Ultra Abstinence Approach?

I'm glad I'm not a drug addict in Ireland:

Two doctors specialising in treating substance abuse in Dublin have called for new thinking in treatment services and say doctors need to be aware that the evidence-base shows that abstinence in opiate drug addiction treatment does not work.

...Dr Quig­ley believes some doctors take an “ultra abstinence approach” which doesn’t necessarily work in drug addiction.

Says Dr Quigley: “As we have gone along with the metha­done programme we have abandoned some previous processes like attempting to pressure addicts to detox. On the basis of medical evidence, that just doesn’t work and creates more difficulties.”

Dr McGovern supports this view: “Unfortunately, evidence doesn’t support this [abstinence] approach and very few would remain free of opiates, and with any illicit substance, relapse is the norm.”

Both doctors say most general adult psychiatrists seem to advocate an abstinence ap­proach for opioids, and say the historical approach of abstinence and Alcoholics Anony­mous for alcoholism simply does not work in drug addiction treatment. “If you bring that sort of thinking in automatically into drug addiction, you are liable to get it wrong. You have to leave that approach outside the door of the surgery,” Dr Quigley adds. He also expresses concern about the abstinence ap­proach taken by the country’s forensic psychiatry services. “The Central Mental Hospital is strongly abstinent in orientation and that is where the problem arises with retaining dangerous addicts in treatment,” says Dr Quigley.

If that doesn't convince you that they've got an addiction stigma problem, it appears that they have a problem finding treatment for all of the violent drug addicts:

While there is a debate over whether patients who are violent should be excluded from treatment, either for a period, or for good, Dr McGovern says he believes that the patients who are violent are the very ones who most need treatment.

Both doctors believe the lack of services in which to refer violent patients on to is a major flaw in the system.

Dr Quigley adds: “Some people threaten the medical staff, and smash our vehicles or assault us. If they manifest that, we have to be able to pick up the phone [to the central treatment centre in Trinity Court]. If you can’t say that, and have to say ‘you’re barred from the clinic,’ you’re likely to be assaulted personally.”

Dr McGovern calls for better training for staff in dealing with violence. “Such patients need to be treated in a unit that is safe for both staff and other patients. The unit needs to be staffed by professionals who have specialist forensic psychiatric experience. I also believe that treating patients in a secure unit is only half the battle. Patients need to be offered treatment that ad­dresses aggressive behaviour.”

But often, no help is available to violent drinkers, says Dr Quigley. “They are getting no help because the addiction services that exist are not attractive to them, they are too rigid and not geared to people who are still drinking,” adds Dr Quigley.

While working in an agency that's treated over 10,000 of the poorest and most severely addicted people in our region, this has never been more than a rare problem.

Narcotic Meds for Back Pain Questioned

This caught my attention and has some practical application, for physicians treating back pain--they should engage in pretty tight follow-up of they are prescribing opiates on long term basis for back pain. What I found more interesting is that this figure of 24% matches previous "capture rate" data pretty closely.

While the pain may be relieved to some extent over the short-term (3 months), the risk of addiction and long-term effectiveness may override any temporary benefits.

Researchers from the Yale School of Medicine found use of opiods for short-term relief of chronic back pain lead to behaviors of opiod abuse in 24 percent of the cases reviewed.

Congress raises buprenorphine patient limit

The 2000 legislation that authorized doctors use of buprenorphine for outpatient opiate detox limited doctors to a maximum of 30 patients. Last week, congress passed legislation that would raise the limit to 100 patients. Our own Carl Levin co-sponsored the bill.

Opiate Addicts Find Fewer Hospital-Run Detox Beds Available

Michigan is not alone in the decline of treatment and detox services:

Addicts who overdose on heroin or other opiates are likely to land first in a hospital emergency room, where doctors can often save them from brain damage or death.

For many of those who want to get clean, the next step is a hospital-run drug detoxification program. There, patients are physically and emotionally prepared to move into a long-term recovery program.

But with fewer detox beds available, some of Long Island's hardest-core opiate addicts are finding it harder to take that crucial step. St. Catherine of Siena Medical Center in Smithtown shut its 12-bed unit in July 2005, and Southside Hospital in Bay Shore shut its 10-bed unit in April.

According to the New York State Office of Alcohol and Substance Abuse Services, these closures followed two others at Long Island hospitals in 2002 and 2003. All told, the number of beds reserved for the sickest addicts has dropped 69 percent in the last four years, from 81 beds in 2002 to just 25 in 2006.

Hat tip - New Recovery

Ice addicts flood injection rooms

A safe injection center in Australia is experiencing unanticipated problems with meth addicts:

Injecting centre medical director Ingrid van Beek said eight per cent of the 220 addicts using the centre each day were injecting ice - more than twice the number 18 months ago.

"Ice changes people's behaviour in such a dramatic way and can be quite scary,'' she said. '

"People become incredibly strong and quite aggressive, and that's what makes the impact of this drug greater.''

Staff had undergone additional training to manage abusive behaviour among ice addicts and to identify the early signs of psychosis, Ms van Beek said.

"Staff have to be aware of how to manage that sort of crisis situation, and our staff are specially trained in that.''

Ms van Beek said that if people showed sings of emerging psychosis, they were counselled and not allowed to enter the centre.

The Sunday Telegraph approached several addicts outside the injecting centre who admitted to using ice inside.

One man said staff did not check the type of drug he injected.

"I just don't tell them. They don't care; they just write you down on a piece of paper,'' he said.

"You just say, `I'm doing hammer (heroin)' and go boom, boom quickly. Just keep it quiet.''

Another addict, calling himself Ace, said: "Hell yeah, bro, it's a proper sealed joint in there with security guards and all. You can do what you want.

"It's amnesty once you cross the door; cops can't touch you.''

A security guard at the Mansions nightclub, across the road, said ice users were often seen stumbling on to the street, drug-fuelled and aggressive.

"They must be on ice - they're screaming and ranting and raving,'' he said.

Methadone Substitute: New And Cheaper Way To Treat Heroin Addiction

A cheaper and safer alternative to methadone. How does it compare to buprenorphine?

In contrast to methadone --which comes in liquid not tablet form -- dihydrocodeine is much easier to store and comes under less stringent regulations because it is not as toxic and less likely to cause a fatal overdose. It is estimated that whereas methadone treatment can cost almost £1,500 annually per patient, the cost of dihydrocodeine is £713.