tag:blogger.com,1999:blog-4845992337963104415.post7997096677501166285..comments2023-07-30T13:37:17.999+01:00Comments on the prof speaks out: Methadone maintenance in treatment services today: a form of palliative care?David Clarkhttp://www.blogger.com/profile/08173564089937759693noreply@blogger.comBlogger49125tag:blogger.com,1999:blog-4845992337963104415.post-7848562340358796172008-11-06T08:49:00.000+00:002008-11-06T08:49:00.000+00:00"If cancer patients were only offered what am..."If cancer patients were only offered what amounts to a form of palliative care, it would be seen as a scandal" It would be, but ONLY if there were alternative effective treatments, hence the analogy is somewhat flawed. Thats said, I'm behind your general position on this. I speak as someone who's technically still on a methadone script and who has been going in once a month for a 5-10 minute chat with a rather friendly drugs worker, and who pootles off with 2 14-day scripts. Palliative care indeed.<BR/><BR/>But, and I don't think I'm saying something that is over contentious here, a user must want to quit in order to quit. There is no substiture here. Sure, a dramatic intervention (aka a kidnapping, either by the family or the state; i.e. a prison sentence) may work in the short term, but any abstinence is unlikely to last [OK there is the posibility that an enforced withdrawal and major psychological work could make a recalcitrent user quit. I don't know of any theoretical reason why not, but I've just not seen it, so it's statistically irrelevant I think]<BR/><BR/>In terms of harm reduction, and I'm not going to review the literature just to post here, methadone does work. However a lot of methadone users are still using other things on top.<BR/><BR/>So, what's the solution to this? We could say (this list is not exhaustive) a) no more methadone ever, except as a detox agent. b) status quo. c) a greater access to services and information to those that want d) enforced access to services for those that want MMT.<BR/><BR/>I'd think most folk would go for c). I would. When I went in for my latest MMT I wanted counselling. I kind of talked to my drug worker in a general way, but counselling and prescribing should be kept completely apart in my opinion. One might want to say things that could jeopardise one's MMT (i.e. I sell it all to buy H. I don't want to, please help!)<BR/><BR/>"his generally leads people from one addiction to another without providing a realistic opportunity to attain recovery".<BR/><BR/>Again this is wrong, but only because it's been over-egged. There are perfectly realistic ways to obtain recovery, especially in the internet age, when all the information is on tap. Speaking personally for a second, I'm into day 19 off methadone which I quit unaided except for the help of my wonderful wife, and the use of an internet forum (drugs-forum.com). Maybe I'm not real (or simply not realistic whatever that might mean!!!) but I feel rather real, if still a bit gacky from still-not-all-gone w.d.s. For many the 12-steps are a gateway to clean living. I think a minimal treatment is justified in some senses because someone who wants to quit will seek help. The change needed is that a better set of support structures needs to be in place. When I asked about rehab I was told I'd only get a place if I essentially agreed to 6-7? months of primary and secondary care. Sure I could have done this, gone to primary for a few weeks and bolted. I've done the 6-7 month stretch before and it was incredibly helpful, but a second time I think would be unnecessary. I wanted a supportive environment to quit in, where for 4-6 weeks, I'd be able to work on myself, feel shit in as much comfort as possible, etc. But as it wasn't available, no problem.<BR/><BR/>Maybe surfing would be a good analogy; every now and again a wave of desire comes that can be ridden into the sure of abstinence (or whatever. I'm not dogmatic here), but the board (maybe treatment options) and surfer must be ready to take advantage of it. There's bugger-all point of trying to catch a trough, as opposed to a a wave!<BR/><BR/>Finally I'm all against the insulin/methadone analogy. The only truth is that on neither drug do you achieve normality. I've posted a long spiel on the "methadone wellness" thread in drug-forum.com so I'm not going to repeat what I said there here. It's in the addiction > opiates section, and I refer anyone who thinks I could be quasi-intelligent or have an inkling of what I'm talking about there. Of course if you think I'm talking shit, then you should have stopped reading ages ago!<BR/><BR/>Love to all, especially those trying to get off the nasties. It's doable, it's not how I'd like to spend Christmas, but approaching w.d.s with an "it's all good fun" attitude works far better than moping!