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Prescribed Drugs A Step Forward

This article goes along with the one I posted the other day: Common Cough Drug Helps Addicts More Than Methadone: Study Why they call Dilaudid a cough syrup is beyond me!! I was addicted to Dilaudid, and I can tell you, it’s NO cough medicine!! It’s a strong narcotic. It’s heroin-based and very, very addictive!!

http://www.canada.com/victoriatimescolonist/news/comment/story.html?id=be01cdf4-f111-45de-9b6f-18aeffb9e875

October 25, 2008  It’s worth working toward an ideal world in which people would not be dependent on drugs. In the meantime, we should be looking at measures – like prescription heroin – that would make our society safer and more secure.

Even if we can’t stop people from abusing drugs, perhaps we can stop them from breaking into our cars.

The North American Opiate Medication Initiative, a.k.a the NAOMI project, has completed a three-year trial that tested the idea of prescribing heroin and a heroin substitute for confirmed addicts.

The participants, in Montreal and Vancouver, had all been through repeated addiction treatments without success. “Society had basically written them off as impossible to treat,” said Dr. Martin Schecter of the University of British Columbia, who led the project.

The project tested three approaches: Methadone substitution, which is the current norm; prescribed heroin; and prescribed hydromorphone or Dilaudid, a prescription opiate-based painkiller.

The results were striking. All three were effective. But based on every measure, prescribed heroin and hydromorphone were far more effective than methadone.

After 12 months in the program, almost 90% of those prescribed heroin or Dilaudid continued to participate, had entered treatment or were clean. Only 54% of those using methadone met the same standard, indicating a higher rate of relapse to illegal drug use.

Those receiving prescribed heroin or opiates were less than half as likely to also use heroin illicitly. They reported having spent less money on drugs of any kind in the previous month after a year in the program.

Those who stayed on the therapeutic program, whether with methadone or heroin, demonstrated improved physical and psychological health. The amount they report spending on drugs in the previous month fell from a median of about $1,500 – or $50 a day – to about $400.

And, not surprisingly, the number of participants who said they committed crimes fell; from 70% to 36% and the level of criminal activity was also cut in half. Freed from the need to buy street drugs, the users were much less likely to resort to crime to get money.

And the study found no negative impact on communities. (Are they saying being on methadone causes negative impact on communities?!??)

None of this is surprising. Similar studies in other countries have produced the same kinds of results. Freed from the daily scramble to get illegal drugs – and the money to buy them – people’s lives improve. The stability and improved health allows some to work or make the decision to enter treatment. Crime is reduced.

The idea of prescribing drugs, or substitutes, troubles some people.

But if we accept addiction as an illness, then the goal should effective treatment and management. The evidence from NAOMI and other trials is that prescribed drugs can play an important role.

Not, of course, for everyone. The NAOMI participants were all over 25; the mean age was 40. All were long-term users who had been through treatment at least twice. There is no thought of making drug access overly easy.

The NAOMI project dealt only with heroin addiction. But studies in other countries have reported similar outcomes in trials of prescribed substitutes for cocaine and crystal meth.

Too much of our drug policy has been based on myth, ideology and wishful thinking. It is time to look at the measures – like prescribed drugs – that really make a difference for those who are addicted and their communities.

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  1. October 27, 2008 at 4:34 pm

    Whoops! I read the first article and thought this was a repost of it with some additions to the end!

    The first article made it seem as though heroin and diluadid were more successful treatments than methadone….which isn’t true. I was trying to disprove that point (as I did in an earlier comment).

    I do believe, as this person does, that we need to look beyond our “myth, idealized and wishful thinking” ways of treating addiction AND START looking for real answers for patients and their families.

    WE need to start treating people with addiction the way we treat people with epilepsy, depression or diabetes…like they are human beings who are sick and no “success” is too small or insignificant.

  2. October 27, 2008 at 4:27 pm

    This column misses a very important element of this study-which is that the participants were chosen BECAUSE they had failed methadone treatment. >80% of patients at a good methadone clinic will be successful as long as they stay in treatment. This study is about the other 20% that didn’t do well on methadone.

    In this study the people participating had to have failed methadone treatment at least twice before they could even be a part of the study. In other words, the whole point of this study was to prove that we shouldn’t give up on patients who don’t do well in standard treatments (methadone)…that there are options that can make their lives better, but that may involve “feeding” the addiction.

    However, even if prescription heroin/diluadid merely lowers the patients chances of viral infections, keeps them in contact with medical care, reduces their use of other drugs and keeps them stable enough to stay out of trouble—-even if that is “all” the treatment does, it’s still a success for people who have been unable to do any of those things since they became addicted.

    BUT-In MY humble opinion- it’s not fair to compare standard methadone treatment to this study….because we already KNOW that methadone didn’t work well for these patients. In fact the fact that any of them did well on methadone while participating in this study is unexpected, considering it didn’t work for them before.

    Had the study had a random sample of patients (from the first timer entering treatment for the very first time, to the old timer and everyone in between) then I would be willing to bet that methadone would have done as well as the dope AND it would have seen the added benefit not needing to be injected, once per day dosing (rather than three per day for dope) and a steadier more STABLE rate of medication in the blood stream. Meaning: no ups and downs. No highs No withdrawals..

    If methadone doesn’t work for someone and their entire life is being ruined and ruled by endorphin dysfunction/addiction and we have it in our ability to make their lives better (for them and US)…then we have to offer that treatment and we have to call it successful–no matter how small that success may seem to society, I am sure it feels HUGE to that patient.

    I do love the fact that the above column points out a great thing about methadone treatment: it IS medical treatment. The way we have treated drug addiction for a very long time is by merely doing whatever it took to end DRUG USE and the patient then had to “live with” the symptoms of ADDICTION…..medication is more about ending the symptoms of ADDICTION….and hopefully as a result drug use will be reduced.

    Kristan

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