Afghan Heroin production soars

Apparently the amount of Afghan land under poppy cultivation has grown by 21% in the past year - whatever our beleagured troops are doing in that tragic country, clearly any efforts to reduce this trade has been unsuccessful. But to tell an Afghan farmer not to produce one of the few things that has a chance of making any money, seems a bit fatuous anyway - it is in effect punishing him for meeting the demands of our own people. As Simon Jenkins said in The Guardian this week, the ONLY hope for reducing the problems of heroin consumption in the West are to reduce the demand by more investment in treatment and in addressing social exclusion. Attempts to curtail supply have never worked, anywhere, ever.

In the meantime I guess that this increase in heroin supply will be translated into our practices in the year ahead in terms of stronger purity for the same cost - we shall see.

25% Rise in Drug Related Deaths in Scotland

This news from Scotland is depressing:

Scotland you will remember was at the vanguard of introducing supervised methadone consumption in response to its appalling rate of drug related (and methadone related) deaths in the late 80's - the fall in deaths that followed was further evidence of the value of high quality methadone prescribing. And it was Scotland's heroin users who discovered the value of buprenorphine as well in the great Scottish Temgesic "scandal" which led to the CD Classification of buprenorphine and later, in a poetic twist of irony, to buprenorphine receiving a licence for the treatment of opiate dependency. And it is Scotland where high doses of methadone are championed, and where just last year, some Chief Police Officers were calling for a return to abstinence treatments because of the "failure" of methadone programmes! what a confused state of affairs. It is remarkable that since Dole and Nyswander first wrote about methadone treatment in JAMA in 1965, every single study published has reinforced the message of the life saving effects of high quality substitute prescribing - I hope that Scotland does not loose sight of that message - whatever is going on in Caledonia to increase the rate of drug related deaths now is evidence (if we ever needed it) of the need for more treatment, not less.

http://www.drugscope.org.uk/newsandevents/currentnewspages/Scotland_DRD_rise.htm

Suboxone on FP10MDA

There was a minor cock up when this drug was put on sale in the UK - there was some sort of legal reason why it should not be prescribable on "Blue Scripts", making interval prescribing impossible. Soon after there was an unofficial dictat sent out to pharmacists for them to accept Blue Scripts (and be paid for doing so), but now I am happy to tell you that the situation is resolved and it's official, Suboxone MAY BE PRESCRIBED ON FP10MDA - hurrah.

Of course this drug's major selling point over buprenorphine (without naloxone included) is that it is less likely to be diverted because it has no appeal for injecting - so ironically, you might be more inclined to take the patient off supervision more quickly and onto less frequent collections to save the poor old PCT's cash.... and the latest edition of "Addiction" (102) has a study by Prof Bell showing that unsupervised Suboxone is every bit as effective at retaining patients in treatment as supervised buprenorphine - something to ponder.....

"After The War on Drugs"

Our friends at Transform have produced a new document that you may be interested in. Titled: "After the War on Drugs: Tools for the debate" is a guide to making the case for drug policy reform designed to:

• Re-frame the debate, moving it beyond stale ideological arguments into substantive, rational engagement




• Provide the language and analysis to challenge the prohibitionist status quo, and to make the case for evidenced based alternatives

You can access it from Transform's Blog here.

As I write, I have just spent a day attending to casualties of this "war" - including one chap who was released from prison with no methadone, no benefits and no home to go to. He stole a tent to keep out of the rain, is stealing to buy food, and has had two near-fatal overdoses in ten days. If he survives long enough he may live to be sent back to prison again. I am not sure who the winners are in this war, but there seem to be plenty of loosers.

Dalrymple says that Heroin Detox is "No worse than Flu"

For years, Theodore Dalrymple's writings on all things medical have been enjoyable for their dry wit and keen observations - but when he writes about heroin users he seems to me to loose his normal compassion and humanity. Maybe he has some personal "agenda".... but anyway....

Dalrymple was plugging his new book on Radio 4 this morning (hear the interview here) but some aggrieved methadone patient was shouting him down constantly so I did not hear the full argument and I have not read the book.... but it seems pointless to say that stopping using heroin is no worse than a dose of flu - and that it is all "psychological" (as if psychological distress didn't matter), because quite clearly people seem to have a great deal of difficulty coming off heroin which is disproportionate to a dose of flu...... But in another sense of course he is right - traversing an opiate detox can be achieved within 2 weeks by 80% of our patients at Clouds - rather less I suspect if we did not medicalise the event - but then we medicalise flu with aspirin and going to bed as well..... and I also agree with him that by medicalising addiction we turn clients into patients, tacitly suggesting that as "sufferers", they are not responsible for their "disease" ... and the ongoing daily dosing of methadone petrifies that mindset.

But I am not greatly bothered by Dalrymple's prejudices, because when people like him talk about heroin addicts, they talk about heroin, rather than talk about why people become unhappy and look for chemical relief in the first place. Returning to the unhappiness that the chemicals null out is what is hard, not relinquishing the chemicals themselves. Perversely, I am rather glad that we do have heroin and alcohol sloshing around our streets.... for every society has always had inequality of opportunity brought about by intellectual, social, mental and family dysfunction, and that inequality brings about enormous unhappiness. Whilst others, dealt a decent set of cards, get on with their lives, there is a big section that is left behind. If comforting chemicals had never existed, noone would know these people or their unhappiness - but because they find temporary solace in drugs and alcohol, and the knock on effects of their habits are health and criminal consequences, whole care systems have been invoked to look after them. Yes, some of them Dalrymple will say, are indeed lazy blackguards - but not many - the rest are lost souls behind a smokescreen of chemicals, who we try to help and care for - and by looking no deeper than the smoke, his simplistic arguments disrespect them.