sure most rational people would prefer to cut out nasty social ills like robberies, HIV, HCV, violence and murder but I am just as sure that some muffins would be so anti-drug that they would refuse to answer or try to change the question. 

Most informed people already know that prohibition causes crime and violence whilst not having much success at lowering drug use but how about the public? Do they know this or do they simply find it difficult to acknowledge due to decades of misinformation from the authorities? Is legalisation or handing out free drugs to addicts just too radical for the everyday citizen even if it cut crime rates by half and changes society dramatically for the better? According to a recent survey by McNair Ingenuity Research, 66% of Australians think people would be more likely to try or use drugs if legalised but only 5% confess that they would indulge. 

One of the survey’s most interesting results concerned what people thought would happen if illegal drugs were decriminalized. Although only 3% of people said they would personally use drugs more often, 62% said they thought other people would. The results were similar when we asked whether you’d be more likely to try drugs at all (only 5% said they would, but 66% thought others would).

It seems we define the people who can’t be trusted with drugs as everyone but ourselves.

-Kirsten Drysdale - Hungry Beast. ABC TV

Giving drugs to drug addicts is not new. Most western countries supply highly addictive opioids like methadone, buprenorphine and suboxone to heroin addicts. Other countries give out Slow Release Oral Morphine (SROM) and even free heroin. These programs are heavily regulated and restricted to opiate abuse like heroin because opioids are basically non toxic. The most success has come from supplying heroin to long term addicts who have failed repeatedly in other treatment programs. The success or prescription heroin has prompted a growing trend for drug experts to push this strategy. 

The main problem is that many addicts don’t qualify for the program because of the strict guidelines and heroin is the only targeted drug (a limited number of cocaine addicts were also given their drug of choice in the latest UK scientific trial). What about those who missed out on the trials or those who are just not “hard core” enough to make it to a permanent program? What about users of cocaine, methamphetamines and prescription medications? Once again it seems that politics and ideology are robbing addicts of valuable treatment options. 

As an addict in Vancouver for 38 years I was certain I would have no problem attending the program. It seems they only took Downtown addicts which gave them a very limited demographic and my calls went from wait to forget it. You could contact the NAOMI people if you want info but you'll be searching through an unpublished project.I hope you discuss parameters as most trials make getting off of heroin a prerequisite, which kills the project as you may well imagine. Harm reduction and working and happy clients should be the goal.Don't let them set you up to fail. 

-Comment by Terry McKinney. Vancouver BC (28/05/2008) - The Australian Heroin Diaries

How imbecilic can we be when we know that most established addicts will use street drugs everyday but the idea of government supplying safe and free drugs is simply out of the question. Up will come that old argument that dishing out illicit drugs is dangerous to their health and we should be trying to get people off drugs, not encouraging them. These reasons might be fine in prohibition utopia where drugs can be eliminated but not in the harsh realms of reality. And that’s the problem. The people who make these important decisions aspire to a “Drug-Free World” which has more chance of being a Disneyland theme park than materialising on planet earth.

I was in Canberra when the trial was set to happen. Now a decade later, failed relationships, failed uni attempt, lost employment and still raging habit, i often wonder where i'd be now if it had've gone ahead. damn howard! i wrote to chief minister stanhope last year at 3am, hanging out, begging for him to think about another try. 6 wks later he replied (shock horror) and said he was 100% behind it, but couldnt do anything til howard was gone. well hes gone.......Methinks its time i start emailing again :) 

-Comment by plzHoldSteady (22/01/2008) - The Australian Heroin Diaries

I always wonder how many lives we could have saved and how many addicts would now be clean if the proposed ACT heroin trials weren’t poo-pooed by Howard. Given the success from every heroin trial overseas, it must be quite a few. Imagine how many lives we could save or change for the better if skipped the strict criteria for candidates of prescription heroin. What if we simply opened it up to anyone who has been on methadone for more than a year or had attended a rehabilitation program and failed? And what if we supplied all dangerous drugs like ice, cocaine, heroin etc. and even ecstasy and other drugs that can be contaminated with filler products? What is the real downfall of this idea compared to the benefits? The same groups would continue to use the same drugs and those who don’t use drugs would continue to abstain. The sky would not fall in and societal chaos would not engulf mankind. Some dedicated users might increase their intake but many more will take advantage of extra treatment options and quit using drugs. 