<BR/><BR/>DickonDr Dhttps://www.blogger.com/profile/17144422750582274697noreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-23858543505498110622008-10-26T17:28:00.000+00:002008-10-26T17:28:00.000+00:00I have been on methadone on and off for over 20yrs...I have been on methadone on and off for over 20yrs. This year is the first time I've been voluntarily clean of class a's since my teens. I have been able to do this only because of the RIOTT(randomized injectable and oral treatment trials)For the 1st time ever I'm working, start studying with the O.U. in March 09, I'm the healthiest I have ever been. I could not have done this without methadone maintanance and don't see why I should change something that quite blatently works for me. Methadone maintanance is not for everyone but for those of us that it does work for should not have to be worrying about losing it because someone decides abstinance is the only way forward.Anonymoushttps://www.blogger.com/profile/12425554293802466589noreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-70573729145852687142008-10-24T11:51:00.000+01:002008-10-24T11:51:00.000+01:00ANON ANONIs thought something that appears out of ...ANON ANON<BR/><BR/>Is thought something that appears out of our experiences and is then deduced by our selves in some part of our conscious or is it a mechanical process that arrives from electrical patterning and DNA based computing. I think it's a quantum question in that it depends who is looking.. <BR/>Here we are debating chickens and eggs and guess what! You're all right and you're all wrong, depending on the observer. As someone earlier said, get over and let's get on with it and just be nice to people (Studies say that is what treatment users want most, not some highly trained robot). Stats show that if you want to stop something will help, just depends at what you arrive at. Choice IS all but some apparent advocates for it (choice) have a really strange way of putting it.<BR/><BR/>By the way methadone deaths are up in Edinburgh but how many more would be dead if there wasn't any available.<BR/>And how many are dying because of the disinhibiting factor of alcohol or benzo's <BR/>And how many sleep problems are due to benzo use rather than 'done<BR/>and i could go on but due to my quantum state I am wondering whether I actually exi...............Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-53514198674095522332008-10-24T09:22:00.000+01:002008-10-24T09:22:00.000+01:00If cancer patients were only offered what amounts ...If cancer patients were only offered what amounts to a form of palliative care, it would be seen as a scandal.'<BR/>Palliative Care is defined as ...<BR/>"Medical or comfort care that reduces the severity of a disease or slows its progress rather than providing a cure."<BR/>I feel as a retired oncology nurse (RN, BSN) as well as a terminal liver cancer patient myself, in addition to being an MMT advocate and patient who is a recovering prescription pill addict I probably am qualified to take issue with this statement. LOL<BR/>There is no cure for addiction. There is only treatment. If you look at the definition I would say "palliative care" applies to ALL forms of treatment for recovery as well as most forms of cancer (since many cancers are only treatable & not curable). This misunderstanding causes a great debate regarding MMT treatment. MMT does not claim to cure only to treat addiction with a medication. Like any illness, one may be able to use the medication for a short time while moving on to non-pharmacological treatments in time while others will be on medication for life. Someone who takes high blood pressure meds for life is not said to be taking them because they are addicted to them. While Methadone can cause dependency those that take it for life are taking it to prevent the recurrence of a chronic illness. Why this is so hard to accept is puzzling to me but even more puzzling is the aggressive behavior some exhibit when discussing this issue.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-41744581145286042592008-10-23T20:30:00.000+01:002008-10-23T20:30:00.000+01:00This comment has been removed by the author.tim1leghttps://www.blogger.com/profile/17060688293127101645noreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-9742968161088766282008-10-23T13:01:00.000+01:002008-10-23T13:01:00.000+01:00Addiction is not a disease ... not even if you spe...Addiction is not a disease ... not even if you spell it in capital letters. Have a read of John Davies' book 'The Myth of Addiction' or Stanton Peele's 'The Meaning of Addiction'. Neither of those two are 'shallow' or 'half-wits' as you charmingly put it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-49408779325026798462008-10-23T10:24:00.000+01:002008-10-23T10:24:00.000+01:00Can I just point out that the response to Tim1leg ...Can I just point out that the response to Tim1leg was not mine! I did state that I believe addiction is not a disease, but please dont think I responded to Tim1Leg in that manner.