Thursday, December 3, 2009
Saturday, September 19, 2009
Heroin trials welcome - but the wait has cost lives
Heroin trials welcome - but the wait has cost lives
Transform yesterday wholeheartedly welcomed the results of the heroin prescribing trials (as reported by the BBC), and the understanding that these pilots would be rolled out further still – perhaps to four or five new locations.
However, as the RIOTT Trials are published to much celebration, what have we really discovered?
That problematic heroin users do better on legally regulated pharmaceutically pure diamorphine, than street junk - they steal less and their health improves
That should not be news to anyone. I realised during my third or fourth interview yesterday, that the feigned shock from radio presenters that the Great British Public would be funding heroin users ‘addiction’, should be as nothing compared to their real shock that we are all funding the prohibition that leads users to steal and compromises their health in the first place.
Whilst the presumed roll out is to be welcomed, one has to ask why it has taken so long to come to this conclusion. Evidence has existed for years that, for those assessed as having a clinical need, heroin prescribing will keep them alive, improve their health and wellbeing and reduce the collateral damage of their use to wider society. Indeed there has been a barely concealed sense of inevitability about these trials; the strong impression being that they were needed to provide political cover for a roll out, rather than to provide yet more evidence of the blatantly obvious.
Of course supervised use of legally regulated supplies of heroin significantly improve the lives of users, who otherwise have commit crime to raise money to score dirty drugs from gangsters, for consumption using dirty paraphernalia in marginalised and unsafe environments. The lesson here is that moves to take users out of the illegal market and into a regulated supply where drugs are quality controlled will produce the kind of outcomes we all want to see.
The fact is that thousands of long term dependent heroin users have died, or contracted serious diseases in the last three decades because of the failure of Government to maintain or develop heroin prescribing services. And, with the Department of Health playing badly strung second fiddle to the Home Office, much of the medical establishment has been complicit in this tragedy by maintaining a deafening silence.
But NHS heroin isn't the only way forward here; access to cheap smokeable opium from licenced outlets would also achieve significant decreases in crime and improvements in health, as it would also promote transition towards safer products, using behaviours, and using environments. We would hope too, that the next round of trials includes provision of oral morphine (and possibly other pill form synthetic and semi-synthetic opiates), which will be effective for many, and is also dramatically cheaper, and safer, than injectable dry ampules.
The substantially increased cost of prescribing injectable heroin, compared with oral methadone, must also be seen in the context of the Macfarlane Smith monopoly on the UK opiates market that the Department of Health buys from. That means that the UK pays well over the odds for our diamorphine (£12,000 a year per user), compared to the Dutch (£2000 a year for the same product). This artificial cost barrier has been a major political obstacle.
Finally, let us hope that these trials pave the way to more discussion of how best to control and regulate drug supply and use, beyond the limited numbers able to avail themselves of medicalised heroin. And that those members of the medical establishment who have held this initiative back, feel their consciences pricked and support a scheme that could save the lives of hundreds more in the future.
Sunday, August 23, 2009
Heroin better than Methadone for hard-core drug addicts: Study
Chicago, August 20: A key ingredient of heroin could be the safest and most effective treatment than methadone or other treatments for hard-core heroin addicts, a new study by Canadian researchers has found.
The study, titled North American Opiate Medication Initiative (NAOMI), found giving pure, pharmaceutical heroin to hardcore drug addicts at a supervised clinic could lead to a higher rate of recovery than giving them methadone, a substance that has been used for decades by some addicts to try to control their heroin cravings.
Diacetylmorphine more effective than methadone
The NAOMI report, published Thursday in the prestigious New England Journal of Medicine, suggests that the key ingredient in heroin- diacetylmorphine – is more effective in treating longtime addicts than methadone.
In the study, addicts who received injections of prescription heroin were more likely to stay in treatment than those who got methadone.
The study participants who were treated with the diacetylmorphine were 87 percent more likely to stick with rehab compared to 54 percent on the methadone program.
“It showed that heroin works better than methadone in this population of users, and patients will be more willing to take it,” said Dr. Joshua Boverman, a psychiatrist at Oregon Health and Science University in Portland.
Dr. Boverman believes the reason why the methadone treatment is not taken by many addicts is that they “don’t want to take it; they just don’t like it”.
To reach their findings, the Canadian researchers conducted a trial in which 226 long-term addicts, who had failed at least twice to kick the heroin habit, were involved.