I don’t think the public has correctly been told what would happen to their surroundings if illicit drugs were distributed by the government or legalised. The most obvious effect is that crime would drop by about half and several billion dollars would be saved every year. This are not just a slight decrease in costs or small improvements but massive, unparalleled changes to crime rates and government spending. Whole police departments used to fighting drug crimes would be relocated to other, understaffed divisions ... including more cops on the street. The back log in courts would eliminated. Huge percentage drops in overdoses and deaths. Organised crime losing their most profitable source of illegal income. Prison populations dropping so much that not only won’t new jails be required in the near future but some actually might shut down. Dangerous meth labs would almost cease to exist. You would be able to buy flu tablets with pseudoephedrine again without having to produce your passport, a personal reference from an astronaut or leaving your first born as collateral. Convenience store workers, pharmacy staff and train travellers  won’t have to worry about desperate junkies robbing them anymore as they will cease to exist. The CourierMail, Adelaide Advertiser, Daily Telegraph etc. will have to expand their subject matter or lose 8-10 pages. The quality of drug education will improve ten fold. Young adults will no longer be so susceptible to a permanent criminal record. Teen drug use will drop as the mystique of drugs will be gone as well as unscrupulous drug dealers who don’t ask for age ID. The problem of alcohol will be addressed more rigourously and classed as a dangerous drug. And so on...

Ironically, easier access to drugs will improve life for users and addicts. Their health will greatly improve and many of them will be able to work once again. They will be able to re-establish relationships with their families and no longer run the risk of being imprisoned. Many of the health issues for drug addicts are the result of prohibition, especially for heroin users. Opiates including heroin are basically non toxic and can taken for decades with very few physical problems. Haven’t you ever wondered why street junkies on heroin look sick but those on pain medication look normal? They are both taking the same sort of drug but the most visible heroin addicts in society often don’t eat very healthily, sleep where ever they can, have very few clean clothes and are more focussed on dodging the police and paying for their next hit. Take away the high cost and the stigma attached to drug addiction and they get to live much more productive lives. In the countries where heroin is prescribed to addicts, there has been substantial improvements in their health and personal lives. Most of them cease any criminal activities and many find work. 

The big question is - why are other countries looking into evidence based strategies like heroin assisted treatment and related programs while Australia keeps regurgitating tired, old drug policies that fail every year?

New Approach To Drugs Seeks Footing In Costa Rica

Tico Times

By Mike McDonald 

April 2010

The drug debate in Latin America has started to shift.

For decades, possession and addiction in the Americas have been treated with a zero tolerance policy. Efforts to slow drug use have largely centered on arresting and punishing users.

But packed jails, overburdened court systems, and a growing consensus that the war on drugs is failing are transforming the discussion.

In August, 2009, Argentina's Supreme Court ruled that it was unconstitutional to prosecute people for possession of drugs for personal use. One month later, Colombia's high court issued a similar ruling.

In Peru and Bolivia, there are now small clinics that give cocoa leaves to crack addicts in order to manage and lessen their addiction. Bolivia's President, Evo Morales, has asked the United Nations to eliminate the narcotics label on the coca plant.

Now, in Costa Rica, high-ranking officials are joining the tolerance dialogue.

In March, Costa Rica's Chief Prosecutor, Francisco Dall'Anese, proposed offering free drugs to addicts as a way to compete with dealers. Squeezing in between the addict and the supplier to offer a cheap alternative would “break” the finances of drug pushers and “reduce demand,” he told the Spanish–language daily La Nación.

“Here, what we would do is preempt the business of drug dealing,” he said.

The reasoning behind the proposal is fairly simple. By stopping the flow of income to drug dealers and eradicating the addict's need to steal in order to buy another fix, crime rates should drop.

This idea is not revolutionary. Countries in North America and Europe have used harm reduction techniques such as methadone clinics for years to treat heroin addiction.

These efforts have been regarded as successful in reducing crime and curving addiction by medical journals.

Dall'Anese's proposal, though, does represent a fundamental shift in Costa Rican drug policy, as providing addicts with free, chemical substitutes would take the drug addiction problem out of the hands of law enforcement and place it at the doorstep of public health officials.

Related Articles

Who Supports a Heroin Trial?

What Does Prescription Heroin Really Mean for Junkies?

The Start of Prescription Heroin in Australia?

Would You Give Heroin to Addicts ... Why Not?

Heroin Assisted Treatment Winning Approval in Europe

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.

