Amid heroin deaths, authorities debate drug that stops overdose

At least we're not alone. The fentanyl OD deaths have hit Boston. They're considering distributing naloxone, but not a word about treatment.

U.S. Cigarette Sales Reach Lowest Point in More Than 50 Years

U.S. smoking continues to decline. However, over 85% of our clients smoke, and research consistently demonstrates that it negatively impacts their recovery.

Once-Weekly Opiate Treatment with Buprenorphine/Naloxone Called Effective

Once a week Buprenorhine found effective.

New Recovery Management Monographs

The Northeast Addiction Technology Transfer Center just released two new recovery management monographs. The first is about linking treatment to communities and the second is on building resilience.

IV Drug Users Don't Cope Well When Others Overdose, Study Finds

Here's a summary of a study examining responses to overdoses:

A study of IV drug users in Baltimore found that more than two-thirds had witnessed an overdose. But only two-thirds of those called 911 for emergency medical help, and even then, they delayed making the call by five minutes or more.

Often, witnesses to an overdose tried their own remedies, such as walking the victim around, shaking them or inflicting pain, and one in four injected a home-made solution of salt water in an attempt to reverse the overdose, said Robin Pollini, Ph.D., lead author of the study, which appears in the September issue of the American Journal of Preventive Medicine.

Most witnesses did not call 911 promptly because they thought the victim could be revived without help, but many reported fearing involvement by the police

Two Studies on 12-Step Groups

A new study finds that mentally ill alcoholics and religious skeptics benefit equally from 12-Step Programs.

Another reviews studies on AA and concludes that 12 Step Facilitation is no more effective than other treatment methods. Here's an article providing a little background discussion.

Principles of Drug Abuse Treatment for Criminal Justice Populations

The National Institute of Drug Abuse (NIDA) has just released a now booklet on treating people in the criminal justice system.

Interventions to Facilitate Smoking Cessation

This article provides a good overview of smoking cessation interventions. It's got a handy table that provides information on the evidence base and quit rates for various interventions.

More on methadone

An article I linked to in my last post referred to Neil McKeganey as a critic of methadone. I wasn't sure that was a fair characterization, but this editorial makes it clear that he is a critic. While he's sometimes dismissed as a critic, I haven't seen criticism of the methodology of his studies. This editorial is worth a read. Here's an excerpt:

Methadone will undoubtedly continue to play a role in our drug-treatment services, but not as a drug provided for ever-increasing numbers of users for ever-lengthening periods, with little or no expectation of their eventual recovery.There is in the world of drug-abuse treatment a division between public knowledge and private knowledge, exemplified in the following conversation. I was speaking recently with one of the UK's top medical advisers on drug addiction. We were discussing methadone when he said that if his daughter had a heroin problem, he would do all he could to get her into a residential programme.

"When I am prescribing methadone in my day-to-day work," he said, "I know in my heart of hearts it is not a solution to the individual's drug problem but the only option I have for the majority of addicts I am seeing".

There is a simple truth here but one that is rarely shared, namely that methadone has all too easily become the drug-addiction treatment for the masses. There are no superstar heroin addicts or drug-dependent doctors signing themselves up for long-term methadone programmes. Residential rehabilitation is the gold-standard treatment for those who can afford it or those who are lucky enough to get it on the state.

Our masses, however, need more than the cheapest treatment if they are to live a life that is not dictated by the rhythms of their drug addiction. What they need are fewer drugs and greater support in their attempts at remaining drug free. And that is no quick fix.

Injecting crack cocaine is surprisingly common

While we're talking about a relatively small number of people, I've definitely been hearing more clients report injecting crack cocaine in intake interviews over the last year.

Methadone: Curse or cure?

This article does a decent job of presenting one addict's experience with methadone and a couple professional's opinions on it. Unfortunately the discussion is limited to opinions. One statement that leaped out at me is this:

"I hear that from a lot of health-care professionals too, who don't have a lot of faith in it, you know, because (addicts) want that methadone. But, you know, they're not sticking something in their arm. There's so much hepatitis and HIV out there and it's dangerous. So, maybe it is another drug. The harm-reduction drug works very effectively for the majority of people," she says.