The researchers divided the study participants into two groups-addicts in the first group were injected with diacetylmorphine while addicts in the other group were given oral methadone, the most widely used treatment.
Study Findings
After one-year of follow-up, the researchers in Canada found that 88 percent of those receiving the heroin compound were still in the study, and 67 percent of them had significantly reduced their drug use and illicit activities.
In the methadone group, 54 percent were still in the study and 48 percent had curtailed their illicit activities.
In addition, the study has found that addicts who were treated with diacetylmorphine “had greater improvements with respect to medical and psychiatric status, economic status, employment situation, and family and social relations”.
“The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits,” concluded Martin T. Schechter, a professor in the School of Population and Public Health at the University of British Columbia, and the senior author of NAOMI report.
Wednesday, July 29, 2009
three upcoming conferences
Drug Policy
2009 INTERNATIONAL DRUG POLICY REFORM CONFERENCE
The biennial conference of the Drug Policy Alliance
November 12-14 , 2009
Albuquerque, New Mexico
Full info on the web site: http://www.reformconference.
Reduced rate for ‘early-bird’ registration, until October 9
If you’re committed to bringing about drug policies based on science, compassion, health and human rights, if you're working in any area of drug policy reform, or want to be, you have to be part of this conversation. There is no better crash course in drug policy than this three-day event.
Canadian delegates will have the opportunity to caucus at this event.
Addiction / Treatment
ISSUES OF SUBSTANCE 2009
'PATHWAYS AND BRIDGES TO CHANGE'
The biennial conference of the Canadian Centre on Substance Abuse
November 15–18, 2009.
Halifax, Nova Scotia
Full info on the website: http://www.issuesofsubstance.
Reduced rate for ‘early-bird’ registration, until September 18
The theme for this conference draws inspiration from the National Treatment Strategy (NTS). Released in November 2008, the NTS sets out a vision and action plan for improving Canada’s substance abuse treatment system. The conference theme explores the personal "pathways to change" that individuals can pursue into and through a tiered model of treatment that strives to ensure services and supports are matched to individual needs, are provided in a timely fashion, and are evidence based. The conference will also examine "system bridges"—some established and others yet to be developed—across the range of services that are important to ensure tightly coordinated care experiences.
Harm Reduction
HARM REDUCTION 2010
'HARM REDUCTION - THE NEXT GENERATION'
The 21st annual conference of the International Harm Reduction Association
April 25 - 29, 2010
Liverpool, England
Full info on the website: www.ihraconferences.net
Reduced rate for ‘early-bird' registration, until January 21st 2010
This conference will look at issues such as the adequacy of existing harm reduction models for low- and middle-income countries, stimulant users and young people, the integration of harm reduction into health systems, and how harm reduction intersects with drug control systems and fields such as human rights, security and development.
A dynamic gathering of academics, activists and people with lived experience
Monday, July 20, 2009
More than 200 heroin addict prisoners forced to go 'cold turkey' win £4,000 damages each for human rights breach
More than 200 heroin addict prisoners forced to go 'cold turkey' win £4,000 damages each for human rights breach
Last updated at 00:37am on 18.04.08
197 prisoners claimed compensation when they were forced to come off heroin in jail
The convicted criminals claimed their human rights were infringed when they were deprived of the heroin substitute methadone and had to go "cold turkey".
A High Court test case involving six prisoners was given the go-ahead but the Government agreed to settle out of court and pay £750,000 to 197 inmates.
When lawyers' fees are taken into consideration, the total cost to the taxpayer is well over £1million.
The payouts were branded "disgusting" today as full details of the settlement emerged for the first time.
Andrew Rosindell, Tory MP for Romford, said: "This is astonishing. It's an outrageous waste of public money.
"You go to prison to receive punishment and drug addicts are supposed to be taken off drugs."
Matthew Elliott, chief executive of the TaxPayers' Alliance, said: "It's disgusting that law-abiding taxpayers are being forced to pay money to these drug-addled criminals.
"If you are in jail of course you should be forced to be clean. The prison system is failing precisely because meddling bureaucrats and foolish legislation stops prison guards doing their job."
The former heroin addicts claimed the cash from prisons around the country.
The prisoners had all been using methadone - paid for the the Government - to combat their addictions.
They claimed their human rights were breached when this approach was ditched in favour of a cold turkey detox.