Cannabis - Another Possible Fix for Opiate Addiction

Sorry about posting another research related item but I couldn’t help it. Look at the headline of the article below from ScienceDaily and you might start to forgive me. Even though the headline is an eye catcher, there are no human trials yet and any real results are years away. Still, the study is strangely compelling. The premise is straight forward enough but the irony is priceless ... smoking dope to stop being a smack junkie. I can see the anti-drug nuts having a mild seizure and the pro-cannabis supporters drooling with anticipation. Is cannabis going to be the wonder drug that even cures opiate addiction? Maybe ... maybe not, but there’s enough here for the weed worshippers to be optimistic. Unfortunately it’s too early to be excited for those on the receiving end of this potential treatment, the opiate addicts themselves. Sadly, the future for this type of treatment in Australia looks grim. We don’t even have provisions for medical marijuana yet and with the current trend of conservative politics, I can’t see a radical change anytime soon. There is already plenty of opposition to any form of medical treatment with cannabis but using pot to treat heroin addicts would create a sensation. Can you imagine the war cries from moral crusaders in the media like Miranda Devine, Piers Akerman and Andrew Bolt? What about political screwballs like Fred Nile, Chris Pyne and Tony Abbott? Even if the federal government gives it the okay, would the states support it? Can you imagine SA giving it the nod with Attorney General, Michael Atkinson and indpendant Anne Bressington being so anti-drugs. Would WA Premier, Colin Barnett have a change of heart regarding pot? What about the hysterical NSW government? Or the redneck wonderland, Qld? You get my point. Anyway, it’s early days and there’s plenty of rats yet to become martyrs. Maybe by the time it comes to phase III human trials, there might be more support for evidence based drug policy? Maybe, some new, fresh blood in politics has initiated change? Maybe a new wave of fact driven journalism has replaced the old, stale, self righteous opinion based dribble? Maybe....

Active Ingredient In Cannabis Eliminates Morphine Dependence In Rats ScienceDaily July 2009 Injections of THC, the active principle of cannabis, eliminate dependence on opiates (morphine, heroin) in rats deprived of their mothers at birth. The findings could lead to therapeutic alternatives to existing substitution treatments. In order to study psychiatric disorders, neurobiologists use animal models, especially maternal deprivation models. Depriving rats of their mothers for several hours a day after their birth leads to a lack of care and to early stress. The lack of care, which takes place during a period of intense neuronal development, is liable to cause lasting brain dysfunction. The study was carried out by Valérie Daugé and her team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / INSERM). Valérie Daugé's team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / Inserm) analyzed the effects of maternal deprivation combined with injections of tetrahydrocannabinol, or THC, the main active principle in cannabis, on behavior with regard to opiates. Previously, Daugé and her colleagues had shown that rats deprived of their mothers at birth become hypersensitive to the rewarding effect of morphine and heroin (substances belonging to the opiate family), and rapidly become dependent. In addition, there is a correlation between such behavioral disturbances linked to dependence, and hypoactivity of the enkephalinergic system, the endogenous opioid system. To these rats, placed under stress from birth, the researchers intermittently administered increasingly high doses of THC (5 or 10 mg/kg) during the period corresponding to their adolescence (between 35 and 48 days after birth). By measuring their consumption of morphine in adulthood, they observed that, unlike results previously obtained, the rats no longer developed typical morphine-dependent behavior. Moreover, biochemical and molecular biological data corroborate these findings. In the striatum, a region of the brain involved in drug dependence, the production of endogenous enkephalins was restored under THC, whereas it diminished in rats stressed from birth which had not received THC. Such animal models are validated for understanding the neurobiological and behavioral effects of postnatal conditions in humans. In this context, the findings point to the development of new treatments that could relieve withdrawal effects and suppress drug dependence. The enkephalinergic system produces endogenous enkephalins, which are neurotransmitters that bind to the same receptors as opiates and inhibit pain messages to the brain.

Miranda Devine Vs. Reality

What is it with Miranda Devine and reality? Is she really that far detached from the real world? Every time the Sydney Morning Herald publishes her ramblings about illicit drugs, the more obvious the answer becomes. Every drug related article by Devine that I have read reeks of ultra conservative ideology and is hellbent on pushing the "War on Drugs" mentality. This is not some concerned citizen nobly defending society from drug crazed junkies but a hardcore zealot using deceit and the media to pursue her ultra right wing views. Most worrying is that she is free to proselytise her flimsy views via a national platform like the Sydney Morning Herald. Considering her conservative, apocryphal articles and the quality of her information, it’s surprising that that her rants are not under the corporate umbrella of News Ltd.


And where does she get her information from? In her latest article, Addicts Say Abstinence Sets Them Free, Devine once again, takes deceit to a whole new level. The assumptions are brain chilling and much of her information is simply wrong. For example, Cabramatta police turning a blind eye to drug dealers? Very few options for addicts apart from Opiate Substitution Treatment (OST) like methadone? Abstinence is a dirty word in the AOD treatment industry? The biggest advocates for drug prohibition are former addicts? An addict’s last hope is naltrexone implants? The “methadone industry” benefits greatly from a large number of patients? Nearly every point Devine makes is a fantasy dreamt up to support the “drug free world” illusion. This is not worthy of publication in Mad Magazine let alone the Sydney Morning Herald.

