Sober N Clean

Take The First Step
Dr. Michael Levy

Q: I have been hearing that parents of opioid-addicted children want more information about naltrexone. Do you have any experience with this treatment? Does it work? Thanks.

A: There are two ways that naltrexone-type medication is being used for the treatment of opiate addiction. I say naltrexone-type medication because in general, naltrexone is an oral form of the medication naloxone, and naloxone is also used, which can be injected or inhaled. One use of this drug is to increase abstinence rates and enhance treatment outcome, and the other is to counter an opiate overdose.

First, naltrexone is a pure opiate antagonist, which means that it blocks the effects of opiates because it binds on the same receptor sites that opiates bind to in the brain. If a person has ingested naltrexone and uses opiates, the person will not feel the effect of the opiate.

Naltrexone has been around for many years, and while it is effective, its use has been fairly low for a number of reasons. One big reason for this is that many individuals who struggle with opiates are ambivalent about taking this drug because they clearly will not be able to get high on opiates if they have naltrexone in their system. As often there is ambivalence about changing, compliance with taking this drug has been low.

However, if a person is very motivated, treatment outcome can be very good. As I always say, ongoing psychosocial therapy in conjunction with taking this medication is also important. There are also naltrexone implants that can be used, which increases compliance as the naltrexone in the implant lasts for an extended period of time and there is no need to remember to take it daily. Finally, an injectable form of naltrexone, called Vivitrol, can also be used, which lasts for one month. However, Vivitrol is not FDA-approved for the treatment of opiate addiction, but some physicians have been using this off-label for that purpose.

Narcan, or naloxone, is also used to treat opiate overdoses and saves lives. If a person who has overdosed on opiates is given this drug, it rapidly will counter the effects of opiates and reverse the overdose. This drug is given at emergency rooms and by emergency medical technicians (EMTs).

There are also several pilot programs in Massachusetts that give a nasal form of Narcan to opiate addicts, as well as friends and relatives of opiate addicts. These individuals are trained how to use Narcan in the event that someone has overdosed on opiates. This obviously allows the opiate overdose to be treated quickly, even before EMTs arrive, and helps to save the person's life. CAB is one of the pilot programs and a person can call 781-592-4477 to find out more about this.

So in answer to your question, different forms of naltrexone are being used for the treatment of opiate addiction, both to help individuals recover from opiate addiction, and to treat, on an emergency basis, opiate overdoses. This medication can be helpful to opiate addicts who are motivated to stop using opiates, and on an emergency basis, it can clearly save someone's life.
____________
source: http://www.gloucestertimes.com

WASHINGTON — The Bush administration underscored its continued support for Afghan President Hamid Karzai on Thursday despite fresh allegations from a former U.S. anti-drug official that Karzai is playing both sides of the effort to combat a raging drug business.

Thomas Schweich, who until June was one of the State Department's senior counter-narcotics officials, accused Karzai of protecting drug lords for political reasons. Schweich wrote in an article to be published Sunday in The New York Times magazine that "narco-corruption went to the top of the Afghan government."

Schweich said the Taliban-led insurgency fighting Karzai's government profits from drugs, but Karzai is reluctant to move against big drug lords in his political power base in the country's south, where most opium and heroin is produced.

"Karzai was playing us like a fiddle," Schweich wrote. The article appeared on the Times' Web site late Wednesday.

"The U.S. would spend billions of dollars on infrastructure development; the U.S. and its allies would fight the Taliban; Karzai's friends could get richer off the drug trade," he wrote.

State Department spokesman Gonzalo Gallegos did not directly address Schweich's allegations but defended U.S. policy and backing for Karzai.

"We know and understand that there is a corruption issue in Afghanistan but we're working with the sovereign government," Gallegos said Thursday. "President Karzai has shown us through word and deed that he is working with us to help improve the plight of that country."

Corruption is a deeply rooted problem and addressing it, along with the country's massive development need, will not be quick, Gallegos said. "This is a long-term commitment in terms of time and this is a large commitment in terms of dollars."

Afghan officials were not immediately available to respond to Schweich's allegations.