Opposition to it is based on addicts wanting it? That's a pretty reductionist characterization of those who don't have faith in it. It's also based on an assumption that could well be false. A U.K. study found that 60% of methadone clients would prefer to be in abstinence focused treatment.

Anti-heroin project transforms towns

A story about the impact of treatment on a drug ravaged community. It's pretty vague about the treatment provided. I suspect it's methadone but could be naltrexone or buprenorphine.

PRESS RELEASE: Free Site Offers Real Help for Friends and Loved Ones Hooked on Drugs

I saw this press release and wanted to take this opportunity to give you a heads up about press releases like this and the occasional news stories based on them.

I can't confirm it yet, but I suspect that this press release is linked to Narconon (they have a program in Michigan), a treatment program tied to the Church of Scientology. The address was previously used by a Scientology linked business, Scientology has a large base in Clearwater, and the name listed in the press release (although it is a pretty common name) is associated with Scientology.

Narconon and the church issue dozens of press releases like this every year, they also have dozens of websites. Many of these press releases and website appear to hide their association to Narconon and try to get you to call an 800 number. Even when you talk with someone, you can't count on getting straight answers. I once took a call from Stone Hawk and they denied any affiliation or basis in Scientology.

I also see this press release strategy used by Hythiam. The company that has licensed PROMETA, a protocol of prescription drugs and nutritional supplements.

It's easier to be skeptical of a press release, but these press releases are often written as news stories and sometimes lazy journalists or publications will print them with little or no editing.

Pot doesn't lead to heroin

More discussion of the recently published studies on marijuana.

Telephone counselling for smoking cessation

More good news about a simple, cost effective way to help people stop smoking:

Authors' conclusions:Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.

Homeless Admissions to Substance Abuse Treatment: 2004

SAMHSA just released a report on homeless admissions to treatment in 2004. No surprises.

• Homeless admissions are up from 10% in 2000 to 13% in 2004.
• Homeless people were more than twice as likely to have ad 5 prior treatment admissions.

State may face dearth of drug and alcohol counselors

A story from Columbus, Ohio on the the coming shortage of addiction counselors.

On the same subject, here's a Bill White article about a coming leadership crisis in addiction treatment.

Homeless Alcoholics in Seattle Find a Home

Here's an NPR story the program that houses drinking alcoholics in Seattle. The story makes it clear that they've given up hope that these people can get better. I'm all for housing them, but put some expectations on the client (participation in some form of treatment and/or mutual aid groups) and keep working to facilitate recovery.

Impact of practitioner's training in the management of alcohol depende

This study finds marked differences in outcomes between doctors with training in alcoholism versus those without. The average amount of training among the group of trained doctors was only 10 hours.

Trained GPs proved better i) in the attempt at abstinence, with 67% patients becoming sober vs. 47% in a comparison sample and ii) in repeat attempt at abstinence in the event of relapse, with an average 2.99 vs. 1.31 attempts per patient.

Companies Must Stop Fraudulently Promoting Laser Therapy as a Treatment to Quit Smoking, Public Citizen Tells FDA

Public Citizen is asking the FDA to prevent the promotion of laser therapy as a smoking cessation treatment. More here.

Help Seeking Quadruples Likelihood of Abstinence; Dawson

Here's a summary of a recent study on the impact of seeking help on the likelihood of abstinence. People who sought help had more severe and more numerous problems, but they were significantly more likely to recover than people who did not seek help. I went to the article and founce no mention of whether the person sought help because of external pressures (like courts).

Even though they had more comorbidity and therefore were at risk for worse outcomes, seekers of formal and informal treatment had better odds of recovery from alcohol dependence.

Searching for Strategies to Help the Homeless

NPR's Morning Edition is running a series on chronic homelessness. Today's segment talked about the importance of supportive housing and addressing "root causes of homelessness" like mental illness and addiction. This was a controversial assertion in Ann Arbor 10 years ago, it is less controversial now. A representative from the Rockefeller Foundation talked about what a mistake it is to provide housing without also addressing these root causes.

Tomorrow's segment is on the housing program in Seattle that I posted about recently. It provides permanent housing for chronic alcoholics, apparently without any expectations that they try to recover.

