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.”
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References

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.

SouthCoast Recovery Debuts Gay and Lesbian Track Program

SouthCoast Recovery, a premier California alcohol and drug rehab center, announces the addition of a Gay, Lesbian, Bi-sexual, and Trans-gender (LGBT) Track to its 30, 60, 90-day and six month residential treatment programs.

SouthCoast Recovery recognizes the need for specialized drug rehab and alcohol treatment programs that address and provide support to the gay and lesbian community. Regardless of age, race or sexuality, people from all walks of life seek help for alcohol and drug addiction. Men and women in the LGBT community may struggle with issues pertinent to their sexuality that could contribute to alcohol or drug abuse. SouthCoast Recovery recognizes the need for specialized programs in drug and alcohol treatment tailored to the individual. SouthCoast Recovery provides the leading gay rehab treatment program in California, with a safe and supportive environment for those in the LGBT community, offering an assigned LGBT counselor for one-on-one sessions, individual therapy treatment targeting LGBT issues. Drug and alcohol dependency is often a symptom of underlying issues that need to be addressed on an individual basis. At our state-of-the-art facility, the finest clinical and medical physicians work together with skilled practitioners in advanced Eastern holistic therapies for the most comprehensive physical, emotional and spiritual renewal of each person.

We offer seven residential facilities, a clinical therapist, marriage & family therapist, certified drug & alcohol counselors, a medical physician, a licensed acupuncturist with a Masters in Oriental Medicine, a licensed massage therapist, sessions in primordial sound meditation, as well as, group support in the local 12-step community as a part of our gay addiction treatment program.

At SouthCoast Recovery, we believe that recovery from addiction is a transformation in all areas of life. Our Gay, Lesbian, Bi-sexual, and Trans-gender Track Program is now available during 30, 60 and 90-day residential treatment. For more information, please call Tom Petersen at (866) 847-4506 or visit www.southcoastrecovery.com.

Like many noteworthy companies, SouthCoast Recovery started out of a garage in 1994 and today is one of the leading recovery centers in the nation offering advanced clinical, medical and holistic therapies in the individual treatment of drug and alcohol addiction.
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source: http://www.free-press-release-center.info

Freedom From Drug Addiction

He went from a cocaine and alcohol addiction, to a successful drywall businessman in Sioux Falls and Rapid City.

Greg Sands overcame his demons with a little help and a lot of determination. Now he's being honored with his name on a brand new treatment center for meth-addicted women.

His business is drywall, the company he built from the ground-up. But his passion is helping those with addiction.
"Addiction's a very subtle thing,” said Greg Sands, owner of Sands Drywall of Sioux Falls and Rapid City. “It's a process, not an event. Eventually, the addict ends up with problems in his life because of the addiction. For me, it was incarceration."

In 1989, at 31 years old, Sands was arrested for conspiring to deal cocaine, and spent two years in prison. Afterward, he moved into the Glory House in Sioux Falls.

"Have a warm spot in my heart because they helped me change my life," said Sands.

The facility is a halfway house that helps drug users shift back into the community. Sands says there's always a need for such facilities; in fact, the Glory House is now celebrating 40 years in business.

"The transition is extremely important,” he said. “If they leave incarceration and go straight to the streets, or go to a halfway house, it lowers their chance of violating by like 50%. It's a huge number."

And now, the Glory House is about to open the Sands Freedom Center, in September. It will specifically treat women addicted to meth, a fast-growing problem across the country.

"I believe the statistic is they go to prison at a rate of two to one over men."

Sands says the Freedom Center will be a top-notch facility, with both inpatient treatment for women and outpatient treatment for anyone battling meth. Between 300 and 400 people will walk through the doors every year.

"If we can teach people how to live a new way of life, it's better for society, better for our state as a whole because they're out becoming responsible, productive members of society," said Sands.

The facility is just another way Sands can reach out to people who are in the same place he was nearly 30 years ago.

His story has inspired many, and even earned him a presidential pardon from the Clinton administration back in 2001.

Since his record has been wiped clean, Sands can enter almost any institution and speak to prisoners about his experience.

