I read the news of increased funding for drug treatment with much interest
as it is a welcome change of direction. I also read the article in the
Herald with Ingrid van Beek suggesting the evidence shows that methadone
is preferable to no methadone. Of course this only relates to people who
use heroin (you notice they don't mention this). It does not include the
many thousands who are dependent on morphine who are, or were, chronic
pain patients who are much worse off on methadone (although many are
forced onto it) and it certainly does not relate to those thousands who
are drug free.
The vast majority of people who have been dependent on heroin have at some
point quit and gone on to live productive lives and they are much better
off than living for the rest their days on a dangerous and highly
addictive synthetic drug. There is only a small proportion who benefit
from methadone otherwise it just tends to perpetuate their addiction well
beyond the time they would otherwise have stopped.
For that group who need to stay on methadone there is a need to make it available, however with more people exiting from methadone and less people joining the program more time and effort can be provided for adjunctive services such as counselling. And of course it means that here are more places for those who want to transition from heroin to methadone.
Naltrexone has now been shown to be highly effective in getting people off
opiates, especially methadone, as tapering over time just doesn’t work,
and of course the research shows that naltrexone implants have overcome
the compliance issues of oral naltrexone and results are very good with
very few adverse events these days.
The clinic has been prevented from doing detoxes while we are being licensed. The Dept has dragged out an 8 weeks process to 9 months with no end in sight
Even though there is a strong desire within the Dept of Health to develop an
effective exit strategy for people on methadone.
We are getting lots of calls from people who are desperate to get clean
who, other than fly to Perth, have no options now other than methadone.
Some have suggested they would like to do something and I have encouraged
them to write to their members of parliament.
For moer information go to my website at www.addictiontreatment.com.au
Monday, January 24, 2011
Thursday, January 20, 2011
Today’s announcement by the Liberal opposition promising to increase spending on treatment places to help heroin addicts overcome their problems is a major advance in the way we approach the problem and a welcome relief for those who are wanting to beat their habit, but are only offered methadone.
Those who suggest that being on methadone is better than being drug free are imposing a very biased and destructive set of values on those who want other alternatives. To deny a person the right to seek help to be drug free, especially the great majority of those who cannot get off methadone and are actively discouraged from trying to do so, is coercive and a denial of those peoples' right to choose.
The dubious statistics that are quoted by the methadone supporters suggesting that people are better off on methadone are misleading. The figures quoted relate to those who are on heroin, but do not hold for those who are drug free. Clearly someone who is drug free is much better off on all measures compared to someone addicted to a dangerous, unhealthy and highly addictive drug. To suggest that people can't become drug free and stay that way is also completely misleading as thousands of people have had an addiction at one time in their lives, but go on to lead normal and productive lives. If they could never attain drug-free status then the numbers addicted to opiates would be in the hundreds of thousands not the estimated 40,000 that are currently dependent on heroin. The numbers on methadone have increased significantly over the last 10 years (and some are still addicted after 25 to 30 years) from some 10,000 to over 19,000, while the numbers dependent on heroin have been halved over the same period. Thankfully most of them gave up often with help and never succumbed to the methadone trap.
More damaging is the phenomena of people who have chronic pain issues becoming addicted to morphine and then dosed on methadone to then be trapped in a lifetime of dependency and stigma.
The evidence is now overwhelming that naltrexone used both for detoxification and then as an implant to protect a person form re-addiction for a time sufficient to set out on the road to recovery, is highly effective and, moreover, cost effective.
You can read more about how naltrexone can free people form opiate addiction by going to my website at www.addictiontreatment.com.au
Those who suggest that being on methadone is better than being drug free are imposing a very biased and destructive set of values on those who want other alternatives. To deny a person the right to seek help to be drug free, especially the great majority of those who cannot get off methadone and are actively discouraged from trying to do so, is coercive and a denial of those peoples' right to choose.
