Heroin treatment also works on cocaine: study

Methadone, a drug used for many years to treat heroin addiction, appears to work well in cocaine addiction, too, a new Canadian study suggests.

Psychologist Francesco Leri of the University of Guelph has been making rats addicted to cocaine, and then treating them with methadone.

Most of the rats responded well, he says. They lost their powerful urge for cocaine, and in addition, their brains "re-set" themselves into the same pattern that existed before they first used cocaine.

"It can be done tomorrow with humans, and should be done tomorrow," he said.

That's because methadone -- unlike a new drug -- already exists as a tested drug, with clear prescription rules and clinical staff trained in giving it out.

"There is an entire system that is already in place for the employment of methadone," that could be used for cocaine addicts.

Mr. Leri said the U.S. National Institute for Drug Abuse is looking into the use of methadone -- or a similar drug such as buprenorphine -- in a clinical setting.

The idea came up because in real life, people mix drugs.

There's no such thing as a "pure heroin addict," he said. "The norm is people who are addicted to opiates, so heroin or prescription opiates, and they co-abuse cocaine at the same time."

Researchers have wondered what happens to their cocaine problem when they start taking methadone for the heroin addiction.

But it's hard to tease apart the two addictions in humans. In his Guelph lab, Mr. Leri worked on rats with a cocaine addiction, but no exposure to heroin.

The cocaine-addicted rats in his lab didn't get a cocaine high on methadone, he said. Instead, "the methadone may be able to curb the desire that they have for that drug (cocaine)."

In addition, methadone actually reversed changes in the rats' brains that are caused by cocaine, and are known to play a key role in addictive behaviour.

"What's interesting is that, among the rats given cocaine and then methadone, these regions of the brain looked similar to how they appeared in the rats that were never exposed to cocaine.

"We feel we may have the hope of re-setting the brains of some individuals to a type of normality," he said. "I think it should be tried and I guarantee you there will be some individuals -- not everybody -- who will do better on methadone, who will be stabilized on methadone."

The study means a person who is motivated to stop taking cocaine may benefit from methadone as one tool to help, the psychologist says.

"You cannot give methadone left and right and hope that it is going to work. You need to work with individuals who in addiction to social support, in addition to cognitive therapy, will need something to curb their desire" for cocaine.

His study is published in European Neuropsychopharmacology, a research journal.
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source: The Ottawa Citizen

Methadone Legal under the UN Drug Conventions, according to...the UN Drug Conventions!

Over the past week, the HR2 team has been reading through our recently arrived (and notoriously difficult to obtain) copies of the Official Commentaries on the 1961, 1971 and 1988 UN Drug Conventions, as well as the Commentary to the 1972 Protocol amending the 1961 Convention.

These four volumes, each several hundred pages in length, are the official explanatory notes from the UN itself to member states on how to interpret each of the articles in the Conventions. In essence, the Commentaries put ‘meat on the bone’ in providing detailed guidance to states on what the drug conventions mean, don’t mean and how they are to be interpreted and implemented.

Already we are finding some interesting material.

For example, the Commentary on the 1988 Convention under Article 3 (Offences and Sanctions) expressly recognises methadone as a legitimate form of treatment. To quote the Commentary:

‘The 1971 Convention and the 1961 Convention as amended by the 1972 Protocol include a provision (identical in the two texts) to the effect that when drug abusers have committed offences under the Convention, the parties may provide, either as an alternative to conviction or punishment or in addition to conviction or punishment, that such abusers undergo measures of treatment, education, aftercare rehabilitation or social integration. Paragarph 4, subparagraphs (b), (c) and (d), of the 1988 Convention, while drawing upon that earlier provision, widen the scope of application to drug offenders in general, whether abusers or not.’ (at para 3.106) [emphasis added]

Leaving aside the antiquated language of ‘abusers’, what the 1988 Commentary reiterates is the support found in all three Conventions for drug treatment instead of, or in addition to, penal sanctions for drug offences. This is not news. What is interesting, however, is where the Commentary on the 1988 Convention goes on to define what the Conventions mean by ‘treatment’.