Drug production has skyrocketed since the U.S.-led invasion that ousted the Taliban regime. In 2007, Afghanistan produced 93 percent of the world's supply of opium, the raw material of heroin.

Karzai has repeatedly promised his U.S. backers that he is committed to rooting out endemic corruption and fighting the drug trade.

"Karzai had Taliban enemies who profited from drugs but he had even more supporters who did," wrote Schweich, who used to serve as coordinator for counter-narcotics and justice reform for Afghanistan. He was based in Washington.

Presidential elections in Afghanistan come next year, and Karzai has indicated he'll seek re-election.

Schweich accused the Pentagon and some U.S. generals of obstructing attempts to get military forces to assist and protect opium crop eradication drives.

NATO and U.S. military commanders have been reluctant to get involved in the drug fight, arguing that destroying farmers' crops would alienate tribesmen and increase support for the Taliban.

In 2003, about 198,000 acres of land was used to cultivate poppy. By 2007, it rose to 476,900 acres.

Opium production topped 9,000 tons, enough to make over 880 tons of heroin with a street value of $4 billion, according to the United Nations.

Figures for 2008 are not yet available.

The Ministry of Counter Narcotics says that 20 of Afghanistan's 34 provinces will be poppy-free this year — compared with 13 provinces in 2007. But in the south, cultivation remains rampant.
___________
source: e-ariana.com

Drug-users tend to die young, but we know surprisingly little about those who survive the dangers of overdose or violence to which their lifestyle makes them susceptible. A study of a group of injecting heroin-users in Edinburgh reveals that even those who stop the most dangerous forms of behaviour remain at risk.

Drug-related deaths in Scotland reached a record high in 2006 and a recent report by the UN showed that Scotland has almost twice as many drug-related deaths (at 8.2 per 100,000) as the rest of the UK and comparable European countries. The Edinburgh research, carried out over 10 years from the mid-1980s to the mid-1990s, found that more than half the users were HIV positive and that Aids-related illness was replacing overdose as the main cause of death. That is largely due to a switch from injecting heroin to oral drugs, both prescribed (including methadone) and illegally-obtained ones. Despite this, however, the overall mortality rate among drug-users and former users will remain high owing to Aids. There are other worries attached to their behaviour, including a high number of sexual partners, with HIV now more likely to be acquired by sexual transmission than by sharing needles.

The study confirms the other bleak long-term effects of drug use. Two-thirds of the group had at least one child, but the majority of the men and 16% of the women did not live with their children, resulting in those who could not be cared for by the other parent going to grandparents, being adopted, fostered or in residential care.

This research (carried out among patients in Muirhouse, an area with a high concentration of deprivation) is published as Audit Scotland is investigating the effectiveness of drugs policy in Scotland, in particular the £12m a year spent on the methadone programme. According to the Edinburgh researchers, however, the decrease in injecting predated the policy of prescribing methadone and they suggest an increase in sentences both for dealers and people found in possession of heroin, which "disrupted an active drug-using community" was an important factor.

Their conclusion, that drug-users require long-term support for a multiplicity of problems, follows a green paper from the Westminster government which suggests that drug addicts on long-term benefits should be required to attend treatment and rehabilitation programmes. That is easier said than done: only 18% of the group abstained completely from drugs during the course of the study, while 21% had periods of abstinence and relapse. At a time when 50,000 people in Scotland have a problem with heroin or other opiates, and proposals on how to reduce associated problems include drug consumption rooms, or "shooting galleries" where intravenous users can inject in a safe environment, a coherent, effective drugs policy is urgently required. This study stands as a warning that there are no short-term solutions.
_________
source: The Herald, http://www.theherald.co.uk

State's only public treatment system says 93% of patients aren't using other opiates

A client of the Charleston Center of Charleston County takes a dose of methadone.

When he tried to quit using OxyContin, heroin and other opiates cold turkey, Ken S. said the pain was so great he felt it in the marrow of his bones.

Ken, 40, who chose not to give his last name so he could remain anonymous, said that about a year ago he landed on the doorstep of the Charleston Center of Charleston County, a drug and alcohol treatment program that runs the state's only public methadone program.

