Thursday, July 24, 2008

NY prohibits smoking in addiction recovery centers

ALBANY, N.Y. (AP) — Many drug addicts, problem gamblers and alcoholics may find it harder to kick their habits in New York now that the state has become the first in the country to ban smoking at all recovery centers.

Some addicts say losing the tobacco crutch could keep them from getting clean and sober, or from trying at all.

New York's 13 state-run addiction treatment centers have been tobacco free for more than 10 years. New regulations that take effect Thursday will also apply to private treatment centers. Some are worried that people who need help for drugs and alcohol won't pursue it because they aren't ready to quit smoking.

Bryan Lapsker, a 21-year-old PCP addict from Brooklyn who has been getting help for his addiction at a treatment center in Queens for nearly nine months, has been dreading the change every day.

"Nicotine helps (addicts) get through the day," he said. "Now you take the nicotine away from us, it's almost impossible to get through the day ... addiction is addiction, I understand that, but nicotine is a legal substance."

Legal or not, state officials behind the new rules believe banning tobacco is critical to successful treatment programs.

"Often times smoking was given as a reward in the day-to-day treatment programs, and we need to make sure that we're changing the culture to really promote an overall recovery plan that involves health and wellness for the optimal chance for recovery," said Karen Carpenter-Palumbo, the commissioner of the New York Office of Alcoholism and Substance Abuse Services.

About one in five New Yorkers smoke, compared to nine in 10 chemically dependent New Yorkers, she said.

Addicts are more likely to have long-term success if they quit smoking at the same time they enter treatment, Carpenter-Palumbo said.

A 2004 study in the Journal of Consulting and Clinical Psychology found that smoking cessation intervention provided during addiction treatment was associated with a 25 percent better chance of maintaining long term abstinence from alcohol and drugs.

Thomas Carr, the manager of national policy at the American Lung Association, said he's not aware of any other states that have taken this kind of action — although individual facilities around the country have eliminated smoking and offered cessation help.

An $8 million grant from the New York Department of Health will help train employees to deal with treating nicotine dependence and provide free nicotine replacements.

Providers say that's a start, but it won't pay for everything the mandate requires.

If people leave treatment because of the new rules it could create "an economic crisis for the field," said John Coppola, executive director of Alcoholism and Substance Abuse Providers.

Treatment facilities will have a six-month grace period in which tobacco use won't be a factor in whether their certification is renewed. They will also be able to develop their own plans to become tobacco-free and decide at what point an addict would have to leave for violating the rules.

Robert Doherty, the executive director at St. Peter's Addiction Recovery Center in Albany, said the new regulations are more fair to facilities that have already prohibited smoking in the interest of their patients.

Doherty said St. Peters has had few problems since banning smoking in May 2006.

"I think it's a more healthy approach to providing care, it's a more useful approach to treating addiction ... it just seems to be a responsible thing to do," he said.

OASAS estimates that 250,000 addicts in New York are in non-state-run addiction treatment centers and could be affected by the change. Some of those facilities already have nonsmoking policies.

Roy Kearse is the vice president of residential services at Samaritan Village, the Queens-based long-term treatment facility where Lapsker and other addicts get treatment at multiple locations.

While Kearse supports eliminating tobacco use among addicts, he is concerned the zero-tolerance policy could discourage some from seeking help.

"We don't know how many people will leave, if any at all will leave," Kearse said. "But we did have patients who said 'I didn't come in here to deal with my smoking addiction, I came in here for my heroin addiction, or my addiction to crack.'"

Lapsker, getting treatment through a court-ordered mandate, says he is grateful for his time at Samaritan. But he said if he faces a potential relapse after leaving the facility he will "definitely not" go seek help because he doesn't want to quit smoking.

"I look forward to my every cigarette that I smoke," Lapsker said. "That's what gets me through the day, through the stress, through the pressure."
source: Associated Press

Wednesday, July 23, 2008

Horizon Village to expand mental health, addiction services for veterans

War veterans in Western New York who are recovering from alcohol and drug addiction will soon have additional help with the construction of a 25-bed addition at Horizon Village in Sanborn.

