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It is unusual for politicians to face up to the obvious, but the Scottish Executive seems for once to have done so: it has recognised what has long stared it in the face, namely that dishing out methadone to drug addicts is not the answer to their problems or to the problems that they cause society. A different approach is needed.

Perhaps in 100 years historians will wonder why so many of the governing elite, from senior doctors to Cabinet ministers, persisted for so long in the belief that doling out methadone was the answer. The explanation, I think, will be that they wilfully misunderstood the nature of the problem.

Many years ago I used to dole out methadone like the best (or the worst) of them. This was before I thought at all deeply about the question of drug addiction and accepted uncritically all that I had been taught about it by doctors senior to me. I began to change my opinion when I worked in prison where it was the clinical policy to give addicts methadone. I noticed that, far from creating an atmosphere of contentment and satisfaction, it created one of perpetual tension and irritation. Shortly after having been prescribed a dose, the prisoner would return and say, in an intimidating fashion: “It's not holding me, doc, it's just not holding me,” and sometimes announce that, unless he was prescribed more, he would end up attacking other prisoners, and then it would be the doctor's fault.

In Scotland the great majority of addicts prescribed methadone by their doctors never stop taking it, and most of them take other drugs as well. A particularly dangerous combination of drugs is methadone and benzodiazepines (drugs such as Valium), and yet drug clinics and other doctors persist in prescribing this often fatal combination - largely, I suspect, because they are too frightened of their patients to refuse them anything.

The number of people admitted to hospital having taken a dangerous overdose of methadone (556 in 2006-07) is greater, proportionately, than the number of people admitted to hospital having taken a dangerous overdose of heroin (1,530 cases). In Dublin recently, more people have died of methadone poisoning than of heroin overdose. The supposed cure causes as many problems as the supposed disease. If addicts prescribed methadone are given the opportunity to divert it on to the black market, they will: which suggests that they do not really need it in the first place.

In France, addicts are often prescribed a different drug, buprenorphine, which soon became the street drug of preference in Finland, to which it was illegally re-exported by the addicts. More recently, a huge epidemic of buprenorphine addiction has occurred in Georgia (the ex-Soviet republic), numbering scores of thousands of addicts, who take buprenorphine diverted from France. If the addicts really needed the drugs, they would take them rather than divert them on to a black market.

In the prison in which I used to work, a buprenorphine tablet that had been prescribed for an addict to alleviate the symptoms of withdrawal from heroin on arrival in the prison, and which an addict had put in his mouth and spat out for sale to another prisoner, was known as a “furry” because of its rough surface. Again, this suggests that addicts did not really need what they were prescribed, and that the whole basis of prescription was flawed.

The fundamental error that the Scottish Executive has now admitted is in having regarded addiction to heroin as a technical medical problem, to be solved by technical medical means. But that old approach amounts to a surrender to blackmail: give me what I want or I will continue to behave badly and to hold you responsible for the ill-effects of my own behaviour.

Suppose we gave money to burglars to induce them to stop burgling. No doubt most of them would stop for a length of time depending upon how much we gave them. But this does not mean that money is the treatment of the dreadful disease of burglary, or because we prevented certain individuals from continuing to burgle it means that we had reduced the disease of burglary in society as a whole. Rather, we would have encouraged its spread.

This is precisely the logic that has been applied to drug addiction. Just how precisely is evident from the Government's recent declared policy that clinics should now give drug addicts money or other rewards for not taking drugs (as least as proved by drug-free urine samples, something experienced drug addicts have long learnt to provide). This is the first time in the history of medicine, so far as I know, that bribery has been considered a medical treatment.

Contrary to what everyone supposes, withdrawal from heroin is not a serious medical condition - unlike, say, withdrawal from alcohol when it results in delirium tremens (the DTs). The suffering is grossly exaggerated and, in so far as it is genuine, is largely produced by anticipatory anxiety that is itself the consequence of years of mythologising the fearsomeness of withdrawal.

Addiction to heroin is a medical problem only to a minor extent, which is why predominantly medical means will never solve the problem. Most of Britain's 300,000 addicts are drawn from broken families, have a poor education, are without much hope for (or for that matter fear of) the future and have no cultural life, intellectual interests or religious belief. Delusory euphoria - the paradise at three pence a bottle that De Quincey described in his Confessions of an English Opium Eater - is the best that they think that they can hope for in life. This is not a medical problem. Where addiction is concerned, it is time to throw physic to the dogs.
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author: Theodore Dalrymple is a retired prison doctor and author of Junk Medicine: Doctors, Lies and the Addiction Bureaucracy

source: Times Online

Ontario regulations banning medicinal-marijuana users from smoking on bar and restaurant patios violate the human rights of people with disabilities, alleges an Ottawa man who has filed a complaint over the issue.

Russell Barth submitted the complaint to the Ontario Human Rights Commission on Monday on behalf of himself and his wife, Christine Lowe.

"We're not asking for special rights; we're just asking for the right to use cannabis where people use tobacco," Barth, an amateur comedian, said Tuesday.