As stated in paragraph 3.109 of the Commentary:

‘”Treatment” will typically include individual counselling, group counselling or referral to a support group, which may involve out-patient day care, day support, in-patient care or therapeutic community support. A number of treatment facilities may prescribe pharmacological treatment such as methadone maintenance, but referrals are most frequently to drug-free programmes.’ [emphasis added]

Paragraph 3.110 of the Commentary also lists 'a maintenance programme' within the definition of legitimate - and therefore legal - 'aftercare' programmes.

But the 1988 Commentary is not the only one that cites substitution treatment as a legitimate and legal intervention.

The Commentary on the 1971 Convention also lists 'medically justified "maintenance systems"' under the definition of 'treatment' (at page 332, para 3, fn 1080) and a 'maintenance programme' within the definition of 'after-care' (at page 332, para 4). The Commentary to the 1972 Protocol to the 1961 Convention similarly lists 'medically justified "maintenance programmes"' within the definition of 'treatment' (at page 84, para 3, fn 4) as well as under 'after-care' (at page 85, para 4).

So according to the official UN Commentaries, methadone maintenance is an accepted form of treatment and after-care under all three Drug Conventions, and is explicitly recognised as being legally consistent with the definition of these terms under the Conventions.

This will certainly come as news to the Russian Government, which prohibits methadone on the claim that it is illegal under the Conventions. As stated by Russia’s Minister of Internal Affairs Boris Gryzlov in 2003, the country’s prohibition of methadone was ‘not the government’s own initiative…but rather the result of our responsibility to implement the UN drug conventions of 1961, 1971, and 1988.’

Just the opposite, methadone is expressly allowed under all three Conventions according to the official Commentaries.

It might also come as news to the International Narcotics Control Board, whose record of luke-warm support for methadone is chronicled in the excellent 'Closed to Reason' report produced by the Canadian HIV/AIDS Legal Network and the Open Society Institute.

For the benefit of the Russian Government, the INCB and the many others who could benefit from access from these hard-to-find Commentaries, IHRA is currently working with Transform Drug Policy Foundation to make them available online.
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source: http://www.ihrablog.net

Who lives in a park? Who lives in a cage?

Thanks to blogs of David and others from Wired In, I am slowly getting familiar with the current situation in drug policy and services in UK and I read the debates around its expected transformation with a lot of concern. As I understand it (and correct me if I am wrong…), the situation has reached the point when methadone treatment is applied as a number 1 choice for heroin users who may then stay on the substitution for a long time without any (or only small) additional support.


In Czech Republic, we experience a different situation, partly because of the fact that heroin is not as popular here as in UK and partly because of the fact that not many practitioners or psychiatrists are actually willing to prescribe any kind of substitute drug. But it seems that the general direction goes towards more methadone and Subuxone prescriptions. I do not think it is bad but it needs to be followed by efficient and improving ways of recovery. Apparently, the problem starts when these approaches are seen as binary oppositions. Then, this „treatment“ x „recovery“ controversy would remind me of similar contradiction between a cage and a park.


The famous experiments with rats in a cage with access to unlimited source of heroin or cocaine are well known. A surgically implanted catheter was hooked up to a drug supply that the animal self-administered by pressing a lever. Their increasing consumption of the drug was used as an explanation for the assumption that the drug is causing the addiction which is progressive and leads to death.


Professor Bruce Alexander, a Canadian psychologist from Simon Fraser University, tried similar experiment, but with an alteration. He did not place the rats into a cage, but into an „Eden“ for rats: it was a place 200 times larger than the cage, there were cedar shavings, boxes, tin cans for hiding and nesting, poles for climbing, and plenty of food. Also, because rats live in colonies, the „Rat Park“ housed sixteen to twenty animals of both sexes. Bruce Alexander put there two bottles: in the first one, there was plain water, in the second one, there was a morphine-laced water.