Construction of the $3 million building, next to the existing 50-bed residential facility at 6301 Inducon Drive East on Horizon's 11-acre campus, is scheduled to begin early in the fall and be completed next spring.

As many as 85 percent of veterans in Western New York are not receiving the treatment they need, Commissioner Karen M. Carpenter-Palumbo of the state's substance abuse office said Tuesday.

"The development of this facility at Horizon Village will offer timely access to specialized services for veterans and their families desperate for the help they need and deserve," she said.

About 40 percent of veterans who have served in Iraq or Afghanistan will experience a mental health problem, and 60 percent of those will experience issues with chemical dependency, according to the National Association of Alcoholism and Drug Abuse Counselors.

"Currently, there can be a four to six week wait for a bed at Horizon Village," said Paige Prentice, the executive director.

The 22,000-square-foot treatment facility will provide specialized chemical dependency and mental health services for veterans with post-traumatic stress disorder and traumatic brain injury. Residents will have full access to Horizon Village's broad range of services, including pre-vocational preparation and on- and off-site educational opportunities.

Further information is available at Horizon's Web site:
source: The Buffalo News

Monday, July 21, 2008

Overindulgence Of Alcohol Encouraged By Loud Music

Commercial venues are very aware of the effects that the environment - in this case, music - can have on in-store traffic flow, sales volumes, product choices, and consumer time spent in the immediate vicinity. A study of the effects of music levels on drinking in a bar setting has found that loud music leads to more drinking in less time.

Results will be published in the October issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Previous research had shown that fast music can cause fast drinking, and that music versus no music can cause a person to spend more time in a bar," said Nicolas Guéguen, a professor of behavioral sciences at the Université de Bretagne-Sud in France, and corresponding author for the study. "This is the first time that an experimental approach in a real context found the effects of loud music on alcohol consumption."

Researchers discretely visited two bars for three Saturday evenings in a medium-size city located in the west of France. The study subjects, 40 males 18 to 25 years of age, were unaware that they were being observed; only those who ordered a glass of draft beer (25 cl. or 8 oz.) were included. With permission from the bar owners, observers would randomly manipulate the sound levels (either 72 dB, considered normal, or 88 dB, considered high) of the music in the bar (Top 40 songs) before choosing a participant. After the observed participant left the bar, sound levels were again randomly selected and a new participant was chosen.

Results showed that high sound levels led to increased drinking, within a decreased amount of time.

Guéguen and his colleagues offered two hypotheses for why this may have occurred. "One, in agreement with previous research on music, food and drink, high sound levels may have caused higher arousal, which led the subjects to drink faster and to order more drinks,"" said Guéguen. "Two, loud music may have had a negative effect on social interaction in the bar, so that patrons drank more because they talked less."

In France, observed Guéguen, more than 70,000 persons per year die because of chronic alcohol consumption, and alcohol is associated with the majority of fatal car accidents. "We have shown that environmental music played in a bar is associated with an increase in drinking," he said. "We need to encourage bar owners to play music at more of a moderate level ... and make consumers aware that loud music can influence their alcohol consumption."
source: Medical News Today

Friday, July 18, 2008

Groups file human rights complaint over treatment of Vancouver's homeless

VANCOUVER — Private security guards that patrol downtown Vancouver on the lookout for crimes and other social ills violate the rights of drug addicts and the homeless, says a complaint to be filed Thursday with the B.C. Human Rights Tribunal.

The complaint alleges the guards hired by the Downtown Vancouver Business Improvement Association and known as "downtown ambassadors," unfairly harass addicts and limit their access to public spaces.

The unarmed guards' role, according to the association's website, includes assisting the public with directions and other questions, monitoring and deterring crimes in public spaces and reporting crime and "quality of life" concerns.