<BR/>Personally, I am all for choice, and if the recovery/12 step/ Minnesota Method works for you, all fine and dandy.<BR/>What I do object to is the evangelical posturing that "if it worked for me it must be the only way" and the whole "It's not my fault, it's a disease" which can lead to the self - fulfulling prophecy that "I am a drug addict and will always be a drug addict."<BR/>My view is that drug use / addiction is a learned behaviour, which means that what has been learned can be un - learned, if you like.<BR/>I've worked in addictions for nearly 19 years and have referred many of my clients to AA and other organisations which adopt the recovery process philosophy, because this is not about me, it is about my clients and what best suits them.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-79335198181398084512008-10-23T08:45:00.000+01:002008-10-23T08:45:00.000+01:00Anon,In reply to your last'outburst',could you ple...Anon,<BR/><BR/>In reply to your last'outburst',could you please explain to me your reasons behind it.I have seen and have wreaped the rewards of this recovery 'movement' because 'anon',they understand addiction IS A DISEASE and where able to help me,where shallow minded and pompous individuals like you wouldnt.So whats your take on it then 'anon' is it"its not a disease you have got,your just greedy!!" or maybe you still practise drilling out the front of the brain and padded rooms!.<BR/><BR/>Honestly,people like you disgust me,how are we ever gonna move forward with half-wits like you turning the recovery movement into a mud slinging competition when it is clearly evident the huge impact that understanding 'ADDICTION IS A DISEASE' can allow us to start to come to terms,understand and deal with our DISEASE!!!!<BR/><BR/>Chris g (ex-user)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-14553195414187241422008-10-23T00:21:00.000+01:002008-10-23T00:21:00.000+01:00Tim1legComments like yours just tell me that this ...Tim1leg<BR/><BR/>Comments like yours just tell me that this recovery 'movement' is going to kill itself off before it even gets going. The levels of self-delusion, pomposity and self-righteousness are astounding. I should just let you and the prof keep posting and watch you hang yourselves...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-54692868242177608012008-10-22T20:24:00.000+01:002008-10-22T20:24:00.000+01:00Anon ADDICTION IS NOT A DISEASE!!! YOUR RIGHT. sat...Anon ADDICTION IS NOT A DISEASE!!! YOUR RIGHT. satire is alive and well.<BR/>Addiction is regarded by most as a social problem to be solved with social solutions, i.e. incarceration. But, scientific evidence argues otherwise: addiction is a brain disease. this meams then that addiction is a clinical condition and has both behavioral and social components that need to be attended to, just as other disorders, such as schizophrenia and Alzheimer’s are treated. Advances in the fields of neural and behavioral sciences have led to this new-found definition of addiction. Researchers have identified physical differences between the structure of an addict’s brain and the brain of a “non-addict,” implying that these habits are behaviors that alter pathways built by neurons and synapses, as well as altering the availability of recently identified receptors, gene expression, and even an addict’s responsiveness to his/her environment. Biologists have also uncovered elements common to all addiction, regardless of the substance that is being abused. Such standardization acts as a great advancement in treating the disease. Prolonged abuse of any substance can cause long-lasting, widespread changes in brain function and structure. This fact should then encourage research exploring ways to treat this disease—addiction—because of how universally the effects of substance abuse are felt. Its implications are even felt in the realm of public health, seeing as how drug-use is responsible for the transmission of many diseases (ex: AIDS, hepatitis), and a recognition of this abuse as a brain disorder “characterized by compulsive drug seeking and use” will help lower social costs for the consequences and ineffective treatment of the disease of addiction.<BR/>According to Webster’s Dictionary disease is defined as follows:<BR/>“Disease: Any departure from health presenting marked symptoms; malady; illness; disorder.”<BR/><BR/> <BR/><BR/>Works Cited:<BR/><BR/> <BR/><BR/>(1)Addiction is a Brain Disease, Alan I. Leshner<BR/><BR/>(2)Anatomy of Addiction, Ellen M. Unterwaldtim1leghttps://www.blogger.com/profile/17060688293127101645noreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-4512491200531228722008-10-22T19:24:00.000+01:002008-10-22T19:24:00.000+01:00This blog is hilarious. I haven't laughed so much ...This blog is hilarious. I haven't laughed so much in ages. Thanks, Prof. Who said satire's dead?