The results were very clear: unlike rats in cage, the rats in park preferred the plain water to the morphine. The modification of this experiment was that the rats had access only to the morphine water for some time.After several months, a bottle with plain water was added and the rats in the park were more likely to switch to the water! „Addiction“ did not seem progressive, chronic and untreatable any more. More importantly, it seemed that it is not the drug that induces the addiction.


People do not live in cages. But we do not even live in parks. However, in some conditions, life can look like a cage, the same as life can look like a park. Since drugs, as heroin or cocaine, may be the only possibility how to cope with life in a cage, in a park, it is one of the many options. And what needs to be said: people are not at the same distance between cage and park. But even if some are caught in a cage, many of them find their way to the park.

Obviously, we want to help people who are in a cage. As I see it, methadone makes the life in cage less stressful. Recovery is a way from the cage.
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source: http://pavelwiredin.blogspot.com

Rehabbing: Abstinence vs. methadone

It’s not a news flash that Pike County has an above average percentage of drug abusers, nor is it a revelation that opiates are the drug of choice for most of the area’s addicts.

And, with the recent trial of Billy Reed, who was convicted of manslaughter for killing a motorcyclist while driving under the influence of methadone and other drugs, some in the county have questioned methadone’s use in the treatment of opiate addiction.

One of methadone’s opponents is the state’s largest anti-drug coalition, Operation UNITE, which favors abstinence-based treatment.

“In general, UNITE is greatly concerned about any method that would treat addiction without counseling. Methadone just exchanges one drug for another. We don’t see it as an effective way of treating a person with substance abuse issues,” said UNITE Communications Director Dale Morton.

Joe Chapman, the director of the methadone-prescribing Williamson Treatment Center, disagrees.

“I’m a firm believer in abstinence (treatment), and it works for a lot of people. We’re here for those it doesn’t work for,” he said, adding that those being treated with methadone, as a requirement to receive the drug, must attend counseling treatment.

And, while abstinence-based treatment is the more noble of the two, methadone treatment is arguably the more successful one. According to UNITE’s Web site, of the 1,591 adults and juveniles who have entered its drug court program, only 594, or 37 percent, have graduated.

“Most that go through treatment end up relapsing,” admitted Morton, who added it takes several rehabilitation attempts, in many cases, to achieve success with abstinence-based treatment.

Conversely, of the 200 people currently under treatment at the Pikeville Treatment Center, 85 percent of those, “maybe more,” are being treated successfully, according to Dr. Steven Lamb, who prescribes methadone at the clinic.


Strengths

Chapman said 86 percent of the 700 patients treated at his center are performing successfully.

Success, however, in terms of methadone, does not equal rehabilitation as it does with abstinence treatments. Addicts do not stop being addicts because they switch from heroine, Oxycontin, Lortab, or another opiate, to methadone, which is also an opiate, said Lamb. They are merely addicted to a less-destructive drug.

Success with methadone, said Lamb, is defined when a person stops committing anti-social acts and begins committing pro-social acts. In other words, “they stop robbing drug stores and selling their babies’ diaper money,” and, instead, they become better parents, get jobs, or, in some way, they become more beneficial to society.

Part of methadone’s success — and in UNITE’s shortcomings — can be attributed to the nature of opiate addiction, which, according to Chapman, is “the most difficult addiction to overcome.”

Lamb said the reason it is so hard for opiate addicts to stop using is that after a person has been on narcotics for a long time, something happens to his brain. He said even people who have been using for a short time have trouble, because once they stop taking the drugs, they get sick and suffer withdrawal symptoms.

For these reasons, addicts “can’t go 24 hours without thinking where the next pill is going to come from,” he said, and obtaining more drugs become the addict’s constant thought.

Lamb said methadone is successful because it allows people to stop craving street drugs. Under medical supervision, a “therapeutic dose” can be obtained, which is strong enough to block the thought of drugs from a person’s mind, but not so strong as to make the person drowsy.

Because patients are less plagued by the thought of drugs, they can focus on improving their lives and are able to search for friends who aren’t drug users. Finding friends who do not use, said Lamb, greatly reduces chances of relapse.

Unfortunately, what makes methadone is so successful at treating opiate addiction is also liable for the negative aspects of the treatment.