The complaint by the Pivot Legal Society, the Vancouver Area Network of Drug Users and the United Native Nations claims the guards discriminate based on the disabilities of addiction and mental illness.

And they say the guards' actions disproportionately affect aboriginals.

In particular, the groups complain the guards order people sitting or laying on the sidewalk to move and try to prevent people from looking for recyclables in dumpsters.

They say the guards follow and stare at people they find "undesirable" and take photographs and notes for unknown purposes.

"Each of the above-noted tactics individually and collectively have the effect of 'humiliating' and 'shaming' homeless people who have equal legal access to public spaces, including sidewalks and back lanes," says the complaint, which contains allegations that haven't been tested in court.

No one from the business association was immediately available for comment.

The groups note the guards enjoy a sanctioned position of authority, but don't have any special legal mandate or protection.

They ask the commission to declare that the guards are violating the province's human rights code and order them to stop.

And they want the commission to order the business association to pay $20 each to people affected by their actions. They also ask the association to pay the costs of pursuing their complaint.

The security-guard program started eight years ago and has expanded with the blessing of Vancouver's city council.

The downtown ambassadors, along with the business association's loss-prevention programs, have a budget $961,000 for 2007-2008 - nearly 60 per cent of the association's entire budget.

The business association is funded through a levy imposed on the municipal property taxes of downtown commercial properties.

Abuse treatment program praised

A man who's helped implement substance abuse recovery programs throughout the world says the Baldy Hughes Therapeutic Community near Prince George is on the right track to success.

"I can't tell you how impressed I am with this therapeutic community" and how much it's achieved in a short time, said Fred Tent, who has been leading a five-day conference at the site, located 27 kilometres southwest of Prince George.
"It usually takes from three to five years to establish a (therapeutic) community so it's stable enough to stimulate those who come into it," said Tent, who attributes the success of the first seven months to the leadership and vision of Vancouver-Burrard MLA Lorne Mayencourt, who founded the program.
The focus of the conference is to learn and understand how and why a therapeutic community with a three-year program works for those recovering from drug and alcohol addiction.

"Forty years of research on people with addiction problems shows (during recovery) that up to 90 days there is no change at all. After that, then you start to see some slight changes, and at 12 months, you can start to accomplish things. The longer they stay, the better," Tent said.
The conference attracted about 45 administrators, directors, parole officers and other resource people from around the province.
"My hope is that they go home with an understanding of the model and how it can be used throughout the province," said Tent. "The unique thing is that we also have 15 residents (at the sessions), who I hope will gain a better understanding and ability to assess their own situation."

Mayencourt, who participated in the conference lectures, workshops and group sessions, said there are now 23 residents from across the province in the program.
"We'll have 30 in September, but right now we are stabilizing the community. We still have problems, but we are growing. I've learned the community is consistently better the closer we walk and work together. Whether staff or residents, we are all one family," Mayencourt said.
Among first residents were Stefani Meinster and Jeremy Ward, who became the parents of a baby boy in May.
The couple has left the community and is now back in the Lower Mainland, Mayencourt said.
"I'm just glad they were here six months and had time to stabilize their lives," he said.

Another resident, Ken Young of Prince George, has been there since the beginning and says he is committed to stay for the long haul. He said he's doing well both physically and mentally, and is connecting more closely with family members.
Tent said the former military base and radar station location is "a perfect setting" for the three-year program due its distance from the city and the facilities available.

He added the need for rehabilitation of the site buildings, being done by residents, will give them a strong sense of ownership and belonging, and he expects a number of successful clients will become staff members and continue to work at the site.
Mayencourt modeled the centre on the San Patrignano Community in Italy, which during 30 years of operation, has treated more than 20,000 people. Research found that 72 per cent of the clients remained drug-free after stays of at least two years.

Thursday, July 17, 2008

Neighborhood rallies against methadone clinic

SEABROOK — Residents of the Pineo Farms subdivision came with their neighbors, spouses and even toddlers to tell the Planning Board how much they didn't want the proposed methadone clinic on Stard Road within 1,000 feet of their homes.