The group claimed breaches under Articles 3 and 14 of the European Convention on Human Rights - which ban discrimination, torture or inhuman or degrading treatment or punishment - and Article 8, which enshrines the right to respect for private life.
They also claimed they were the victims of trespass in the form of unwanted treatment and accused the Prison Service of "clinical negligence".
A test case involving six of the 197 prisoners was given the go-ahead after a preliminary hearing at the High Court in May 2006.
The prisoner's barrister Richard Hermer, a human rights lawyer specialising in group actions against the Government, told the court: "Many of the prisoners were receiving methadone treatment before they entered prison and were upset at the short period of treatment using opiates they encountered in jail.
"Imposing the short, sharp detoxification is the issue."
Inmates claimed their drug treatment was "handled inappropriately" so they suffered "injuries and had difficulties with their withdrawal".
The full month-long hearing was due to take place in November 2006 but the Government settled out of court shortly before it was due to begin.
The money was then paid out through a set up called the "opiate dependent prisoner litigation scheme".
Among those to receive payouts are six inmates at HMP Altcourse in Fazakerley, near Liverpool, seven at Blakenhurst, near Redditch, Worcestershire, nine at Exeter, Devon, and 11 in Hull.
A Prison Service spokeswoman yesterday said the payments made were a minority of the claims made against the Government by lags but refused to give out details.
She said: "We successfully defend the majority of contested claims.
"We make payments only when we are instructed to do so by the courts or where strong legal advice suggests that a settlement will save public money.
"Each compensation claim received by the Prison Service is treated on its individual merits.
"Legal advice is sought and, on the basis of that advice, a decision is made on whether or not the claim should be defended.
"We cannot therefore comment on individual cases or the reasons that they were settled, as the terms of each settlement vary and may be subject to confidentiality clauses."
There are legal precedents to the settlement. In 2004, Lord Bonomy awarded armed robber Robert Napier awarded £2,400 for enduring the same treatment at Barlinnie prison in Glasgow.
During the same year, gunman George Knights, 46, given nine life sentences for shooting three police officers, repeatedly sought compensation after being refused extra luxuries for his cell.
The Government has paid out £9million in compensation to convicted offenders for a huge range of claims over the last few years.
Pay-outs were made for incidents including assaults by fellow lags, medical negligence and even sporting injuries while exercising in jail.
Government spends £4m on methadone vending machines for prisons
Ministers are spending £4 million on a programme to install 'vending machines' in prisons to supply drug-addicted offenders with methadone, a substitute drug used to wean addicts off heroin.
The Conservatives claimed the figures showed that ministers were prepared to "manage offenders' addiction" rather than tackle the problem.
Phil Hope, a justice minister, told MPs that vending machines have so far been installed in 57 prisons. The machines allow prisoners to receive a personalised dose of methadone automatically by giving a fingerprint or iris scan.
The plan is to have the machines in 70 out of the 140 prisons in England and Wales.
Dominic Grieve, the the shadow justice secretary, said: "The public will be shocked that Ministers are spending more on methadone vending machines than the entire budget for abstinence based treatments."
"Getting prisoners clean of drugs is one of the keys to getting them to go straight. We need to get prisoners off all drug addiction - not substitute one dependency for another. The Government's approach of trying to 'manage' addiction is an admission of failure."
A spokesman from the Department of Health said that the department spends around £240 million on offender health each year – with £40million going on drug treatment programmes.
He said: "Methadone dispensers are a safe and secure method for providing a prescribed treatment. They can only be accessed by the person who has been clinically assessed as needing methadone and that person is recognised by a biometric marker, such as their iris."
Friday, July 10, 2009
2009 INTERNATIONAL DRUG POLICY REFORM CONFERENCE
November 12-14
Albuquerque, New Mexico
Every two years, people committed to drug policy reform from across North America and around the world come together at the Drug Policy Alliance conference to listen, to learn, to network.
Right now, there is a growing realisation that the 'War on Drugs' has, in every respect, failed and that to continue it is folly, pure and simple. Concurrently, world wide, there is unprecedented momentum toward positive change. Clearly it is time to meld these two streams, to strategise, to act.
If you’re committed to bringing about drug policies based on science, compassion, health and human rights, you cannot afford to miss this extraordinary gathering. If you're working in any area of drug policy reform, or want to be, you have to be part of this conversation.Simply stated, there is no better crash course in drug policy than this three-day event.
Full info on the web site: http://www.reformconference.
Reduced rate for early-bird registration
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