Addiction careers and the natural history of change

The British National Treatment Agency for Substance Misuse (NTA) recently released a research report about addiction careers and natural change. Looking at addiction careers is a pretty new area of research and represents a shift toward looking at addiction as a chronic condition. When one starts to look at addiction this way, one possible outcome of treatment is a reduction in addiction careers.

Highlights from the report include:

• A table of the "capture rates" of different drugs. How many people that try it eventually become addicted.
• Discussion of the concept of natural recovery.
• Discussion of the impact on maintenance interventions on careers.
• The impact of treatment on careers.

It's a great primer on "natural recovery." We known for years that most people recover without treatment, we're just now beginning to explore how these people change and why others are unable to change without help.

BTW - The NTA website is building a library of reports like this. Many are very good and concise. Worth browsing.

Smoking To Blame For More Than Half Of Difference In Men's Mortality Risk Across Class Lines

Quit smoking to stick it to the man!:

The direct correlation between lower socioeconomic status and mortality risk is well known, but a new study by the University of Toronto and the University of Oxford is the first to determine that more than half the difference in risk of death between men in the highest social strata and those in the lowest can be attributed to smoking.

My Marijuana Post

A reader makes a fair criticism:

Just a comment that from a prevention advocate's point of view (the ones who are creating the "firestorm",) the potential innate harm of a drug is not limited to or defined by whether or not someone becomes addicted to it. E.g. It's well documented that cannabis impairs driving skills, esp the ability to stay in a lateral lane. If my son smoked dope and was killed or injured in a car accident, or was hit by someone who had been smoking dope, all I would care about is that my son was injured or killed; I wouldn't much care whether or not the use resulted from a chemically dependent limbic system or a poor choice. [Some friends] once did a workshop for parents on marijuana, and several legalization advocates showed up to argue and it was turning into a circus until a local student who was attending as part of a class assignment stood up and said she had a 2 year old son she had not planned to have and she ever would have slept with the father if she hadn't been high on marijuana. Those are the kinds of consequences that are hard to measure and do not result only from addiction, they result from use.

My point (poorly made), was not that addiction is the only harm or only important harm that might result from marijuana use. Rather, that both sides seize upon these kinds of findings and stretch the truth to make their case.

Cannabis in the News

A recent marijuana study concluded that there was no link between smoking marijuana and lung cancer. This set off a firestorm - cannabis advocates argued that it's safe; anti-drug activists argued that it's still dangerous. One of the recent studies that they seized upon concluded that marijuana use in rats was linked to heroin use. This brought retorts criticizing these activists of reviving the "gateway theory". Now there's a new study linking marijuana smoking to pre-cancerous cells in smokers' lungs.

My problem with all of this is that it focuses far too much on the drug (the drug's dangerous - the drug's not dangerous) and not enough on the relationship between the drug and the brain of the user. Clearly, most adults who use marijuana are not and will not become addicted. However, people with the wrong limbic system will develop problems.

Safe Injection Rooms in the News

There have been several recent articles about supervised injection centers. Here's a recent one praising an Australian center and another from today asking hard questions about the same center.

Personally, I'm underwhelmed with the referral rates. The first article cites more referrals than the second, I'm not sure where the discrepancy comes from. They also don't clearly define "referral." Is it a passive referral, "call this number"; or an active referral, "we'll take you directly to the detox center right now"? There's a big difference. Whatever the definition or the number, the best scenario is a 1.7% referral rate. I don't know what a good referral rate would be, but I'm not impressed.

In Vancouver, there's concern about the future of the supervised injection center because its license is about to expire and the new prime minister opposes the site. At the same time, there have been several articles about the addition of 30 beds to the site. I don't have a clear understanding of their purpose. They say they are for people waiting for treatment. I guess it would operate like a shelter for them? But, isn't an injection center a lousy place to shelter someone who's decided to stop using? Don't they have any social detoxes or shelters with recovery support services?

First recovery center breaks ground in Kentucky

The State of Kentucky has broken ground on a women's recovery center. This is part of Governor Fletcher's "Recovery Kentucky" initiative. (Here's an NPR story on it.) He plans to open 10 regional recovery centers that provide sheltering, transitional housing and recovery support for up to 2 years.