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-67117035217433119852008-10-22T11:32:00.000+01:002008-10-22T11:32:00.000+01:00A disease is something which is communicable ; air...A disease is something which is communicable ; air borne, blood borne etc. Addiction is not a disease.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-5507830029448196732008-10-21T15:03:00.000+01:002008-10-21T15:03:00.000+01:00Jason S said"One more wrinkle on the subject. The ...Jason S said<BR/><BR/>"One more wrinkle on the subject. The term palliative care implies that the patient is focus of concern, that the purpose of the treatment is to reduce their suffering. Unfortunately, this isn't the history of methadone in the U.S. It was used to reduce our suffering at the hands of the addict. It was crime and infection control."<BR/><BR/><BR/>Actually, Jason, if you read about the beginnings of METHADONE TREATMENT (not the drug, but the treatment we know today as MMT) you would realize that the intentions of the "father of MMT" (Dr.DOLE) were never about anything OTHER THAN THE PATIENT. He may have gotten the dumb bells in government to ACCEPT the treatment by offering crime control, but it was NEVER his reason for doing the research. He believed from the very beginning that addicts were people who suffered hormonal dysfunction and opiates were a way of self medicating. He realized that many of them "caught" this illness the first time they used drugs, but he felt their was a genetic reason that made an addicts endorphins SHUT DOWN completely, while other people could take opiates or leave them without so much as a ripple in their endocrine function. Which means the comparison of opiate addiction to diabetes or hypo-thyroidism accurate.<BR/><BR/>One of the things that struck me MOST about Dr. Dole's work was a simple thing that LED him to methadone rather than simply maintaining people on heroin or other short acting opiates.<BR/><BR/>His subjects were in a trial that involved regular injection of morphine. These addicts spent most of their days watching tv and waiting for their next dose. They had no interests OTHER THAN their next shot.<BR/><BR/>However, when he gave them methadone to start the detox process he noticed that all of his subjects "came to life"...one was an artist and started to paint again-another started working on getting his GED. So began DOLES research into methadone treatment and his passion for it. Nothing to do with helping "society"--everything do to with helping his patients.<BR/><BR/>This is why methadone is MUCH different than simple "substitution" therapy. It's much different than spending your life waiting for the next dose, or obsessing about the next dose or how much the next dose will be. It's the ABSENCE of those feelings and the ability of the addict to focus on OTHER THINGS that makes methadone so much different than other opioids. It's why the comparison to heroin addiction is laughable to anyone that has ever received very good methadone treatment...that includes an adequate dose, education about addiction and methadone, supports (where needed and wanted) and medical care.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-9008230121698898342008-10-21T14:43:00.000+01:002008-10-21T14:43:00.000+01:00Anonymous said... drug use is not an disease da...Anonymous said...<BR/><BR/> drug use is not an disease dammit!<BR/><BR/><BR/>NO IT ISN'T but ADDICTION IS. This is why so many people have such a hard time (even treatment professionals) accepting MMT as a viable option! We keep trying to solve the problem of drug USE instead of focusing on the symptoms of addiction that make it so hard for the patient NOT to use.<BR/><BR/>Addiction is hard to explain to someone that hasn't lived it but let me see if I can give an analogy--however crude it is:<BR/><BR/>Addiction feels like riding in a car and having to go to pee REALLY bad, but the driver says "NO WAY--I am not stopping! Think about something else!"<BR/><BR/>That's what addiction is--much different than someone that simply ENJOYS using drugs. Addicts feel they MUST use drugs just like they feel they MUST eat. Addiction hijacks the "survival mode" part of the brain and tortures the addict until it gets what it wants. Some people assume that not giving the addiction what it wants is the way to get it to stop torturing--and for some patients it does ease up...however for many others it doesn't. So for many addicts finding a way to "feed" the addiction without ruining their lives is the best possible solution. Not a dead end street at all--but an oppurtunity to LIVE.