The dubious statistics that are quoted by the methadone supporters suggesting that people are better off on methadone are misleading. The figures quoted relate to those who are on heroin, but do not hold for those who are drug free. Clearly someone who is drug free is much better off on all measures compared to someone addicted to a dangerous, unhealthy and highly addictive drug. To suggest that people can't become drug free and stay that way is also completely misleading as thousands of people have had an addiction at one time in their lives, but go on to lead normal and productive lives. If they could never attain drug-free status then the numbers addicted to opiates would be in the hundreds of thousands not the estimated 40,000 that are currently dependent on heroin. The numbers on methadone have increased significantly over the last 10 years (and some are still addicted after 25 to 30 years) from some 10,000 to over 19,000, while the numbers dependent on heroin have been halved over the same period. Thankfully most of them gave up often with help and never succumbed to the methadone trap.
More damaging is the phenomena of people who have chronic pain issues becoming addicted to morphine and then dosed on methadone to then be trapped in a lifetime of dependency and stigma.
The evidence is now overwhelming that naltrexone used both for detoxification and then as an implant to protect a person form re-addiction for a time sufficient to set out on the road to recovery, is highly effective and, moreover, cost effective.
You can read more about how naltrexone can free people form opiate addiction by going to my website at www.addictiontreatment.com.au
Wednesday, January 12, 2011
Methadone
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.
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.
Addicts urged to go cold turkey
Addicts urged to go cold turkey
By Julie Robotham Medical Editor
First published December 3, 2005 (SMH)PEOPLE who use the heroin substitute methadone will be encouraged to kick their drug addiction completely using a treatment that sends them into immediate withdrawal, under an option being considered by the federal health department.
The Health Minister, Tony Abbott, confirmed he wanted to expand access to rapid detoxification services using the drug naltrexone, which fights addiction by neutralising the body's response to opioids such as heroin and methadone.
The plan, which ups the ante in the Government's abstinence-based Tough on Drugs strategy, comes in response to the growing number of people in long-term treatment with methadone.
In NSW the number of people treated with methadone or an alternative, buprenorphine, has doubled over a decade, and stood at 15,523 last year. Based on an estimate from the National Drug and Alcohol Research Centre that methadone costs on average $9.63 daily per patient, that is a total of more than $50 million annually in NSW alone.
"Methadone is an important part of our response to the drug problem, but in the end it's just a substitution of a legal for an illegal product," Mr Abbott said.
"It doesn't stop people being addicts … This Government would like to see people off drugs. One accepts that naltrexone treatment in this country is not always regarded as mainstream … but I think it shows great promise. It has this great benefit that it controls the craving."
Mr Abbott said he had asked the department to advise on ways of making the treatment more widely accessible. At present there is no Medicare funding for the detox procedure - performed under sedation in doctors' rooms.
Naltrexone is subsidised through the Pharmaceutical Benefits Scheme for alcohol addiction but not for drug use.
Mr Abbott last month made a $50,000 special grant to the Sydney-based Psych n Soul clinic, which offers rapid detoxification, slow-release naltrexone implants to help people remain drug-free, and intensive counselling. A West Australian clinic has also received a $100,000 grant.
Ross Colquhoun, Psych n Soul's director, said he would use the money to reduce the $4000 price of the program for people who could not otherwise afford it.
Methadone was "a form of social control", Mr Colquhoun said. "There's no exit strategy."
Mr Colquhoun said one in three of his clients were users of methadone rather than heroin.
But David McGrath, the acting director of NSW Health's Drug and Alcohol and Mental Health programs, defended the number of people on methadone. "In terms of a starting point for best health outcomes and social outcomes, methadone's clearly the best place to start," he said.
The longer people remained on methadone, the relatively healthier they were.
Research had indicated people found it hard to stick with naltrexone, and those who began using opiates again after a rapid detox were at increased risk of overdosing because their bodies were no longer tolerant to the drug, Mr McGrath said.
NSW already provided detoxification services for people on methadone, based on phasing down the drug dose over a month of in-patient care, and would soon open an additional seven beds.
For further articles go to http://www.addictiontreatment.com.au/Sunday, January 9, 2011
We are presenlty involved in the process of becoming licensed to provide rapid detoxification for people who are dependent on opiates, including methadone and morphone for people who are chronic pain sufferers. We have successfully done this now for over 12 years. Research shows that rapid detoxification is not only highly effective, but cost effective. The research of Dr Jon Currie also concludes that it is also safe. If this is the case then those who want to be free of opiate addiction should be able to access these services. I would like to hear from people who have benefitted. For more information contact www.addictiontreatment.com.au
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