Dr Ross Colquhoun

2011-01-24T16:36:00.001-08:00

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

2011-01-20T02:49:00.000-08:00

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

Methadone

2011-01-12T18:43:00.000-08:00

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.

Addicts urged to go cold turkey

2011-01-12T17:33:00.000-08:00

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/

2011-01-09T16:09:00.000-08:00

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

Can You Beat Heroin? Note 4

2010-07-13T20:00:00.000-07:00

Can You Beat Heroin?

Stories of those who have become clean and still are doing well.

FS: I was the first person in NSW to receive a naltrexone implant in 2000. Prior to this I had a long history of heroin dependence. My life was chaotic, I had overdosed on several occasions and I was unable to function or achieve my goals. Since then I have not looked back and I am now employed full-time, I am married and have two lovely children. I cannot imagine what my life would be like now without the help I had from Psych n Soul.

GT: In 1993 I suffered severe neck and back injuries following a MVA. I suffered from persistent pain and became addicted to prescription opiates. By the time I found Psych n Soul I was being dosed on over 800mg of morphine daily. As time went on my doctors became more and more concerned about the level of pain-killers I needed just to function. There was pressure on me to go on the methadone program, which meant that my confidentiality in a small town would be compromised and I would be seen as a heroin addict. I became obese, I suffered mood swings, I could not work, my marriage was failing and I was profoundly depressed.

I have come back into Psych n Soul with my husband to thank them for the help you gave me four years after my detox and implant. I think you were shocked to see me as I was smiling (and so was my husband), I had lost a lot of weight, I felt so happy and I was working in a Health Centre as a nurse. I had not been able to work for about 6 years prior to this. When I was asked to record my story I was only too happy to do so. Thanks to Dr Ross and the team I am now well and suffering less pain than I did when I was addicted to morphine.

ME: I heard that Psych n Soul were being attacked and read the stuff in the press which I thought was rubbish about naltrexone killing people. I have offered to speak in public to support the program. My story is that about three years ago I got detoxed and had an implant. At that point I had just got out of jail and was determined to get my life on track and not go back. I now run my own small business, I employ two people, I have a lovely girlfriend and I go back to my old school to tell students about what happened to me and to warn them not to go down that path to destruction. I owe my new life to Psych n Soul

DR: When I was addicted to methadone (on it for 10 years) I felt that I was mentally and physically unwell and that I would not survive much longer. I was suicidal, I was in fear of certain people at the methadone clinic and I was addicted to benzos that I got from people hanging about the clinic. I was constantly harassed by people wanting to buy my methadone.

Today I have just given birth to my beautiful little girl. I am married to a great guy who doesn’t use drugs and up until recently I was working full-time in a shop. I cannot imagine that this would have been remotely possible without the Psych n Soul program. By the way I never paid a cent and I still don’t know why you decided to help me.

SB: When I arrived at Psych n Soul I thought I was mad and that I could never get my life on track. I had only recently tried to kill myself by shooting up as much hammer as I could lay my hands on, but no luck. A local guy (some pathetic hero type saving the girls from sin I suppose) from the Hillsong Church offered to help me get off the gear, but I thought if you are stupid enough to pay well let them. My mother injected me with heroin when I was twelve. I had a habit by the time I was 14 and my mother was selling me to who ever could pay. By the time I got to do the rapid detox I was 19, I had a girl who was 3 years old and I was shacked up with a customer I didn’t trust with her and who regularly knocked me around.

I remember the counsellors from Psych n Soul hung in there with me for 6 months and slowly I started to feel better and even gave up my pot. More than that I started to feel lime I had some brains and that I could do better.

I remember the shock on your faces and the tears in your eyes, when I walked in the door of the clinic two and half years later to tell them I had just finished my 2nd year of a law degree at UWS. Not bad since I left school when I was twelve. I have since gone on and finished the degree and have been doing my time with a community legal service in Blacktown. As I have quite few convictions I might not be admitted to the bar, but I going to try and anyone no-one can take this from me and I can still be qualified to give legal advice to people like I once was and maybe inspire them to do better.

Dr Ross Colquhoun
http://addictiontreatment.com.au/
D H Sc, M App Sc (Neuroscience), B Sc Hons (Psych), Grad Dip Counselling and Psychotherapy, Member of College of Health Psychologists, MAPsS, MACCP, MAPSAD,
Registered Psychologist; Clinical Director, MindCheck Wellness Centres, Addiction Treatment and Psychology Services, Ultimo.

Can You Beat Heroin? Note 3

2010-07-13T19:58:00.000-07:00

Can You Beat Heroin?
Will it work for me?

Okay so rapid detox and naltrexone implants can go a long way to get the addict on track, but what do you need to do and can you do it?