"The best thing about that was that it carried a message of hope that you can change your life and you can do this too, if you're willing to do the work," Sands said.

Sands still works every day to keep his life on track, but doesn't have any regrets about the past.

"Everyone makes mistakes in their life and no one likes to experience that pain,” said Sands, “but it's those things I went through that got me to where I'm at today."

Sands says the project is close to his heart, but wouldn't have been possible without some outside help. He says Governor Mike Rounds, Senator Tim Johnson, the Glory House board of directors, staff, and volunteers, along with community leaders and businessmen all contributed in some way.

The Glory House is still raising money for the Sands Freedom Center, expected to open September 1st.
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source: http://www.keloland.com

Medical wellness and fitness center coming to Water Valley

Poudre Valley Health System announced today that it plans to open a medical wellness and fitness center in Water Valley, northern Colorado’s premier resort-style community located in Windsor. This will be the first medical wellness and fitness center in northern Colorado.

The 2-story center will offer physical therapy and cardiac rehabilitation for patients; classes on health care; wellness counseling; spa services; orthopedic care; radiology; and exercise opportunities with fitness equipment and a therapeutic pool.

In addition, medical office space will be available for physicians who practice specialty or primary care.

Rulon Stacey, PVHS president and CEO, said Windsor is an ideal setting for a medical wellness and fitness center due to the community’s location in the epicenter of northern Colorado’s rapid population growth.

“Our goal is to offer high-quality health care that is easily accessible,” he said. “The unparalleled quality and accessibility of Water Valley and its beautiful setting add beneficial dimensions that will complement the medical wellness and fitness center.”

Martin Lind, Water Valley’s owner and president, said the PVHS presence will be a valuable addition to the community.

“Having a medical and health icon like PVHS believe and invest in Water Valley solidifies our vision and motto of “Life’s Better Here!,” Lind said.

“The medical wellness and fitness center, combined with our existing resort atmosphere, will prove to be a regional destination for those seeking medical-based lifestyle changes,” he continued. “In addition to the obvious benefit for Water Valley residents, the center will benefit all of northern Colorado. Water Valley could very well become the Broadmoar of the north by offering world-class wellness, golf and a resort atmosphere.”

The medical wellness and fitness center will be the center piece of Water Valley’s Marina Plaza project that will soon begin development in the 1,500-acre Water Valley community. Water Valley encompasses five lakes; Pelican Lakes Golf Course and Country Club; and residential areas where about 3,000 people reside. Plans for the Marina Plaza include a hotel and conference center, retail space, salon and spa, restaurant, and office complex in addition to the medical wellness and fitness center.
Construction of the medical wellness and fitness center, now in the early design stage, is expected to begin later this year.

The center is slated to open in the fall of 2009.

PVHS will lease about 16,000 square feet of the Marina Plaza to house the medical wellness and fitness services, and another 9,000 square feet will be occupied by physician offices.

Stacey said the center will work closely with physicians who occupy medical office space there.

“Physicians will be able to refer patients to the center for rehabilitation, health classes and other services,” he said. “This will be a significant convenience for patients.”

Stacey said other medical wellness and fitness centers in the U.S. have found that clients tend more often to be adults who prefer the facilities rather than more traditional health clubs.

“Medical wellness and fitness centers combine the outpatient care from rehab centers and primary and specialty care providers with the prevention and educational aspects of a health club—all in one location,” he said. “Very often older adults who want to condition their bodies or undergo rehabilitation feel more comfortable at a medical wellness and fitness center because of the medical presence there.”
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source: Windsor Beacon, http://windsorbeacon.com

A clear vision

A little girl with a big dream. That’s what Tabitha Hall Pennon of Ennis was when she started the outreach shelter, Texas Vision House.

“I knew from the time I was seven-years old that this was something I wanted to do,” she said. “In my simplistic take on it all, I just wanted to provide a house for people who didn’t have one and that is what I set out to do.”
Pennon’s initial plan of temporary housing for those in need went beyond mere thought; she said she obsessed over it, even drew up a blueprint for the center on poster board.