Colorado University-Boulder creates the Center for Students in Recovery

Colorado University-Boulder creates the Center for Students in Recovery. College recovery support programs are beginning to pop up around the country. Texas Tech was the pioneer.

From an older story about the Texas Tech program:

Since the inception of the program, only one student out of 600 who have received scholarship aid has flunked out. Even more impressive is the fact that these recovering students maintain a grade point average of 3.58, well above the university-wide average of 2.85, and 95 percent of the participants have stayed clean and sober.

New study emphasizes the importance of relationships

A study published in the August 2006 issue of the journal Addiction attempted to study the impact of treatment program relationships on treatment outcomes. No suprise, it found that treatment relationships based on acceptance and constructive social relationships resulted in better outcomes. Here are the highlights from the abstract. Let me know if you want a copy of the entire article:

Aims This study presented and tested a model of behavior change in long-term substance use disorder recovery, the acceptance and relationship context (ARC) model. The model specifies that acceptance-based behavior and constructive social relationships lead to recovery, and that treatment programs with supportive, involved relationships facilitate the development of these factors.

Conclusions Patients from treatment programs with an affiliative relationship network are more likely to respond adaptively to internal states associated previously with substance use, develop constructive social relationships and achieve long-term treatment benefits.

Park to be site of sober revelry - Ann Arbor

Soberfest 2006! Sunday! Sunday! Sunday! See you there!

Join Together withdraws PROMETA article

On July 3rd I posted an entry about a study using Hythiam's PROMETA protocol for methamphetamine addiction. I told you about their sketchy sales tactics and to expect to hear more about them. Well, this morning's Join Together email included the announcement below stating that they withdrew their summary of the study from their site.

EDITOR'S NOTE
The June 30 research summary Anti-Anxiety Drug Said to Help Meth Addicts, which appeared in the July 3 edition of JT Direct, has been withdrawn from our service. It reports preliminary uncontrolled results from off label use of a medication approved for a condition that is not addiction. The FDA has not approved this treatment modality, nor has it been supported by peer reviewed NIH research.

Project Prevention

Project Prevention just announced its "2006 In '06" campaign. Project Prevention was formerly known as CRACK (Children Requiring A Caring Kommunity). Their goal for 2006 is to pay 2006 addicts to get sterilized or get some form of long term birth control. According to their website, they have a chapter in Detroit.

The group's founder, Barbara Harris, is reported to have said:

We don’t allow dogs to breed. We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children …

She's also quoted as saying the following:

My mind has changed as far as the women go. When I first started the program I was just so angry with these women. I thought they were scum. But during these years I've had the opportunity to meet many of these women, and eventually realized that my anger is more toward society. If the government had common sense, they would spend more money on drug treatment—then they'd be spending less on caring for these babies. People tell me I should be spending my money on treatment programs and I tell them for every [addicted child] I can prevent from being conceived, there's four million dollars that can be used for drug treatment.

I'm all for preventing drug affected pregnancies. However, we know that the biggest barriers to a meaningful community response are stigma and hopelessness. It seems clear to me that this group's reductionist message - that addicted women are irresponsible, unloving baby machines - only makes the problem worse.

New and improved SAMHSA website

Substance Abuse and Mental Health Services Administration overhauled their website. It was badly needed. Hopefully their wealth of materials will be easier to sort through.

The Not-Quite-So-Grim Neurology of Teenage Drinking

Here is another perspective on the story about the impact of age of first use from a few days ago. The writer argues that the early drinking and future alcohol dependence is caused by environmental factors and hereditary predisposition rather than early drinking cause future alcohol problems.

The author has a pretty strong bias against the disease model and believes that most addiction is self-medication (listen to minute 33:45).

I think she's right that the coverage of this overstates the likelyhood that alcoholism can be "caught" by early exposure. But, she is probably just as guilty of understating the potential impact of early exposure, completely excluding any mention of research on early drug exposure and brain plasticity.

Chantix Quadruples Smoker's Chances Of Quitting Successfully

A new drug from Pfizer shows promising results. The results don't include comparison to nicotine replacement therapy. The results seem to underscore that whatever your method, there's hope for quitting smoking.