<BR/><BR/>In the pee analogy the driver is the abstinant based therapist. They try to teach the person to live with the feeling of a "full bladder" and get on with their life feeling that way. They teach them coping mechanisms. <BR/><BR/>In this analogy methadone would be a medication that takes away the feeling of a full bladder so that you can enjoy the trip (life).....the only catch is you have to keep taking it or the need to pee comes back...and if you don't take it you can become sick. Almost ALL medications for chronic illness have this "catch".<BR/><BR/>(this isn't a perfect analogy because eventually we would HAVE to pee--we don't eventually HAVE to use opiates to get high-- since emptying your bladder in this analogy is equated to "using illegal drugs")Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-20834624428085658782008-10-21T09:50:00.000+01:002008-10-21T09:50:00.000+01:00Mr. O' Loughlin,As I understand it, the word and u...Mr. O' Loughlin,<BR/>As I understand it, the word and use of the word "Recovery" suggests that someone is a "recovering alcoholic / drug user. Often used by people who hold with the 12 steps / Minnesota Method philosophy of the self - fulfilling prophecy "I am an addict and will always be an addict" which in my opinion disempowers people.<BR/>Feel free to correct me if I amwrong, which I'm sure you will.<BR/><BR/>Abstentionist : One who supports the act or habit of deliberate self-denial.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-70630231908513087312008-10-20T18:56:00.000+01:002008-10-20T18:56:00.000+01:00Anonymous said... This whole page of "debate", as ...Anonymous said... <BR/>This whole page of "debate", as usual, falls into two camps ; advocates of recovery (whatever that means) arm in arm with the abstentionists and proponents of harm reduction and long term mathadone maintenance.<BR/>At the end of the day, the shops close and it gets dark, and the CHOICE shopuld lie with the person experiencing problematic drug use.<BR/><BR/>If you don't kno what recovery is, how can you knock it?<BR/><BR/>I don't know what problematic substance abuse is, so I won't knock it perhaps you would care to define it and what the criteria for it is?<BR/><BR/>Perhaps you would also to define what an abstentionist is?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-81072362711304359642008-10-20T16:49:00.000+01:002008-10-20T16:49:00.000+01:00Sophia,Your last five lines sums it up perfectly!!...Sophia,<BR/><BR/>Your last five lines sums it up perfectly!!.<BR/><BR/>Well done and i am with you all the way!!<BR/><BR/>chris gAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-34098706788650063532008-10-20T16:17:00.000+01:002008-10-20T16:17:00.000+01:00drug use is not an disease dammit!drug use is not an disease dammit!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-1940410501060320102008-10-20T16:16:00.000+01:002008-10-20T16:16:00.000+01:00This whole page of "debate", as usual, falls into ...This whole page of "debate", as usual, falls into two camps ; advocates of recovery (whatever that means) arm in arm with the abstentionists and proponents of harm reduction and long term mathadone maintenance.<BR/>At the end of the day, the shops close and it gets dark, and the CHOICE shopuld lie with the person experiencing problematic drug use.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-60131751561295519502008-10-20T16:12:00.000+01:002008-10-20T16:12:00.000+01:00Since the "harm reduction as a form of palliative ...Since the "harm reduction as a form of palliative care" comment came from me and has obviously hurt some folk, let me clarify what i mean by it. i regard addiction as a chronic, progressive and potentially fatal illness - same as cancer. and of course cancer isn't just one illness, it's a whole spectrum of different illnesses, and how you get on depends on what kind you've got and how far it's progressed. same with addiction........except that we don't have the huge armamentarium of different kinds of chemo, radiotherapy, surgical interventions etc etc. despite the morbidity and mortality not to mention the harm to family members and society at large, we just don't have that many treatments to offer people. hopefully that will change as the science moves along. but given that residential rehab seems to be the most effective treatment modality in rendering people drug-free and methadone the least effective, why do most people get offered methadone first and then after years of struggling and getting worse, finally make it to rehab by which time they've destroyed their physical and mental health and that of their family? isn't that the wrong way round? there must be very few patients who come along to treatment services and say "well, my goal is to be addicted to drugs for the rest of my life." my experience is of working in addictions including methadone maintenance, as well as of having been treated for both addiction *and* cancer - very educational! i was lucky enough to be sent to rehab, but that's because i'm a health