Devine argues that Opiate Substitution Treatment (OST) like methadone is evil and abstinence only programs are unfairly being ignored by a greedy, self serving “methadone industry”. The attack includes her old favourites, Harm Minimisation and the NSW government whilst flying the flag for the "War on Drugs". It’s standard fare for Miranda Devine.

But abstinence has no place in the curiously monocultural drug and alcohol world of NSW

-Addicts Say Abstinence Sets Them Free by Miranda Devine - Sydney Morning Herald

So what is the basis for Devine's article? Believe it or not, it’s a few recovering drug addicts who disagree with the mainstream. Three out of hundreds of thousands who have benefited from OST, declare they were not happy being on methadone and buprenorphine. I know first hand that methadone or buprenorphine is not for everyone but that’s not unusual for any medication or treatment. But the facts speak for themselves. Opiate Substitution Treatment (OST) is the most successful treatment we have readily available for opiate addiction. That’s not to say that abstinence only treatment doesn’t have a place in recovery but unless an addict is 100% ready to quit, it’s pointless. Devine's solution is naltrexone implants. Whilst implanting naltrexone is fine for some, pushing patients into this treatment has shown to have dire consequences including death. Devine and co. feel that being totally drug free should be the only goal of drug treatment including programs like the Narcotics Anonymous(NA) 12 steps program, drug free detox centres and of course naltrexone implants. But this model of abstinence only treatment has really only been mainstream since prohibition where before that, the actual drug of addiction was prescribed to the addict until they were ready to quit. It seemed to work very well until the conservative, religious loonies got involved. Now many decades on and with a world where abstinence treatments compete heavily for the this lucrative market, addiction rates remain as they were a hundred years ago when they first stared recording these statistics. The big difference is the number of relapsing patients thanks to abstinence only programs.

Reuben, too, was prescribed methadone when he sought help for his addiction. He was given no other option but to accept addiction for life, a slave every day to the methadone clinic he hated.

-Addicts Say Abstinence Sets Them Free by Miranda Devine - Sydney Morning Herald

It’s difficult to examine the example addicts in Devine's article without knowing more details. The story of Sam being put on buprenorphine appears inappropriate but ironically, once out of jail he was back on heroin. Both Sam and Rueben have only been clean for less than 8 months which is way too early to examine their success. The real danger comes when their naltrexone implants stop working and they relapse. With no tolerance to opiates, even a tiny dose of heroin will kill them. But that’s not important. What counts to Devine and co. is that these addicts are now clean and whether they relapse and die doesn’t matter.

Methadone

Three grumpy, recovering heroin addicts does not compete with the success of OST. Methadone Maintenance Treatment(MMT) was never meant to be a cure for heroin addiction but a way to stabilise a patient’s life. It removed the insatiable need to feed their addiction every day which often involved crime. It allows time to re access priorities and slide back into society giving addicts the chance to work and function like everyone else. Using methadone as a holding treatment until the patient is ready to start a decline in dose wasn’t the standard practice until the last few decades. This has lead to a popular belief that those who don’t completely stop methadone are not successful. And that’s where Miranda Devine’s article fails once again. To ignorant, moral conservatives like Devine, abstinence should be the only goal and methadone is seen as some sort of excuse that just keeps a patient addicted. She is either unwilling to allow medical facts and logic to overcome her conservative views or she’s just thick. The other option is she doesn’t really care and is simply a dickhead.

Devine uses psychologist Ross Colquhoun to back up her argument against methadone. Colquhoun makes some remarkable statements and assumptions that plainly show how wrong Devine is.

The Government does not have an exit strategy for people on methadone, who they are prepared to leave addicted for ever

-Dr. Ross Colquhoun

This is simply a lie but it’s not uncommon for anti-Harm Minimisation zealots to take myths and declare they are facts. It’s only recently that doctors have started to rethink their strategy for some methadone patients. Nearly all patients were weaned off their dose over a period of time but doctors have started to concentrate on keeping some patients stable and maintaining a steady dose. Contrary to Colquhoun’s claim, most MMT patients still have a reducing dose with the goal of abstinence.