The study lasted one year. Here are some facts from that study:

-- 44% of those on Chantix were not smoking at 12 weeks
-- 29.5%% of those on Zyban were not smoking at 12 weeks
-- 18% of those on a placebo were not smoking at 12 weeks
-- 22% of those on Chantix did not smoke from week 9 to 52
-- 16% of those on Zyban did not smoke from week 9 to 52
-- 8.4% of those on a placebo did not smoke from week 9 to 52

Another study, from the Unversity of Wisconsin included 1,027 volunteers, all of them smokers who wanted to quit. Results were almost the same as the ones above.

The third study involved people in seven countries - 1,900 smokers who wanted to quit. All of them took Chantix for the first 12 weeks, after which 1,236 (65%) were still not smoking. The 1,236 quitters were then divided into two groups: One group continued taking Chantix while the other took a placebo. This continued for another 12 weeks. At the end of the 24-week period:

-- 70.5% of those on Chantix were not smoking
-- 49.6% of those on a placebo were not smoking

Cellphone prevents drunk dialing

Does this qualify as harm reduction?

The disparity on crack-cocaine sentencing

This compelling Op-Ed calls for reforming the cocaine sentencing disparity created by the Anti Drug Abuse Act:

Defendants convicted with just 5 grams of crack cocaine, the weight of 5 sugar packets, were subject to a five-year mandatory minimum sentence. The same penalty was triggered for powder cocaine only when an offense involved at least 500 grams.

Twenty years later, the aftermath of these laws is sobering. More than 80 percent of the defendants prosecuted for a crack offense are African-American, despite the fact that more than two-thirds of crack users are white or Hispanic. By and large, these defendants are not the kingpins of the drug trade. Data from the US Sentencing Commission document that 73 percent of crack defendants had only low-level involvement in drug activity, such as street-level dealers, couriers, or lookouts. The commission also has found that crack cocaine sentences are the single most significant factor contributing to racial disparity in federal sentencing.

The Grim Neurology of Teenage Drinking

A new study (NY Times registration is free. If you don't want to register, go to www.bugmenot.com.) affirms what we've learned over the last 10 to 15 years about the importance of postponing age of first use:

47 percent of those who begin drinking alcohol before the age of 14 become alcohol dependent at some time in their lives, compared with 9 percent of those who wait at least until age 21. The correlation holds even when genetic risks for alcoholism are taken into account.

"We definitely didn't know 5 or 10 years ago that alcohol affected the teen brain differently," said Dr. White, who has also been involved in research at Duke on alcohol in adolescent rats. "Now there's a sense of urgency. It's the same place we were in when everyone realized what a bad thing it was for pregnant women to drink alcohol."

Homeless Alcoholics Receive a Permanent Place to Live, and Drink

Take the time to read this. (NY Times registration is free. If you don't want to register, go to www.bugmenot.com.) It's a very sad story.

It talks about the application of the "housing first" approach with chronic alcoholics. Reasonable people can disagree on the merits of using the approach with this population, but whatever one's ideology, this is a difficult thing to imagine celebrating. The article made no reference to any efforts to facilitate recovery among the people in the apartments. I hope that there are some efforts and that the reporter failed to include those efforts in the story. Again, reasonable people can disagree about the merits of a "housing first" approach with these people, but it would be unconscionable to give up on trying to help them recover.

Meth addicts reduce drug use with new treatment

This article* PROMETA. PROMETA is a protocol for combining certain prescription drugs and nutritional supplements. PROMETA protocols are owned and sold by Hythiam, Inc. Hythiam is in the midst of a major publicity and sales push.

Dawn Farm and the local drug court have had several very aggressive sales calls. They've gotten so aggressive, pushing and smarmy that I had to ask the sales person to stop calling and not to come to our facilities. It's worth noting that a lot of their sales pitch was focused on the value of their stock.

You're going to see their name popping up everywhere. PROMETA may represent the best pharmacology available today, but it appears that all of their drugs could be precribed by any knowledgeable doctor.

* Post updated 7/4/06 due to bad link. The story was corrected after it was initially posted.

Remission and Relapse in the General Population

This study suggests that most people who develop alcohol problems resolve them without any professional help. Keep in mind that this is a non-clinical population.