The use may be allowed in the industrial zone where the clinic is planned at 18 Stard Road, they said, but the families who have settled into the houses built on the former Pineo Farm fear their lives will never be the same if the clinic opens. They fear drug-addicted patients using the methadone clinic will endanger the lives of their children, bring crime and more traffic to the area off Route 107 and Interstate 95, and lower their property values, they said.

"I worry for the safety of my daughter," said Pineo Farms resident Tim Reeves at a hearing Tuesday night, holding his toddler in his arms. "If anything happened to my daughter, it would break my heart. I can't see how the risks (to her safety) wouldn't increase if something like this (clinic) is allowed into this place. Here, look at my daughter."

Assurances from Colonial Management Group, the company proposing the clinic, that such fears have not become reality in communities where their clinics are did nothing to assuage residents.

According to Colonial's development director, Joseph Sullivan, Seabrook was chosen for the location of this clinic because of the town's already high drug-related crime statistics, as well as its "well-known drug problem" and shortage of drug treatment facilities.

Although Julio Carrillo doesn't live in Pineo Farms, as a person formerly addicted to drugs, he told the Planning Board substituting methadone for heroin is no way to end someone's drug dependency. Addicts should go through a painful withdrawal, he said, so they remember not to fall into addiction again.

Carrillo, whose comments hushed the crowd, was praised and thanked for his courage in coming forward by Planning Board Chairwoman Susan Foote. The issue of whether methadone is or isn't effective in treating drug addiction, however, isn't one the Planning Board has any authority to address. The Planning Board handles land-use concerns, Foote repeatedly told Carrillo and others in the audience.

When Foote asked abutters to present evidence for their fearful speculations, they had no statistics to offer, but residents insisted their angst was real.

Pineo Farms resident James Prentice said his friend is being treated with methadone for drug addiction. Some do well on the program, but others abuse the program and get cut off from the methadone that quells their drug craving. They then become desperate for the money to buy illegal drugs like heroin and resort to stealing from those near the clinic, Prentice said.

"This clinic is going to place an extra burden on the Police Department and the taxpayers," Prentice said. "We're concerned about our welfare and our well-being and hope (the board) will consider our feelings. This is a neighborhood. It may be industrial, but it's a mixed bag (of businesses and homes)."

The expectation Colonial Management Group and King Weinstein, the owner of the land, would sue the town if turned down didn't worry Prentice.

"Go ahead and let them sue and let's see what happens," Prentice said.

Selectman and Planning Board member Bob Moore said he understands the neighbors' concerns. No one buys a house near an industrial zone and expects a methadone clinic to move in, Moore said. But, given the clinic would be in a multioffice professional building — a use allowed in the industrial zone, according to Seabrook's zoning rules — keeping the methadone clinic out because of neighbors' undocumented fears is most likely beyond the authority of the Planning Board or any other official, Moore said.

Before continuing the hearing to Aug. 5 for more research, Foote tried several times to explain the Planning Board's authority and limitations on the issue. As long as Weinstein builds his 9,000-square-foot office building to the specifications required by regulations for parking, traffic, lighting, utilities and storm water management, the board has little power to refuse approval. Weinstein can then lease 4,500 square feet to the clinic, Foote said, or any other medical professional or business as long as it's a legal enterprise with the appropriate licenses.

Former Selectman and current Planning Board member Bette Thibodeau said this isn't the first time Seabrook residents feared a new business in town.

"We've had this problem when the (Greyhound) racetrack wanted to come in, and we had it when the (nuclear) power plant wanted to come in," Thibodeau told the neighbors. "These things happen. You can't always say 'no' just because you don't like something."