Methadone has a place in treatment in the short term but many people grow out of it and want to get on with their lives

-Dr. Ross Colquhoun

Methadone was never meant to be a short term treatment but with pressure from anti-drug groups and tossers like Colquhoun, the push was on to produce results. For naive governments and abstinence only supporters, success meant addicts being totally clean. There was no room to count rehabilitation whilst on MMT as a success as it only muddied their results. This lead to pushing addicts thorough the system quicker. Being on treatment wasn’t enough, they wanted clean, fully recovered patients regardless of relapse. You probably have heard it before from politicians who call methadone, "liquid handcuffs" or claim addicts are just swapping one addiction for another. A recent announcement from Scotland said that they were considering the removal of MMT and replacing it with abstinence only programs. The reason was of course that too many addicts were still on methadone. Bronwyn Bishop and John Howard have made a point of it, Fred Nile raised it in parliament, John McCain tried to introduce a similar bill in the US and several UK politicians have pushed for it. All of these attempts are based on ignorance and winning popularity. The fact is, OST has helped millions of people worldwide and is accepted by addiction specialists as the best solution currently available.

Naltrexone

I have experienced Rapid Opiate Detoxification (ROD) and naltrexone first hand. Luckily for me, the naltrexone was administered by taking a pill each day because after 3 days, I had a bad reaction and had to stop taking it. If it was an implant, I probably would have taken the same course of action like many others and cut it out myself with a razor blade. The ROD was the worst experience of my life which left me almost comatose for 2 months. So what was the problem? Apart from being on a high dose of methadone, naltrexone didn’t agree with me. Those pushed into naltrexone implants don’t have the easy option to simply stop taking a pill and must request that it be removed surgically. Fat chance of that. The main problem with naltrexone implants is the risk of overdose. If the patient does cut it out or the implant ceases to work, they are left with no tolerance to opiates which means their next hit of heroin might be their last. There are dozens of cases of death from overdose after naltrexone treatment and usually from those who were coerced into receiving the implants. 

What most people don’t know is that naltrexone implants have not been approved by the Therapeutic Goods Administration (TGA).  For 10 years, the biggest clinic in WA which is funded by the government, still has to get a special permit to operate because the implants have not been approved yet. The clinic, Fresh Start is using a clause in health legislation that allows experimental treatments for life-threatening conditions. There have been many articles and reports criticising the practice but the faithful continue to praise the treatment as the only way forward for opiate addiction. The push for naltrexone implants comes from several dedicated anti-Harm Minimisation warriors including Drug Free Australia (DFA), Bronwyn Bishop, Dr. Stuart Reece and Dr. George O’Neil. The latter two being owners of addiction treatment centres who specialise in these implants. Reece was once charged with the deaths of 25 patients and was investigated for treating a pregnant addict although naltrexone implants were never cleared for use during pregnancy. Both Reece and O’Neil are opponents of needle exchanges, OST and even promoting condoms for safe sex. They frequently use quotes from the bible and other religious symbolism in their quest for abstinence only treatments and Reece even went as far as saying that “Jesus cures addiction". These 2 doctors are the basis for the promotion of naltrexone implants. Not because they offer some magic formula for curing opiate addiction but because it is an alternative to OST and Harm Minimisation. Naltrexone implants stop the effects of heroin and force the patient into total abstinence which is the key to it’s popularity amongst the religious right, moral crusaders and prohibitionists. Damn the results, the deaths and the relapses. Who cares if someone is not suited to an implant ... it’s not Harm Minimisation!

Zealot

What drives Miranda Devine to repeatedly push myths and misinformation onto the public? What does she have to gain except criticism from those who are more knowledgeable than her? Every time she writes about drug related issues, dozens of people expose the flaws and fallacies in her article which would be enough to force most writers to re-examine their views. It would at least prompt most writers to double check their facts. 

Devine despises Harm Minimisation and believes that drug use is an issue of law and order. She is a self confessed supporter of the "War on Drugs" and will go to great lengths to discredit any opposition.  Devine has no ability to accept modern medicine and scientific research if it steps on her ideology. It feels remarkably like someone who believe in creationism and who will do anything to prove science wrong for their convictions. These are not the traits of an intelligent, rational adult but a fanatic, obsessed by misguided dogma, fighting their own fears. Ignoring facts and evidence are the traits of a zealot - a person who is fanatical and uncompromising in pursuit of their religious, political, or other ideals, someone who considers their own views more important than those of experts, someone who believes their own bullshit. Having an opinion is one thing but misleading and deceiving nearly a million readers is bordering on the edge of lunacy. 

Addicts Say Abstinence Sets Them Free

By Miranda Devine

Sydney Morning Herald

May 23, 2009

When it comes to drug prohibition, the biggest advocates are former addicts, if you can find any in NSW, where abstinence is a dirty word and the state requires its heroin users to be sedated on methadone for the rest of their lives. 