Drawbacks

While it is a safer opiate alternative than street drugs, it is not a less addictive one, and people usually stay in methadone treatment for years or longer.

“Once you start (methadone), it’s terribly hard to stop,” said Lamb.

Chapman said the average treatment time for patients in the Williamson clinic is three years.

Lamb said the treatment at the Pikeville clinic takes no less than six months, but, for some, it takes years, and others may never stop treatment.

Lamb said the more slowly one comes off the drug, the better chances he has of staying off. But, staying off, said Lamb, is even harder than getting off.

He said many times people who successfully stop taking methadone or other opiates go about six or 12 months and then “the get in a rut. They start to feel awful and give up.” When they feel bad, he said, they often go back to using street drugs.

Methadone itself is a street drug, and can be harmful when used in that scenario.

The Kentucky Office of Drug Control Policy said methadone was the leading cause of overdose deaths in the state during 2006, and was detected in 41 percent of the 484 overdose death cases throughout the state. May times other drugs were also detected along with methadone.

But Chapman said clinics are not to blame. Though they do get blamed for the drug’s diversion onto the street, in reality, he said, clinics are only responsible for a small fraction of the methadone on the street.

Lisa Walls, assistant director for the Kentucky Division of Mental Health and Substance Abuse, agrees. She said most of the methadone obtainable on the streets was prescribed by private doctors, some of whom can prescribe the drug for pain, but not addiction.

Walls said the majority of street methadone is in the form of tablets, but methadone clinics only dispense liquid methadone, because it has less abuse potential.

While a physician may write a monthly prescription for pain, the most that can ever be taken out by a patient at a methadone clinic is a week’s dosage, and only a handful of patients are even allowed that much.

For a patient to be able to take out one day’s dose of liquid methadone, he has to have been a patient at the clinic, passing every drug test, and participating in counseling, for at least 90 days in Kentucky, or at least 30 days in West Virginia. For a patient to be able to take out a week’s worth of methadone, he has to have been a well-behaved patient for over a year, in Kentucky, or nine months in West Virginia.

Relapses

Another problem with methadone treatment arises, as with the case of Billy Reed, when a patient on methadone relapses back to taking street drugs. Though mandatory drug testing is performed at clinics in both states to detect this scenario, even if a patient is found to be taking other drugs along with his methadone, he has to be weaned off the drug. Prescribers cannot just stop giving the drug to non-complying patients right away.

Testimony and evidence showed that Reed had methadone, Xanax, Valium and alcohol in his system in a blood test taken two hours after the wreck on Jan. 7 that killed Ronnie Church.

According to Lamb, it is very dangerous for a patient taking methadone to also take street drugs, especially if those drugs are Xanax and alcohol. He said the combination of Xanax, methadone and alcohol is deadly, and is the cause of most methadone-related overdose deaths.

Another dangerous consequence of a patient on methadone taking street drugs is that it impairs their driving ability, which methadone, when taken properly and by itself, does not do, said Lamb.

And, as the area has recently witnessed, when patients decide to use their methadone as an ingredient in their drug “cocktail,” and then decide to get behind the wheel, deadly consequences can arise as well, though not always for the drug abuser.
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source: Appalachian News Express

Substance and Substitution

Reviews
'Substance and Substitution is an extremely impressive work of scholarship and a genuine advance on existing studies of methadone maintenance treatment and of drug use more generally. It marries innovative theory with diverse empirical materials, and goes beyond a number of well-established binaries (e.g. resistance/conformity, social/material, body/mind, morality/medicine) in trying to understand the ‘co-production’ of substance, time, identities and gender.' - David Moore, Associate Professor, National Drug Research Institute, Australia.

Description
Located between three powerful phenomena, public health, the law and social stigma, methadone maintenance treatment attracts loyal advocates, vociferous critics and innumerable engaged onlookers. This book combines contemporary science studies theory with in-depth interviews, policy documents and media texts to examine this controversial approach to addiction, providing a unique approach to the understanding of illicit drugs. Arguing that methadone maintenance treatment depends for its rationale on two contradictory, yet equally powerful images - the disordered, compulsive heroin user and the responsible, choosing subject of contemporary health care - this book traces the ways the program both reproduces and disrupts conventional understandings of what it means to be human, a citizen, a woman or man, questioning, as it does so, the conditions under which treatment is delivered.