He had been abusing opiates since he chugged a bottle of codeine cough syrup at 10 years old. And he was at the end of a two-year spree of heavy abuse of prescription opiates and heroin that left him in fear of losing his job and his family.

He was so out of control, Ken said, that he physically and verbally abused his wife as his child watched. "My 9-year-old son was scared of me," he said.

Ken was so ashamed of what he'd done that he tried to stop using the drugs, but the withdrawal symptoms were unbearable. He found himself doubled over and vomiting in the shower as nearly scalding water washed over him.

"It was disgusting," he said. He knew then that he desperately needed help.

He remembered hearing that a former girlfriend, who also was an opiate addict, had participated in a methadone program and was successful getting off the drugs.

So, Ken showed up at the Charleston Center. It was his last hope, he said, "the last house on the block."

Ken said he hasn't abused drugs in about a year. And he takes the methadone only as prescribed.

He's rebuilding his life with the help of the methadone program, which includes counseling and regular drug screening. He also is part of a 12-step recovery program. For the first time in many years, Ken said, he can think about doing things to help others instead of simply thinking about himself and planning to get more drugs.

He's aware of the stigma surrounding methadone programs, how they conjure images of homeless junkies injecting themselves with heroin.

Ken is employed, middle class, married and has never used a needle. He thinks the negative stereotype keeps other addicts from seeking the help they need.

Methadone, a long-acting synthetic opiate, has been used to treat heroin and other opiate addicts since the 1960s. Some addicts treated with methadone gradually decrease their dosage until they are drug-free while others stay on it for decades. They don't get high from methadone, and are able to function normally, including holding jobs.

According to the White House Office of National Drug Control Policy, methadone is a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence.

Still, it remains controversial with the public and among some alcohol and drug treatment professionals who believe that only abstinence-based programs are effective.

Dr. Jack Emmel, medical director of the Charleston Center, winces when people ask him whether treating heroin and other opiate addicts with methadone is simply trading one drug for another.

When it comes to opiate addiction, he said, "you'll find no program that has the success rate of a good methadone program."

Addiction to shorter-acting opiates, which include heroin, OxyContin, Lortab and Vicodin, severely alters a person's brain chemistry, he said, while methadone stabilizes it.

Methadone, however, doesn't work quickly. It takes many months, even a year in some cases, for an addict's brain chemistry to return to normal, Emmel said.

Addicts who attempt to stop using opiates too quickly experience severe withdrawal symptoms and are likely to return to abusing the drugs, he said. Ninety percent of such addicts who stop cold turkey, even those whose withdrawal is medically supervised, relapse, he said.

Ed Johnson, program administrator for the center's opiate treatment program, said patients who use methadone fare better.

The center's random drug tests have found that 93 percent of patients who are using methadone aren't using any other opiates. And 65 percent aren't using any other drugs. Those rates indicate that the methadone program is more successful than most drug treatment programs, not just programs for opiate addiction, he said.

Johnson said the stigma surrounding methadone programs has worsened after some recent highly publicized drug overdose deaths involving methadone and other drugs.

Methadone also is used as a painkiller, he said, so it ends up on the street. But most addicts use it only when no other opiates are available. It doesn't give them a good high, but it holds off painful withdrawal symptoms, he said.

Johnson and Emmel said the center's staff thinks gradually decreasing the dosage of methadone and becoming drug-free or staying on the drug long-term are both viable options.

"A person whose methadone dose is adjusted properly is 100 percent functional," Emmel said. And some people can't get off it, just as some people with diabetes can't eliminate the need for insulin by changing their diets and exercising.

The center serves about 250 patients in the methadone program, Johnson said. They are all different ages and come from all walks of life. Fewer than half use needles. Most abuse prescription drugs.

The state has 10 private methadone programs, including one in Charleston.

The Center's program is self-supporting, and patients pay about $13 per day, Johnson said. That includes methadone and counseling. Without counseling, most patients would likely relapse, he said.

Ken says that's true for him. In the year he's been on methadone, he's been "working full-throttle on recovery," he said. He's been decreasing his dosage of methadone over the past several months, and expects to be off of it and completely drug-free by mid-August.
_______
source: Charleston Post and Courier, http://www.charleston.net