Just ask addicts what they thought of the harm minimisation experiments of the 1990s, when police were instructed to turn a blind eye to drug use in Cabramatta, Australia's heroin capital.
"While it's so easily available its always a problem," says Reuben, 28, a former heroin and methadone addict who has been drug-free for four months. In the mid-1990s, he was smoking marijuana every day, when he and his friends started riding the train to Cabramatta to get heroin.
"I avoided it for a little while but it was so good, so pure, so easy to get. Police never told the dealers to back off. A 13, 14, 15-year-old kid doesn't know right from wrong.
"You use it because it's there and because the people around you use it."
Sam, a 30-year-old former heroin addict, is still angry when he talks about Cabramatta. "You couldn't ride on the train without people asking you 50 times [if you wanted to buy heroin]. Why did the government stop police from arresting [dealers]? There were no police whatsoever. It was a safe haven for heroin dealers. It isn't good for us … We need prohibition."
Sam ended up in jail, where he took the opportunity to go cold turkey. He spent three days in a dry-out cell, enduring the nausea, diarrhoea, hot and cold flushes, insomnia, pain and stomach cramps. He spent the rest of his three-year sentence drug-free - or he would have. Three months before he was due to be released he was told that, as a heroin user at risk of relapse, he would have to start taking a highly addictive synthetic opiate, buprenorphine, or "bupe", a methadone substitute, or he would not get parole.
"I didn't want another habit," Sam says. "I kicked the habit when I got locked up. [But] you've got no option." He describes bupe and methadone as "liquid handcuffs". He left jail a buprenorphine addict, and was soon back on heroin.
Reuben, too, was prescribed methadone when he sought help for his addiction. He was given no other option but to accept addiction for life, a slave every day to the methadone clinic he hated.
The harm minimisation industry philosophy that holds sway in NSW is that once you're an addict, you are always an addict. But, for those who don't want to spend their life as a drug-addicted zombie, there are few options.
One of their last hopes is the psychologist Ross Colquhoun's addiction clinic in Ultimo, the only place in NSW to perform rapid detoxification on addicts using implants of the non-addictive drug naltrexone, which blocks the effects of opiates on the brain for about three months.
This morning two addicts will undergo the rapid detox, sedated and under the supervision of a doctor and two registered nurses. Their physical cravings gone, they will need counselling and further implants but, like thousands before them, their chances are good, Colquhoun says, of freeing themselves from addiction.
But abstinence has no place in the curiously monocultural drug and alcohol world of NSW. And so Colquhoun's naltrexone clinic has been under heavy fire for 10 years, with 10 complaints to the Health Care Complaints Commission - all cleared - withdrawal of a federal grant, and general bad-mouthing, to the point where one staffer says: "We are being treated like a backyard abortion clinic in the 1950s."
Two weeks ago came the latest blow that may prove to be the killer, when the NSW Department of Health's Pharmaceutical Services Branch withdrew permission for the clinic to use a morphine drug (MS Contin) as a "bridge" for detoxing methadone addicts. Because methadone is so addictive and causes such terrible withdrawal problems, addicts must abstain for at least five days before detox. Switching to MC Contin stops cravings and is easier to detox.
Critics regard naltrexone as a tool of "coercive abstinence". They say it causes deaths because, when the implant effect wears off, an addict's previous resistance to heroin is gone and they can overdose.
But what is the alternative?
"The Government does not have an exit strategy for people on methadone, who they are prepared to leave addicted for ever," Colquhoun says. "Methadone has a place in treatment in the short term but many people grow out of it and want to get on with their lives."
The methadone industry is booming. Figures from the Australian Institute of Health and Welfare this week showed the number of people on methadone has almost doubled since 1998, up from 24,600 to 41,300 last year, with the majority of doses dispensed privately. No wonder the methadone industry is defensive.
Colquhoun regards methadone as an instrument of "social control".
"They want to keep you nice and happy and sedated and drugged," says Jodde, who managed to wean herself off a massive 120-milligram daily dose of methadone three years ago.
"I was like a vegetable … The doctors, the police, they're all working to keep you in a shithole.
"Once you're a methadone addict, you're public property. You're a piece of crap; you have no rights. It's degrading. You go to seek help and that's what happens."
Sam and Reuben have overcome their addictions so far with the help of naltrexone. Sam has reunited with his family, and has not taken drugs for eight months.
Reuben is at TAFE studying adult literacy. "I've only just started enjoying being straight. It's a dramatic change from not being able to do anything.
"I feel productive for the first time in my life. I haven't ever really felt that."
You need a good reason to deny Reuben that chance.