Wednesday, July 16, 2008

Counseling During Drug Addiction Treatment Reduces Unsafe Sexual Behavior Among People At Risk of HIV, Study Finds

Counseling about sexual behavior during drug addiction treatment could help reduce unsafe sexual behavior among people at risk of HIV in Russia, according to a study recently published in the journal Addiction, ANI/New Kerala reports. According to ANI/New Kerala, the researchers focused on "substance-dependent" individuals in Russia because alcohol use is highly pervasive in the country, and it has been linked with risky sexual behavior.

For the study, Jeffrey Samet -- chief of general internal medicine at Boston University School of Medicine and Boston Medical Center -- and colleagues compared the current method used to reduce unsafe sexual behavior in standard addiction treatment programs in the country with the Russian Partnership To Reduce the Epidemic via Engagement in Narcology Treatment, or PREVENT, intervention program. People living with or without HIV were randomly assigned either to the PREVENT or standard program. PREVENT sessions took place at a hospital in Russia and involved obtaining HIV test results, discussions of personal risk and the creation of a behavioral change plan. In addition, researchers explained to the PREVENT participants the risk reduction plan to promote safer sex, which includes condom use, sex negotiation skills, development of positive attitudes regarding safer sex, and emphasizing the role of alcohol and drugs in impairing decisions. Participants in the standard program received HIV testing but did not receive counseling. People who tested positive in the standard program received a 20-minute HIV post-test counseling session that included creating risk reduction goals and a referral to an HIV care program. All participants were given condoms when leaving the hospital, according to ANI/New Kerala.

The researchers contacted the participants by phone for three months and at six months to assess their personal long-term risk reduction goals and plans, ANI/New Kerala reports. The researchers found that after six months, participants in the PREVENT program had a higher percentage of safer sex, compared with the participants in the standard treatment program. "Both control and intervention groups had improvements in the percentage of safe[r]-sex occurrences, restraining from unprotected sex and increasing condom use between baseline and the three month follow-up," Samet said, adding, "While the intervention group maintained or improved their safe[r]-sex behaviors at the six month follow-up, the standard addiction treatment group worsened." The researchers noted that the results suggest an HIV intervention program targeting the sexual behaviors of alcohol and drug users is feasible and effective at increasing safer sex.

Monday, July 14, 2008

France to crack down on under-age binge drinking

France will ban the sale of alcohol to minors and drinking in public near schools as part of a broad crackdown on binge drinking among youths, the health minister said in an interview published on Sunday.

Roselyne Bachelot said that a recent study showed an over all decline in alcohol consumption among youths but the frequency of drunkenness was increasing.

"Almost half of youths said they had had five glasses of alcohol on a single night on at least one occasion in the previous 30 days, which is the definition of binge drinking," she said in an interview with Journal du Dimanche newspaper.

She said she was working on a new bill that would also ban promotions known as "open bar" which allow customers to drink as much as they want to for a fixed price.

"We are also going to ban open bars ... which are a classic at student parties and which encourage binge drinking," Bachelot said.

She said the number of under-25s hospitalised because of excessive drunkenness had doubled between 2004 and 2007.

"Drinking alcohol in public places close to schools will also be forbidden," she said.

She told the newspaper that at present there was a grey area surrounding sales of alcoholic drinks to teenagers aged 16 to 18, with different rules depending on the kind of alcohol and whether the sales point was a bar, a club or a supermarket.

She said her bill would unambiguously ban any sale of alcohol to under-18s anywhere in France.

Another measure will be to ban sales of alcohol in filling stations. Bachelot said that at present, such a ban exists only from 10 p.m. to 6 a.m. and the new rule should help curb drunk driving.

Bachelot said the measures, which she expected will come into force in 2009, would be accompanied by an advertising campaign featuring youths in a heavenly environment that turns hellish after they have been drinking.