The letter accompanying the complaint alleges that the Ontario ban "infringes on our rights to gain access to services and infringes on our ability to perform on stage and to seek possible future employment as performers.

"It has also caused us much stress, ill health, embarrassment and humiliation."

Barth said he obtained a Health Canada licence to use medical marijuana in 2003 after being diagnosed with a variety of disorders, including post-traumatic stress syndrome, asthma and fibromyalgia, a syndrome characterized by fatigue and multiple pain points in muscles throughout the body.

He lives on a disability pension and is a full-time care giver for Lowe, who has epilepsy and also uses medical marijuana.

Barth said he needs the drug every two to three hours to treat his own medical symptoms.

"If I am having a muscle spasm, if I'm having nausea or anxiety or an asthma attack, I need to have my medicine immediately," he said.

On May 7, after performing at the amateur night of a comedy club in Ottawa, Barth said he began to feel intense pain in his legs and went outside to the outdoor patio area, where people were smoking tobacco.

He walked to the edge of the patio and was about to light up a joint when he was approached by a friend who worked at the comedy club. The staffer asked him not to smoke on the premises because of provisions of the Ontario Liquor Licence Act that ban liquor-licence holders from allowing people to consume a controlled substance on their property.

Afterward, a friend suggested that the incident was the fault of the government's regulations, not the bar owner.

Barth read the regulations and agreed that was the case.

Ontario law has no exemption for medical marijuana

Lisa Murray, a spokeswoman for the Alcohol and Gaming Commission of Ontario, said there is no provision or exemption for the use of medical marijuana in the regulations on controlled substances as they are currently written.

Under Health Canada's medical marijuana rules, people who possess marijuana for medical use must follow all other federal, provincial and municipal laws regarding controlled substances.

"Smoking marijuana for medical purposes in a public setting, thereby potentially exposing others to the drug's effects, is unacceptable," states a federal government document on the issue. "The authorization simply allows possession but does not give patients permission to use marijuana wherever or whenever he/she chooses; the rights of others must also be considered."
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source: Canadian Broadcasting Corporation

Adults with attention deficit hyperactivity disorder do 22 fewer days of work per year than people who do not have the condition, a study says.

The research, which looked at 7,000 workers in 10 countries, found an average of 3.5% had ADHD.

Writing in Occupational and Environmental Medicine, the Dutch team said workplace screening should be used to pick up people with the problem.

A UK expert backed the idea, but warned they should not be stigmatised.

It's important that ADHD isn't stigmatised as many people with the condition can hold down jobs
Professor Philip Asherson, Institute of Psychiatry

People who have ADHD find it difficult to concentrate because they may be hyperactive, easily distracted, forgetful or impulsive.

It is commonly thought of as a childhood disorder, often picked up because of problems at school.

However, there are estimates that around two-thirds of those affected in childhood are still experiencing symptoms in adulthood.

More common in men

In the study, employed and self-employed workers aged 18 - 44 were screened for ADHD as part of the World Health Organisation World Mental Health Survey Initiative in Belgium, Colombia, France, Germany, Italy, Lebanon, Mexico, the Netherlands, Spain and the USA.

They were also asked about their performance at work in the last month.

Those results were extrapolated out to give annual figures.

Workers with ADHD were found to take an average of eight days off sick each year.

They also had, on average, 21 days where they did less work than they should have and 13 days where their work was of poorer quality - each of which was deemed to equate to half a day of lost performance.

ADHD was more prevalent in men and workers in developed rather than developing countries.

The study was carried out by a team who are part of a World Health Organization (WHO) research consortium at Harvard Medical School.

The team, led by Dr Ron de Graaf, said: "It might be cost-effective from the employer perspective to implement workplace screening programmes and provide treatment for workers with ADHD."

Professor Philip Asherson, an expert in adult ADHD at London's Institute of Psychiatry, said the condition did have an impact on people's timekeeping, their relationship with colleagues and the ability to focus on work.

He added: "ADHD should be included in general health screens, in the same way that people would screen for anxiety and depression. This is probably best done by GPs or occupational health departments.

"However, it's important that ADHD isn't stigmatised as many people with the condition can hold down jobs, or may be particularly good at certain tasks."
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source: BBC Health News

Plans to ban the open display of cigarettes in Scottish shops have been welcomed by the UK health secretary.

Alan Johnson said it was important to stop children from taking up smoking.

But he told BBC One's Andrew Marr show that Scottish Government plans to ban 10-packs of cigarettes would "have to be looked at".

Ministers last week announced a raft of plans to restrict and enforce tobacco sale in the drive to cut smoking - one of Scotland's biggest killers.

Other proposed measures, some of which would need the co-operation of Westminster, included tobacco licensing and a move to plain packaging for cigarettes.

Mr Johnson said the UK Government was considering similar moves.

He said: "Banning vending machines, where you can't have any control over the age of the person who's buying it, happened in many other European countries a long time ago, with startling results there."

The health secretary went on: "The ability to buy 10 cigarettes - I'm going to have to confess I started smoking very young when I was a kid, and you could get 10 woodbines, and you could get thrupenny singles.