Related Articles:

Miranda Devine, Drug Prohibition, Abstinence, the war on drugs and the herding of cats

The Ballad Of Alex And Miranda

A Devine Nutter & That Booklet

Miranda Devine - Bitch Slapped by the Doctor

Are Flat Earth Journalist Intelligent? No ... Just Dangerous

What Does Prescription Heroin Really Mean for Junkies?

Switzerland has just become the first country to include prescription heroin as part of official government policy after a referendum voted 2 to 1 in favour of it. Although the 1300 patients who already receive prescription heroin in Switzerland are breathing a sigh of relief, what does it mean to addicts worldwide? Will other countries follow suit and if so, what will be the criteria to be accepted into the program? 


Also heroin trials to date have focussed on one or maybe two cities in each country so that leaves the vast majority of addicts not able to participate until the trial is either extended to cover other locations or it becomes government policy like Switzerland.

Swiss Approve Prescription Heroin BBC 

 

(mmmmm . . . look at all that heroin!)

Swiss voters have backed a change in health policy that would provide prescription heroin to addicts. 

Final results from the national referendum showed 68% of voters supported the plan. The scheme, where addicts inject the drug under medical supervision at a clinic, began in Zurich 14 years ago before spreading across the country. But in another referendum, the Swiss appear to have rejected the decriminalisation of cannabis. 

The heroin vote was one of a series of referendums held to decide policy on illegal drugs. The policy is described as one of last resort - prescribing addicts with the very drug that caused their problems in the first place - but supporters say it works, and Swiss voters appear to have agreed, the BBC's Imogen Foulkes in Berne says. Switzerland would be the first country to include it in government policy. 

Supporters say it has had positive results - getting long-term addicts out of Switzerland's once notorious "needle parks" and reducing drug-related crime. 

Opponents say heroin prescription sends the wrong message to young people and harms the addicts themselves.

Firstly though, congratulations to the Swiss for leading the world in common sense and pragmatic health policies. The world owes a lot to the Swiss (and the Dutch) for having the courage to care more for their people than pleasing the United States or hysterical religious groups. 


Secondly, we shouldn’t forget that this is the second attempt at trying something new. The first project, dubbed Needle Park was a failed experiment but it was still recognition that treating addiction with strict law enforcement wasn’t working. 


There have been several heroin trials now and all with very positive results. Even though they have all been successful, only 2 trials have developed into more permanent programs. One in Switzerland and the other in The Netherlands. Spain, Germany, Belgium and recently Canada have all held heroin trials with the UK’s trial finishing shortly. Also Denmark has announced they will be commencing a 2 year trial with a few other countries toying with the idea. 


Whilst many heroin addicts must be relieved to hear the good news of an ever expanding prescription heroin trend, the reality is not as rosy as it seems. Geographically, it is impossible to include everyone in a trial which is not the objective anyway. Most trials last about 2-3 years and for a program to be approved and operated in other cities, it may be 4 or more years away. Then you have to qualify them. At the moment, trials are for hard core, long term addicts who have failed other treatments and continue to participate in risky behaviour. I think the general consensus is that only the homeless or really desperate addicts will get in on the trials but established heroin assisted treatment (HAT) programs encompass other long term users more readily. But what about those functioning heroin addicts with jobs who appear to live a relatively stable life? Are they eligible? 


This site has shown many functioning addicts who remain outside the law by using and/or selling an illegal substance and are kept in a world of shame by hiding profound issues from their families. The binding thread is that they have all failed repeated attempts at treatment. Will they ever be included in a program for prescription heroin or are they not considered ‘desperate’ enough. A cynic could argue that these addicts might be excluded because they won’t contribute to the success statistics of such a program when there’s no room for improving key issues like homelessness, employment and health. A slap in the face really for those addicts who have been strong enough to stay employed or healthy whilst living with the nightmare of addiction.

As an addict in Vancouver for 38 years I was certain I would have no problem attending the program. It seems they only took Downtown addicts which gave them a very limited demographic and my calls went from wait to forget it. You could contact the NAOMI people if you want info but you'll be searching through an unpublished project.I hope you discuss parameters as most trials make getting off of heroin a prerequisite, which kills the project as you may well imagine. Harm reduction and working and happy clients should be the goal.Don't let them set you up to fail. [...] In my case I offered to move to the moon if transport was available. They seemed to have some issue with my actually having a roof over my head. They seemed to think that if you had it together enough to actually pay rent you didn't need a maintenance program. 
-Terry McKinney. Vancouver BC

I imagine some addicts would consider changing their lives dramatically if prescription heroin was available but not where they live. The opportunity to receive clinical grade heroin as part of their treatment is a huge temptation which I can testify to. Although prescription heroin may have been perfect for myself a few years ago, I am happy on my current treatment. The idea of injecting daily again or having to visit a clinic twice a day doesn’t appeal to me currently and it’s bound to be the same for other recovering addicts on substitution treatment. That’s if we were eligible at all.