In May, a government body in charge of fighting drug and alcohol addiction said it was considering banning "happy hours" during which bars offer cheaper drinks early in the evening to attract customers. Bachelot's interview made no mention of this.
source: International Herald Tribune

Tuesday, July 8, 2008

Weighing in on the alcohol issue

The toughest question about alcohol today isn't whether to shake or stir that martini. It's whether it's going to hurt or help your health. If you've been following the news about alcohol, it's enough to give you whiplash: One study says it's good; the next says it's bad. It depends on the study's perspective. For instance, alcohol is bad for your liver and increases your risk of diseases like breast cancer. But it's good for your arteries. So there's always a tradeoff.

Still, if you're female, you might wonder if it's ever safe, thanks to recent studies that found that two daily drinks raise your risk for the most common types of breast cancer by a scary 32 percent. Three drinks a day raise these odds by 50 percent.

But then there's the healthy side of alcohol: Moderate drinking can cut your risk of cardiovascular disease by 25 percent to 40 percent. That's because the ethanol in a 1990 Bordeaux, a Bud or any other alcoholic drink increases good cholesterol and discourages blood clots. It also may have an anti-inflammatory effect on plaque. True, red wine has special antioxidants (quercetin, catechins and resveratrol) that combat the inflammation and free radicals that make a mess of blood vessel walls. But mouse studies suggest it would take about 180 bottles of red wine a day to do your vessels any good. So it's probably the alcohol that benefits your arteries. And healthier arteries mean fewer heart attacks, strokes, wrinkles, senior moments - plus better sexual function for men. What about the new study linking a glass of wine a day (wine only; not beer or liquor) to lower risks of non-alcoholic fatty liver disease, the No. 1 liver ailment in the U.S.? It's much too early to toast to that. More studies need to be done to see if the link holds up.

So should you sample that pinot noir or not? Someday, a genetic test may help you decide that. For now, here are the five best ways to get alcohol's health benefits without the risks:

1. Set your limits and stick to them. That means one-half to one drink per day for typical women and one to two for men. Men can safely drink a little more because they have an enzyme that metabolizes alcohol in their stomach lining - when most men have two drinks, only one is absorbed.

2. If you're a woman, weigh and balance. Some docs believe that women who are premenopausal, have a family history of breast cancer or are cancer survivors or are thinking about becoming pregnant simply shouldn't drink. (Definitely don't drink if you're already expecting.) On the other hand, heart disease - not breast cancer - is the No. 1 killer of women. Balance, ah, that's the key. If you're at average risk for breast cancer but high risk for ticker trouble, a drink a day might be a helpful addition to the other heart-healthy steps we know you're taking.

3. If you don't drink already, don't start. Especially if you have a family history of drug or alcohol abuse. Alcohol's risks range from addiction to overindulging enough to cause high blood pressure, strokes, heart failure, liver problems and car accidents. There are plenty of other ways to get its protective benefits against heart disease, wrinkles, memory gaps and erectile dysfunction.

The three biggies: Stay active, maintain a healthy weight and eat smart - avoid saturated and trans fats; simple sugars and syrups; and any grain that isn't 100 percent whole.

4. Think small. French fries and clothing sizes aren't the only things that have been supersized. Drinks have gotten huge, too, thanks in part to extra-large barware. Stick to official amounts: 1 glass of wine is 5 ounces (that's little); one beer is 12 ounces; 1 cocktail is 1.5 ounces of 80-proof spirits, such as vodka.

5. One a day doesn't mean seven on Saturday. Forget "saving up" your daily drinks for a weekend binge. The benefits vanish and alcohol turns toxic, aging your immune system and stressing your heart. Not to mention scrambling your ability to avoid waking up with someone you don't recognize or on a bus to Vegas.
source: Athens Banner-Herald

Monday, July 7, 2008

Opiate-substitution therapy quadruples treatment success in Malaysian heroin users: authors urge adoption in non-western countries

A study from Malaysia published in the June 28th edition of The Lancet has found that substitution therapy with the opiate drug, buprenorphine, tripled the length of time heroin users were able to stay “clean” compared with individuals on a placebo, and nearly quadrupled the proportion of participants who completed the trial without relapse.