professional and was therefore considered worth rehabilitating. the GMC is quite unequivocal: addicted doctors are ill, the majority will be sent for residential treatment and expected to become drug-free before they get their registration back. (of course, given that the illness varies in severity, some will not be able to, and the system lacks compassion for those who probably would do better on maintenance.) very few of my patients were able to access that kind of treatment, even those who desperately wanted it, because it was seen as too expensive. it was also considered very unlikely that they would manage to become drug-free, even when they begged and pleaded and tried to jump through all the flaming hoops and over the insuperable barriers put in front of them. those who said "i want to get clean" were patted on the head and told that it was far too hard and their chances were minimal. one of the things that impressed me most about the cancer team was how relentlessly positive they were - but not in a Pollyanna kind of way that avoided the painful reality of a life-threatening illness and distressing treatment. they knew that everyone receiving the diagnosis was terrified and thought they were going to die. even if full remission was unlikely, the message was still that they were in it for the long haul, would respect your wishes and feelings, and wanted you to have the best result possible, even when that wasn't a cure. even if you were unfortunate enough to have one of those cancers that gives you a 30% chance of surviving five years, they would still give you a jolly good bash at treatment, because who knows, you might be one of the 30%. they know the importance of never depriving a patient of hope. <BR/>when i was ill i got some emails from the late Dr LeClair Bissell, one of the giants of addiction medicine, who i'd had the privilege of meeting last year at the International Doctors in AA Convention in Boston. she spoke from the Olympian heights of 55 years' sobriety and a lifetime of experience, and had also been through treatment for cancer. she has said and thought all this long before i did and expressed it far more eloquently than i ever could in her writing. she makes the point about cancer being a "respectable" illness which attracts lots of sympathy and lots of research funding, because people are so frightened of it and so many are affected. addiction isn't quite like that..........and yet the paradox is that statistically i am far more likely to die of my addictive disorder than of my cancer. when was the last time you put money in a collecting-box for addiction research? - well, quite. addiction still kills. quite often it kills people young, and they die in pain and loneliness, leaving devastated parents and bereft children. i'm really glad to see this website up and running, and i hope we can stop fighting among ourselves and concentrate on improving the care available to our patients, who also include ourselves and our friends and families. chat on!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-14196485586443368772008-10-20T15:52:00.000+01:002008-10-20T15:52:00.000+01:00"""Whenever the MMT debate arises, it seems to me ..."""Whenever the MMT debate arises, it seems to me that regardless of what pseudo scientific semantics are used by those who defend it, there is a tendency to avoid mentioning that it is a highly addictive drug, with some horrendous side effects, """<BR/><BR/>Methadone is THE most researched drug on the EARTH--including many studies that set out to prove it didn't work. To believe otherwise is like saying the "earth is flat".<BR/><BR/>What are the "horrendous" side effects? constipation? sweating?<BR/><BR/>Try being on prendisone (also caused DEPENDENCY) for a few months and tell me how bad methadone is in comparison. All drugs come with side effects-methadone less than most (in opiate tolerant individuals).<BR/><BR/>In the latest statistics from the Scottish Government it is evident that in Edinburgh there are now more deaths associated with methadone than are associated with heroin. That is a worrying development and should lead us to be very cautious about accepting such blanket statments as methadone reduces an addicts risk of overdose by 50%.<BR/><BR/>METHADONE TREATMENT reduces an addicts chance of overdosing by 50%--very different from methadone the drug. I can bet that at least 90% of the addicts who died in these overdoses were addicts using methadone incorrectly and illegally. Addicts using this way will die one way or another: the substance doesn't really matter...I can almost bet 90% of these overdoses involved numerous drugs and not just methadone as well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-90988427117406011462008-10-20T14:23:00.000+01:002008-10-20T14:23:00.000+01:00sara mcgrail..You have definately made it onto my ...sara mcgrail..