“My grandmother used to sew and she would have those huge books with patterns in them,” Pennon explained. “I would cut out the pictures of quilts and glue them on the beds in the rooms of the house I made and when I finally did get to build the facility I dreamed of, it was modeled from that poster board blueprint.”
After graduating from Ennis High in 1986, her brainchild was put on hold as she battled doubts and fears of putting into place the resources she would need to realize the project. While working at a correctional facility, she learned first hand the needs of the people she would serve in what would soon become her life’s work.
“At the correctional home I saw many people who had made the wrong choices in life but who were good people underneath it all,” she said. “I knew that sometimes in life people just need a second chance and I wanted to give them that.”

The path for second chances she chose was in the form of an interim housing center for women recovering from substance abuse. This facility would be a place for women to get back on their feet as they struggled through the first stages of being drug free; it would also be a place where they could develop skills that would serve them when they left the house to return to living on their own. The name of the outreach had always been clear to Pennon: Vision House.

Established in 1999, the center was the embodiment of the dream she had once put aside, but had come back to. She now dedicates her life to Vision House.
Due to the nature of residents’ issues, including alcoholism and drug abuse, and the specialized recovery methods needed to aid them in their transition from the facility to living independently, Pennon went back to school, earning a degree in social work and substance abuse counseling. Her no-nonsense approach to the women and the responsibilities they are expected to take on at Vision House allows her to help them with their problems while still supplying a shoulder for them to lean on.

“There is no free ride here,” she said. “I am always telling the ladies that the world does not owe them anything and if they want something they have to work for it, so that is what we put into practice here. They each have their roles to play at the house and they also take part in the work program that we have where we set up booths at the American Airlines Center and the Ball Park in Arlington to sell food. The work program also teaches them about giving back to those less fortunate because the money raised from the booth goes to the Canning Hunger project to help fight hunger in the world.”

Residents who stay at the facility –– from upwards of a year to 18 months ––attend four Alcoholics Anonymous or Narcotics Anonymous meetings a week. They are also asked to attend church at the chapel located on the property. Pennon feels it’s important to heal the mind, body and spirit when dealing with recovery.
“These women must have healing in all aspects of their lives in order to function when they leave us,” she said. “We don’t make going to church a pre-requisite but we do encourage it.”

Although some residents leave Vision House only to return to old ways, there are many success stories.

“We have had people who got out of the program because they weren’t ready for the help and that is their decision,” she said. “I pray for them and work to help the rest of the group so they won’t follow suit. However, I have seen the change that can happen if the residents work toward it. and some of the best cases actually ended up cleaning up their lives and coming to work for us or volunteer with us after they left to reclaim their lives. When I’m feeling overwhelmed, those ladies remind me why it is I do what God has called me to do.”

Vision House, which operates on donations, has been chosen as the recipient of funds raised from a fashion show organized by fellow Ennisite, Charlotte Watson. The event is part of a program called “Meet me in the Boardroom,:” which is focused on helping women find the information they need to help with finances, health care and jobs. Part of the two-day workshop, to be held June 13-14, will feature a style show with some of the residents at Vision House acting as models.
Pennon said she’s thankful for the opportunity and that her residents are thrilled.
“The ladies are so excited and have been looking forward to this since they found out about it,” Pennon said.

“This will be a real ego boost for them and I’m so glad Charlotte thought of us for helping with the fashion show and receiving some of the proceeds.”
For more information about Vision House or to donate visit www.texasvisionhouse.org or call 214-257-0207.
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source: Ennis News Daily

Drug Rehab and Addiction Treatment

Drug addiction is a manageable disorder. By the treatment which is tailored to individual needs, patients can learn to control their condition and live normal, productive lives. Selecting a drug rehab center is one of the most important and difficult decisions that you will take in your life. The majority of the drug rehab and alcohol rehab centers use predominantly group therapy to treat their clients because it is more cost effective. Like people with diabetes the cardiac disorder, people in treatment for drug addiction learn behavioral changes and often take medications as part of their treatment regimen. Drug treatment programs in prisons can succeed in preventing patients return to criminal behavior, in particular if they are related to the programs community-based which continue the treatment when the customer leaves the prison. There is no fast difficulty for the diseases of thedrug abuse and alcoholism. Recovery is a continuous process.