Contents
Introduction
1 Substitution, Metaphor and Authenticity
2 Governing Treatment
3 The Chronotope of the Queue
4 Treatment Identities
5 Repetition and Rupture: The Gender of Agency
Conclusion: Dependence, Contingency and the Productivity of Problems

Author Biographies
SUZANNE FRASER is Lecturer at the Centre for Women's Studies and Gender Research, Monash University, Australia. Her research interests include gender, science, the body and health. She is the author of Cosmetic Surgery, Gender and Culture.

KYLIE VALENTINE is a Research Fellow at the Social Policy Research Centre, University of New South Wales, Australia. She is the author of Psychoanalysis, Psychiatry and Modernist Literature.
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Publisher : Palgrave Macmillan

Methadone Deaths Gain Attention Of Medical Examiners

Formerly a drug used only to treat heroin addiction, methadone is becoming more popular in recent years to treat pain.

As the use of the drug increases, so too do the deaths at an "alarming rate," according the National Drug Intelligence Center. Florida has become one of the leading states for methadone overdose deaths, according to the Center for Disease Control.

Now, authorities are wondering if methadone may be fatal even in therapeutic doses.
"I would never let anybody in my family take methadone unless they were a heroin addict to begin with," said Hillsborough County Medical Examiner Vernard Adams.

The chairman of the Florida Medical Examiners Commission on Friday distributed a study to other commissioners citing increased instances of sudden deaths among methadone users.

Researchers in Oregon reported in the study published last month that methadone has been implicated as a likely cause of sudden death at therapeutic doses. In the study published in the American Journal of Medicine, the researchers recommended clinical safeguards and further studies designed to enhance the safety of the drug.

Adams said he's also noticed some methadone-associated deaths that are different from other deaths attributed to drug overdoses.

In addition to the fact that deaths are occurring at therapeutic doses, Adams said some methadone deaths involve heart issues. Most drug overdoses involve respiratory failure, Adams said.

But Adams said he has no statistics and cannot cite specific cases related to this possible phenomenon. He said he just has a general sense that this is something that should be examined.

"The fact that these people are dying from methadone at therapeutic concentrations, this is anecdotal," Adams said. "We haven't studied it the way these people in Oregon have."

In Hillsborough County, methadone was listed as a contributing cause in 37 deaths in the first six months of last year. Methadone was listed as the only cause in five deaths. In 2006, methadone was listed as a cause in 49 deaths, according to medical examiner data. In ten deaths, methadone was listed as the sole cause. In 2005, methadone was listed as a cause in 30 deaths in the county and as the sole cause in 10 more.

The numbers reflect a trend in Florida, where methadone was listed as a cause in 392 deaths in the first six months of 2007 and in 716 cases in all of 2006, compared with 2005 when the drug was a cause in 620 deaths.

Stephen J. Nelson, the chairman of the state Medical Examiners Commission, distributed the Oregon study at the commission's regular meeting. Nelson said he wanted medical examiners to be aware of the potential problem and to be on the lookout. It's possible, he said, that the commission may attempt to track methadone levels in the deceased.

In November, the National Drug Intelligence Center published a study titled, "Methadone Diversion, Abuse and Misuse: Deaths increasing at Alarming Rate." According to the report, the quantity of methadone dispensed nationwide more than tripled between 2001 and 2006.

The report described methadone as "safe and effective when used as prescribed," but said the drug has increasingly been misused and abused.

Methadone has been used in addiction treatment for the past 50 years, according to the report, which noted that the drug's use in pain management has increased steadily since the late 1990s. Physicians turned to methadone as an alternative to oxycodone and hydrocodone, which were being increasingly abused. It also can be used less frequently and is less expensive than other drugs, the report states.

source: msnbc.com