<BR/><BR/>You have definately made it onto my cool list!!!<BR/><BR/>you rock!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-67583745333065255422008-10-20T13:08:00.000+01:002008-10-20T13:08:00.000+01:00Seems as if you’ve ruffled a few feathers Prof.Whe...Seems as if you’ve ruffled a few feathers Prof.<BR/><BR/>Whenever the MMT debate arises, it seems to me that regardless of what pseudo scientific semantics are used by those who defend it, there is a tendency to avoid mentioning that it is a highly addictive drug, with some horrendous side effects, <BR/><BR/>The first fact which strikes me is that the vast majority of our drug treatment strategy is based on harm reduction via substitute treatment, yet whenever the subject of abstinence arises, those in favour of substitute treatment trot out the old cliché, ‘one size does not fit all’. That being the case why then with the vast majority of those who are addicted, claiming to want to become drug free, is so much of our treatment strategy devoted to keeping people locked into addiction?<BR/><BR/>We are told that long-term MMT of opioid users reduces harm and improves health and social outcomes yet relapses to illicit drug use are common. (1) On that fact alone its ongoing use without abstinence focused interventions is questionable. On the other hand Naltrexone drop out rates are extremely high.<BR/><BR/>MMT, the flagship of drug treatment in the UK, needle exchange facilities, and drug consumption rooms have all failed to reduce or prevent the increasing use of addictive substances, as well as the associated deaths and blood borne diseases. (2)<BR/><BR/>It is also true that the majority of those on MMT perceive their health negatively and experience high levels of health related concerns, but continue to engage in behaviours, including poly drug misuse, are likely to have negative health outcomes. (3) Add that to the common problems of sleep disorders among those on MMT (4) and one is forced to conclude that the chances of those in long term substitute treatment and ongoing use of other substances, of maximising their ‘health and wellbeing’ are indeed slim. Therefore the term palliative care seems to be more accurate. Perhaps if we were to practice what the evidence supports I.E treating the addicted, rather than treating the addiction, we might get more positive outcomes.<BR/> <BR/>1. Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD001333. DOI: 10.1002/14651858.CD001333.pub2. <BR/>2.Department of Health. Reducing drug-related harm: an action plan. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074850 <BR/>3.Philip James, David Spiro, Noreen Geoghegan, Anita Connor, Gail Hawthorne. Nursingtimes.net 28.Aug 2008 <BR/>4.Peter D. Friedmann, citing Peles E, Hetzroni T, Bar-Hamburger R, et al. Melatonin for perceived sleep disturbances associated with benzodiazepine withdrawal among patients in methadone maintenance treatment: a double-blind randomized clinical trial. Addiction::2007;102(12):Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-6134815077515018342008-10-20T13:03:00.000+01:002008-10-20T13:03:00.000+01:00Oh dear, I'm afraid after what feels like far too ...Oh dear, I'm afraid after what feels like far too long in the drugs field I'm afraid I'm something of an agnostic on the whole regulation/deregulation thing. It may be that this position as someone far wiser than me suggested (in reference to religion) is a bit like standing with one foot on either side of a pile of sh*t, but i'd rather that than be immersed in it!<BR/><BR/>Annemarie, have emailed you.<BR/><BR/>SaraAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4845992337963104415.post-65323285037967324692008-10-20T11:43:00.000+01:002008-10-20T11:43:00.000+01:00Sara,My comments about 'science' being rhetoric ma...Sara,<BR/><BR/>My comments about 'science' being rhetoric masquerading as objectivity and substitution therapy being 'nonsense on stilts' were obviously not as clear as I intended! <BR/><BR/>I do not for a minute question the evidence base for methadone maintenance. As you say, it's pretty much unassailable. What I do question though is why we're doing this at all? Why is heroin handled within a criminal law framework (except when used, as diamorphine, in medical care) but methdone isn't? For me, the effectiveness of methadone is evidence that the problem is the prohibitionist framework. Why do we not introduce a regulatory framework to control all psychoactive substances (including alcohol and tobacco), based on actual objectively measurable harm and drawing on well-established principles about 'what works' in regulation? <BR/><BR/>The recovery debate is a red herring. Motivated by compassion for some, but moralism for many others. Either way, it doesn't get to the heart of the real issue, which is about regulation.Anonymousnoreply@blogger.com