Obviously no-one can do this for someone and those looking a for a magic bullet will be disappointed. You can lead a horse to water……

Just as obviously, detoxing will entail a certain amount of discomfort including up to two weeks with low energy, little sleep and no appetite, while the natural opiates (known as endorphins) are produced again. Some people coming off methadone will also suffer with some cramping and diarrheoa. So a level of tolerance for this discomfort will be required.

And you ask yourself: what if I do all this and then just relapse. With everyone’s expectations so high and the risk of disappointment so great the pressure will really be on. You have probably failed many times before and you can’t really see why it might be different. The slaps on the back with people saying how great you are to be clean, getting a job and being normal after a week or so only increases the pressure and adds to the mix a deep sense of being a fake as you know you are not so sure it is going so well…. In fact it feels just the opposite… if this is well I might as well be back there on the gear because at least I know where I stand!

Much of the time people become addicted to opiates because the emotional or physical pain you carry is too great. Chronic pain is not well understood and when no physical cause can be found the person in pain finds they are treated as if it is your fault you can’t work or be the life of the party. You are treated like you are bludgers and you start to feel like one. Opiates relieve the pain, but they also make you feel much better about yourself. As the effect slows down over time you need to take more to relieve the pain, you get addicted. A double whammy: not only a bludger, but a junkie.

Young people often leave home, get into the ‘wrong’ group, and start drug use in their early teens. You don’t leave home because you want to but mostly to escape a situation that is intolerable and where you have experienced physical, psychological and sexual abuse that happens in seemingly ordinary families. More than that it feels good and helps numb-out the hurt and at least those around understand what you feel because they have been there too.

The belief is that if you stop using drugs all the pain you are trying to kill off will be all that you are left with, with no-one to help or even understand.

So it is important to sense that those who want to help you know this and there is a feeling that with compassion comes understanding and with understanding comes an ability to self-sooth and to deal with it without drugs.

The most important thing is that you can talk to someone like you who has done this and, while still shaky if it has only been a few days since their detox, they are doing OK. In the next blog I share some examples of the people I have known who are doing well some years later.

Dr Ross Colquhoun
http://www.addictiontreatment.com.au
D H Sc, M App Sc (Neuroscience), B Sc Hons (Psych), Grad Dip Counselling and Psychotherapy, Member of College of Health Psychologists, MAPsS, MACCP, MAPSAD,
Registered Psychologist; Clinical Director, MindCheck Wellness Centres, Addiction Treatment and Psychology Services, Ultimo.

Can You Beat Heroin? Note 2

2010-07-13T19:54:00.000-07:00

Can You Beat Heroin?

Do I have a Problem?

Firstly, the addicted person needs to realise he or she has a problem. Often young people early in their addiction can’t see what is clear to others around them. You still think its fun or tough; that it makes you stand apart from others and that you are different; it makes you feel special, part of an exclusive club; and mostly it makes you feel good when there seems to be not much else going for you. While parents and friends only see lost opportunity, loss of friends and all that is worthwhile and the possibility of disease or death the addict seems not to see any of this. While family and friends are often on a roller-coaster of anger, fear and exasperation, the addict is just focused on his or her next fix as if it is more important than living. Family and friends often have trouble recognising the person they once knew, while the addict thinks those you thought you once knew have now turned on you.

What Help can I get?

Secondly, once you realise you have become addicted and it is no longer fun and it no longer feels good you need to believe that you can do something to help yourself. If you have learned to survive by lying, you become involved in crime and prostitution, witnessed friends die and been to jail and feel that your family no longer loves you, as often you have stopped loving yourself, the good feelings are replaced by a deep sense of shame and guilt. When you are in the middle of your addiction you often feel useless and worthless and that you deserve what you get …. You feel unable to believe that you can be any good as you have changed forever and so have those who you once looked to for support or that you deserve the help you now need.

Does it work?

Thirdly, you need to believe that those who offer help can in fact help you, and that it is worth it especially if there are strings attached. Parents and some therapists think that they can shame you into change and yet it is shame you most vividly feel and this response only makes it worse as it confirm that no-one cares about you. Some believe that punishment will wake you up and yet this means you often end up feeling completely worthless and in the company of those who don’t really care about you, but who share your predicament .

Some also believe that there is no solution, just a matter of reducing risk by putting people on methadone. While it reduces some of the harms associated with heroin addiction it means that it is harder to detox and get clean and almost no hope of being normal.

On the other hand it seems that in an society where drugs are readily available conventional detox and treatment fails far more often than it succeeds. So what to do?