HAT will expand over the next decade as it’s success becomes more accepted by governments frustrated over current drug policies and so will the requirements for entry into the programs.

Heroin is basically non toxic and users are able to lead relatively normal lives if they don’t have to deal with the consequences of it’s illegality. Most of the problems associated with heroin addiction are purely because of man made laws and not the drug itself. Issues like the spread of blood borne disease (Hep C, HIV/AIDS etc.), crime, health, employment and social exclusion are recent problems caused solely by treating this medical condition as a law and order issue.

Before the 1960s, some countries already treated opiate addiction with either morphine or heroin and there were very few problems. Back then, a great proportion of addicts eventually weaned themselves off opiates and went back to their normal lives, often over a 5-7 year period which is sometimes called the natural addiction cycle. It’s ironic that in this age of advanced technology and medicine, we are starting to revert to treatments from over 50 years ago.

On a sad note, there are many who criticise HAT for all sorts of reasons except those that count. There’s the “sending the wrong message” argument and the “we should be getting them off drugs” excuse. These are all just philosophical opinions that have no bearing in the real world and are just placing the morals of drug use above the health and well being of someone with a medical issue. Associated Press reported that one opponent of the Swiss decision, Sabine Geissbuhler from Parents against Drugs was so adamantly opposed to the program that she publicly stated:

I would never, never, put my children into a heroin prescription programme. What kind of freedom is that? I'd rather they were dead -Sabine Geissbuhler - Parents against Drugs

Releated Links: 
Swiss vote on radical heroin rules 
Swiss likely to approve prescription heroin

Prescribed Heroin Project 'Promising'

For many hardcore heroin addicts, the hustling begins first thing in the morning. They wake up with one thing in mind: How to get their next fix. Some turn to panhandling, prostitution or crime to come up with the cash for drugs. But a heroin study seems to have changed that for some Montreal addicts.

Prescribed Heroin Project 'Promising' Brett Bundale The Gazette June 2008

North America's first research study on medically prescribed heroin will wrap up in a few weeks. The goal of the North American Opiate Medication Initiative, funded by the Canadian Institute of Health Research, is to examine harm reduction and the treatment of illicit drug use.

The $8-million clinical trial started in 2005 in Montreal and Vancouver, the site of Insite, North America's only safe-injection site.

As the project winds down, Quebec is considering setting up a safe-injection facility in Montreal, Health Minister Philippe Couillard said Wednesday.

But unlike a safe-injection site, where addicts inject themselves with their own street drugs under the supervision of a nurse, the research study uses medically prescribed pharmaceutical-grade narcotics.

Although the findings will not be published until the fall, the preliminary results are promising, said Suzanne Brissette, one of the study's doctors and the lead investigator in Montreal.

"The cost effectiveness will be an important part of our findings," Brissette said.

In addition to the human costs, an untreated heroin addict costs Canada an estimated $45,000 a year in public health care, criminal justice and welfare.

Similar studies in Europe suggest prescribed heroin programs can save the public nearly $20,000 a year per addict, after research and clinical costs are factored in.

The North American study offered addicts information about how to avoid some of the risks of drug use, like using shared or unsterilized needles, and how to manage - if not kick - the habit.

Heroin users are at risk of developing abscesses, contracting such diseases as HIV/AIDS and hepatitis C, and other problems related to adulterated heroin sold on the street.

In Montreal, addicts were allowed to come to the clinic three times a day to get their fix.

"What was surprising was that, as their lives gained stability, many came only twice a day," Brissette said.

In addition, the maximum heroin dose allowed was about 400 milligrams, but on average addicts chose to take only 170 milligrams at a time.

"Because the heroin was free, people thought an escalation in use would occur. But this didn't happen," Brissette said.

The study followed a strict recruitment process.

"There was a fear we'd attract more users by giving out free heroin," Brissette said.

"The participants had to have repeatedly failed the standard treatment," Brissette said, which involves oral methadone, a drug similar to morphine, as a substitute for heroin.

Once selected, nearly half the participants underwent the standard methadone treatment. The other 55 per cent received either heroin or another opiate that is injected, hydromorphone.

Many users put on weight and some managed to find jobs, Brissette said.

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