An accompanying editorial states that, given these results, “the preferred oral pharmacological treatment for opioid dependence should be agonist maintenance with either methadone or buprenorphine,” and says that concerns that dispensing these drugs could swell black-market use should not outweigh “the major public-health effects of untreated opioid dependence”. Buprenorphine, like methadone, is currently illegal in Malaysia and many other countries with serious injecting drug use problems, such as Russia.

Four times as many individuals given buprenorphine completed the six-month treatment trial without relapse as individuals given naltrexone or placebo; individuals on buprenorphine took on average nearly three times as long to resume heroin use as those on placebo, and twice as long as those on naltrexone. Furthermore individuals provided with buprenorphine were able to stay completely abstinent from heroin for twice as long as those on either naltrexone or placebo.

Substitution therapy using the oral drugs methadone or buprenorphine has been standard practice as a way of trying to wean heroin users off injecting and off street drugs for years in most developed countries. However, in other parts of the world the idea of substituting one opioid for another is still seen as just substituting one addiction for another and adding more drugs into the black market. More recently the opioid antagonist naltrexone – a drug that blocks opioid receptors and so enforces a state of physiological withdrawal from heroin – has been permitted, but although some naltrexone trials report positive results, others have been neutral or negative.

This study was the first ever study in Malaysia to use an opiate agonist – a direct substitute – rather than an antagonist. In the event, the superiority of that agonist, buprenorphine, over both naltrexone and placebo was so marked that the study was terminated before time, when 70% of participants had completed their six month course.

The study involved dependent heroin users. A total of 44 were provided with buprenorphine plus a naltrexone placebo, 43 with naltrexone plus a buprenorphine placebo, and 39 with two placebos. The patients were initially given a fast six-day detox and then provided with substitution therapy or placebo. Urine tests were performed three times weekly to see if they had taken heroin.

Three primary outcome measures were used: time without any heroin use; time to relapse (being defined as three or more consecutive positive heroin tests or a positive test followed by withdrawal from the study); and time remaining on the treatment regime. One other outcome was a global score of HIV risk behaviours, which was split into drug-use and sex-related behaviours.

Patients had a mean age of 37 and were consistent heroin users, with an average of 27 days’ use in the last 30. Only a minority (approximately 41%) were current injectors, though 80% had injected at some point. Twenty-four per cent had shared needles in the last month. Twenty-two per cent were HIV-positive (with fewer in the placebo group, 13%), and the vast majority (95%) had hepatitis C. Only 7% reported consistently using condoms and a third reported having had multiple concurrent sex partners at some point.

At the time the study was terminated, individuals taking the placebo had stayed in treatment for an average of 70 days (out of a maximum possible 168); those on naltrexone for 84 days; and those on buprenorphine for 117 days. Retention was 2.15 times higher amongst buprenorphine users than those taking the placebo and some 1.55 times higher for those randomised to buprenorphine compared to naltrexone; it was 32% higher on naltrexone than placebo, but this was not statistically significant.

Patients on buprenorphine took 2.17 times longer on average to relapse than patients in the placebo arm and 1.56 times longer than patients taking naltrexone. By the end of the study, eleven out of 44 buprenorphine users were still in the study and still abstinent compared with four of those taking naltrexone and three in the placebo arm.

As indicated above, occasional one-off heroin use did not count as ‘relapse’; the mean time subjects manages to remain completely heroin free was 24 days on placebo, 42 days on naltrexone and 59 days on buprenorphine.

Sexual risk behaviours did not change at all during the study; drug-related risk behaviours (i.e. needle sharing) declined throughout the study but did not differ between treatment arms.

The authors report that their results “lend support to dissemination of maintenance treatment with buprenorphine or methadone…as an important component of an effective public-health approach for reduction of problems associated with heroin dependence.”

Schottenfeld R. et al. Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial. The Lancet 371: 2192-2200, 2008.

Hall W. et al. Oral substitution treatments for opioid dependence. The Lancet 371: 2150-2151, 2008.