Panel Calls for States to Take Lead on Addiction Policy

Michael Dukakis is chairing a panel of government officials, treatment providers and recovery advocates. They recently released a report that calls for states to take lead on addiction policy:

...states bear many of the costs of alcohol and other drug addiction, spending an estimated 13 percent of their budgets on addiction-related problems.

However, the report noted, 'Less than four percent of this is spent on prevention and treatment, while more than 96 percent pays for the avoidable social and physical consequences that result from our failure to apply what we know about how to prevent and treat substance-use problems.' These costs include child-welfare, prison, court, police, and Medicaid expenditures for treating medical problems related to addictive illnesses.

recommendations include that states do the following:

develop a statewide strategy that includes all agencies affected by drug and alcohol problems

increase accountability for all state agencies working on issues related to addiction

educate lawmakers about the costs of alcohol and other drug addiction to improve their participation in policymaking

train judges to address alcohol and other drug use among defendants and improve coordination with treatment services

create a state alcohol and other drug policy advisory board, answerable to the governor and lawmakers, that includes representatives from the recovering community and civic leaders

The whole report is available here. It's not an exciting read, but it is worth downloading.

Reports suggest declines in drug production and use

I'm of the opinion that we focus too much on supply and enforcement, nut here's some good news on those fronts:

• DEA meth lab seizures are down 30%.
• Job applicant drug tests suggest meth use is down and overall positive tests are at a 17 year low.
• The United Nations reports that opium poppy production is down 22%.
• The U.N. also reports that cocaine consumption is down in North and South America, but up in Europe.

Addicts need treatment: Given proper help and support, most will recover

The Ann Arbor News ran an Other Voices piece by me. It was really visible - above the fold, a big headline and a big graphic. Hopefully it will motivate some people to take some action.

Lawmakers back jail terms for drug offenders despite Prop. 36

I wrote something about this a few weeks back. Proposal 36 in California was passed by California voters in 200 and required that the state offer treatment as an alternative to jail or prison for most nonviolent drug offenders.

Ballot mandated funding for Prop. 36 ended this year and the California legislature had to decide what to do. They've passed new funding for it but want to allow short, instant jail sentences for probation violators. The Drug Policy Alliance is prepared to fight them on any incarceration for relapses.

Alcohol-related Liver Disease Numbers Double In Ten Years, UK

Over the past couple of years, there has been a lot of coverage of drinking problems in England. It's been hard to know how much of it is hysteria and how much of the concern is legitimate. This article provides some hard data suggesting that there is significant growth in alcohol related problems.

• Alcohol-related liver disease hospital admissions in the UK have doubled in ten years
• total deaths related to alcoholic liver disease rose by 37%, according to NHS figures.
• In 2004/5 35,400 people were admitted to hospital with an alcohol-related liver disease.
• In 2004/5 21,700 people were admitted to hospital for alcoholic poisoning, versus 13,600 in 1994/5.
• in 2005 25% of 11-15 year old children had had an alcoholic beverage during the previous seven days of being surveyed.
• 33% of men and 25% of women, aged 16-24 had been on a binge drink once during the previous seven days of being surveyed.

I was unable to find precisely analogous numbers for the U.S. I did find that the numbers for past 30 days use of alcohol is 17% for 8th graders and 33% for 10th graders.

Cognitive Behavioral Therapy Appears More Effective Than Sleep Medication For Treating Insomnia

This study provides more good news for people suffering from insomnia (a relatively common problem for people in early recovery). The study supports the findings from a Harvard study that was published last year. Cognitive behavioral therapy appears to be a safe, effective treatment for many people suffering from insomnia.

Ten-Year Recovery Outcomes for Clients With Co-Occurring Schizophrenia and Substance Use Disorders

This study finds good news for schizophrenics with alcohol problems. At 10 year follow up 65% had no signs of a substance use disorder.

The study is much more focused on mental illness than on substance use problems. As usual it's also vague about the nature of the substance use problems. I went to the full article and it does not specify DSM abuse vs. dependence. Either way, this study offers hope.

One other interesting note:

"clients who received clozapine during the early years of the study experienced highly significant improvements in substance abuse outcomes compared with those on other antipsychotic medications."