Evidence indicates that relative to conventional procedures, after rapid detoxification more patients transfer to the opiate-blocker naltrexone and stay opiate free in the short-term, but that this does not guarantee being drug free in the long term. In studies where patients are allocated to either rapid detoxification or more conventional detoxification procedures such as a methadone taper lasting one or two weeks or a clonidine-based conventional inpatient detoxification, all the rapid detoxification patients tend to complete the procedure and start to take naltrexone compared to 25% to 30% completion rates for the conventional treatment.
However, by 12 months all those who had completed detoxification had made substantial but equal reductions in use. These studies suggests that with low levels of support after detoxification (monthly counselling or none at all), rapid detoxification’s advantage in starting more people on naltrexone does not automatically lead to better long-term outcomes for those who managed to complete detoxification. And yet this is a good start, but it is not the whole story.
The factors that tend to improve outcomes include selection of those who are most likely to succeed, involvement in an integrated counselling program that deals with other issues such as chronic pain, psychological and social problems and a significant time free of opiates. People taking naltrexone tablets orally often stop too early and then fall back into heroin use. Naltrexone implants that last from 3 to 6 months provide some of the solution, but again the changes the person makes while drug free is the most important factor in maintaining abstinence.

In the next blog I talk about whether treatment will work for you and your addiction to heroin or methadone.

Dr Ross Colquhoun
http://www.addictiontreament.com.au
D H Sc, M App Sc (Neuroscience), B Sc Hons (Psych), Grad Dip Counselling and Psychotherapy, Member of College of Health Psychologists, MAPsS, MACCP, MAPSAD,
Registered Psychologist; Clinical Director, MindCheck Wellness Centres, Addiction Treatment and Psychology Services, Ultimo.

Can You Beat Heroin? Note 1

2010-07-13T19:42:00.000-07:00

Can You Beat Heroin?

People often talk to me about the “addictive personality”, suggesting that the person who gets addicted to opiates has some fatal flaw… that somehow you are different from the rest of us. It seems to imply that a person, once addicted to heroin or methadone is “always addicted”.

In some ways there is some truth in these statements. For sure, if there is a history of addiction in a family it is more likely that a person might use drugs and then become addicted. We know that some people seem more likely to get addicted than others. In other words, genetics or our inheritance or race plays a role. Probably, more important is the environment we grew up in. A family where drug use is common can mean that children see this behaviour as normal and the chances are that you have been psychologically effected and disadvantaged in other ways. Drug use is closely related to depression and anxiety especially among those who have low self-regard or confidence or who feel valueless or useless.

However, the most important factor in getting people started on excessive and damaging drug use is its availability, that is, how easy it is to get and how cheap it is. When there are lots of drugs about, we know where to get them easily, our friends are using them and, at least to start with, they are cheap. If there is no obvious deterrent, if we believe the chances of being caught are not high it is more likely people will start using, you will get addicted and find it harder to stay clean if you detox.

All this does not mean that a person cannot strive for a drug free life and have confidence that you can do it. It just means that for some you will need to try a few times and you are more likely to need help.

We know that each year many hundreds of people begin drug use and many of these people will get addicted and yet the total numbers addicted to drugs remains the same over prolonged periods. In fact over the past 10 years there has been a large decline on the numbers addicted to heroin in Australia, because of the heroin drought. Whatever caused it, it had the effect of pushing many people to stop. Numbers of addicts have dropped from around 70,000 to about 40,000. In this same period deaths have declined from around 900 each year in 1999 to a bit over 300. Also, the numbers on methadone have grown steadily from 30,000 to just under 40,000. So what happened to all those others who stopped your heroin addiction. So some 10,000 went onto methadone (or buprenorphine), some 4000 tragically died, some took up other drug use and stayed in the lifestyle, but its clear that the majority got clean, cold turkey or with help, and just got on with your lives and left their using days behind.

The people who continue to use heroin have often been using for a longtime or find it really hard to stop and will need help to stop. However, if the right strategies are in place anyone can successfully detox and look forward to a life without addiction, which is your prison and stops you from having a normal life. And of course many will go on and off methadone and some will be content to get dosed for the rest of your lives.

So what are the factors that predict if a person can beat heroin and get back to being normal?

The first factor in beating heroin is to acknowledge that you have a problem and need to get help. In the next post to my blog I talk about this and what help is effictive in beating heroin and then follow up with some of the many success stories from people who have got clean.
Dr Ross Colquhoun
http://addictiontreatment.com.au
D H Sc, M App Sc (Neuroscience), B Sc Hons (Psych), Grad Dip Counselling and Psychotherapy, Member of College of Health Psychologists, MAPsS, MACCP, MAPSAD,
Registered Psychologist; Clinical Director, MindCheck Wellness Centres, Addiction Treatment and Psychology Services, Ultimo.

Mindcheck

2010-06-10T18:49:00.000-07:00