Well they've taken thrupenny singles away. Whether you should still be able to buy 10 cigarettes or whether you should insist that you can only buy 20, that's an issue we need to look at."

It is two years since Scotland led the UK in banning smoking in enclosed public places, and six months since the legal age for buying cigarettes was raised to 18.

Mr Johnson's comments were welcomed by anti-smoking group Ash - but pro-smoking organisation Forest has dismissed the Scottish plans.

Smoking in Scotland is responsible for about 13,000 deaths and 33,500 hospital admissions each year at a cost of £200m to the health service.
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source: BBC News

More than half of women drink alcohol while pregnant despite growing evidence that it can lead to low IQ, attention deficit disorders and more serious lifelong complications in children.

Older mothers are more likely to drink while pregnant than younger ones, the latest figures from the National Health Service show.

This has lead experts to fear the number of damaged children will grow as more women put off having a family.

Children born to mothers who drank while pregnant are more likely to grow up to have alcohol and drug problems, be excluded from school and have antisocial behaviour problems.

More than 8,500 under 18s were admitted to hospital because of their drinking in 2006/7 it was revealed on Thursday and a proportion of those are likely to have some degree of brain damage because of their mother’s drinking, experts said.

High flying women working as stockbrokers and traders in the City have called charity helplines after their children were diagnosed with Foetal Alcohol Spectrum Disorder, along with wives of MPs and members of the House of Lords, showing the problem is increasingly associated with middle class drinkers.

Damage to the child increases with the amount of alcohol drunk and the timing during the pregnancy. The full blown Foetal Alcohol Syndrome is the leading known cause of non-genetic intellectual disability in Western countries and causes severe learning difficulties, impaired intellect, certain facial characteristics and growth retardation.

Less severe damage is associated with hyperactivity, poor memory and planning skills, poor co-ordination and lower IQ, but this is often not recognised as associated with maternal drinking.

Last year the Department of Health revised guidelines to say women should not drink at all during pregnancy but if they choose to they should stick to one or two units once or twice a week and not get drunk.

Figures released by the NHS Information Centre revealed that 55 per cent of women in the UK admitted drinking alcohol while pregnant.

Of the women who drank before they conceived, only a third gave up alcohol altogether while pregnant and the rest said they cut down.

The survey also found 61 per cent of mothers aged 35 or over said they drank while pregnant compared to 47 per cent of those aged under 20.

Older mothers were also less likely to give up alcohol while pregnant.

Susan Fleischer, director of the charity National Organisation for Feotal Alcohol Syndrome, said women in powerful and male dominated careers had been calling their helpline after their children were diagnosed with the disorder.

She said these women were not alcoholics but had a regular habit of drinking with male colleagues and found it harder to stop while they were pregnant.

Ms Fleischer, who has an adoptive daughter with the condition, said: “Not all women who drink during pregnancy will harm their child but the only way to be sure is not to drink at all.

“Some of the children being admitted to hospital because of their own drinking will have brain damage caused by their mother’s drinking and there will be a smattering of middle class kids in there too.”

Survey by the charity Tommy’s in 2004 found one in four pregnant women drink between two and five units of alcohol a week, double the recommended weekly limit.

Reliable studies on the numbers of babies born affected by alcohol have not been carried out in the UK but in other European countries and in America and Canada it is estimated that between 20 and 40 children per 1,000 have feotal alcohol spectrum disorder and fewer have the full blown syndrome.
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source: http://www.telegraph.co.uk

A research team from the University of Granada has carried out a study on the psychological process that triggers the "craving" or intense desire for tobacco, a study that could establish the bases to determine the brain mechanisms that activate this state and how to control them.

Miguel Ángel Muñoz García, from the Department of Personality, Evaluation and Psychological Treatment of the University of Granada has carried out this study, under the direction of the Professors Jaime Vila Castelar and Mª Carmen Fernández Santaella.

"Craving" is an expression used to define an uncontrollable desire for the administration or consumption of an addictive substance. It is usually used in situations of alcohol or nicotine dependence and it is considered as a pathology that affects cognitive resources, as it has an obsessive component.

The researchers of the University of Granada analysed, with the help of a device, 180 regular takers of an addictive substance (cocaine, in this case), to study the emotional mechanisms triggering the addiction for the substance. This study has helped to establish the behavioural mechanisms in cocaine addiction, and consists of the emotional control of different consumption situations.

These results have been the basis of a series of studies with smokers, in withdrawal for 8 hours, to measure the physiological and emotional variables present in withdrawal symptoms using a machine (a polygraph) to estimate the emotional mechanisms responsible for the addiction to that substance. The smokers were shown several images (48) connected with situations that produce desire (related with leisure, free time, coffee…), analysing the heart´s defensive cardiac response produced as well as the startle response. Lastly, brain modifications associated with emotional responses of frustration and impulsiveness in smokers in withdrawal were studied. This system was also used for regular smokers.

Miguel Ángel Muñoz García states that this research has studied for the first time behavioural mechanisms involved in the tobacco craving process determining the brain areas and body responses connected with the compulsive behaviour provoked by tobacco.
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source: MediLexicon