A drug rehabilitation treatment center should offer a variety of treatment programs which meet individual needs. Programs can include inpatient, residential, outpatient, and/or short-stay options. The person usually takes drugs because they attempt to compensate for a certain insufficiency or personal situation of the life. They can be depressed, in pain or incapable of dealing with a loss of a loved one or extreme circumstance. It could also be as simple as a need to fit in and make friends, or a manner of losing the weight. Behavioral therapies can include counseling, psychotherapy, support groups, or family therapy. Treatment medications offer help in suppressing the withdrawal syndrome and drug craving and in blocking the effects of drugs. The ultimate goal of all drug abuse treatment is to enable the patient to carry out the lasting abstinence, but the immediate goals are to reduce drug use, improve the patient’s capacity to function, and minimize the medical and social complications of drug abuse.

Drugs are essentially a pain-killer. They lessen emotional and physical pain and provide the user with a temporary escape from problems. When a person is unable to cope with something in life and take drugs as a result, they feel they have found a way to deal with the problem. There are a number of alcohol rehab programs in Ohio which provide addiction treatment services for adults and adolescents. Drug rehab programs in Ohio, may or may not include a drug detox or alcohol detox program. It is important to discuss this aspect of a drug rehab program with intake staff, as it can make a tremendous difference in a person’s addiction treatment. Successful drug treatment outcomes depend upon retaining the individual long enough to gain the full benefits of treatment. Whether or not the individual stays in treatment and is successful in treatment depends on both the individual and the program.
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source: onlinehealthtips.org

Newport Beach sober-living homes scramble to complete city's permit process

A preliminary rule upheld the ordinance, requiring facilities to fill out a 27-page application and pay a fee. Some operators continue to resist the law.

Following Newport Beach's preliminary courtroom victory against drug and alcohol treatment homes, many facilities are scrambling to comply with the city's strict new ordinance by today's deadline.

Other operators, however, are labeling the process discriminatory and are refusing to obey the court order or are grudgingly filing the required paperwork.

A federal judge last week issued a preliminary ruling upholding much of the ordinance Newport Beach officials passed in January that forces about 80% of the addiction treatment centers to apply for city permits in order to stay open. Many residents contend the homes are a blight on their coastal neighborhoods.

Richard Terzian, an attorney representing the largest treatment operator, Sober Living by the Sea, described the ordinance as "discriminating against the handicapped."

"Any group of college students is going to create a lot more noise, create a lot more ruckus than any of our" recovery centers, he said.

The city ordinance compels sober-living homes -- residential facilities where people receive treatment or counseling off-site -- to apply for the permits; larger state-licensed facilities with on-site treatment for more than six residents must also apply for permits.

Small recovery centers with state licenses, where six or fewer residents receive addiction treatment where they live, are exempt from the permitting process.

The 85 or so treatment facilities in Newport Beach are clustered mostly on the Balboa Peninsula.

The ruling marks the "first time any city in California has been able to use a permitting process on a particular class of homes," said Newport Beach Assistant City Manager Dave Kiff.

If Newport Beach's ordinance withstands further legal scrutiny, other coastal cities hope to emulate it.

"If that ordinance is upheld, we certainly would look into passing it in Malibu," said Mayor Pro Tem Andy Stern, who said similar facilities in Malibu create traffic and septic system problems.

"It would become a high priority rapidly."

Newport's 27-page application requires sober-living homes and other treatment centers to submit detailed maps for transporting clients, floor plans illustrating the number of residents per bedroom, disposal procedures for medical waste, plans to mitigate secondhand smoke, a weekly activities schedule for residents, fire safety compliance, and information about the center's administrator, among other data, plus a fee of $2,200.

A hearing officer will then review the packet and determine if the recovery center can continue operating; city officials expect the process to last through the summer.

So far, the city has received 26 applications from the nearly 60 centers that must meet city regulations, Kiff said.

Newport Beach's attorney in the lawsuit, Jim Markman, believes the comprehensive application could discourage problem operators from staying in business.

If operators are denied a city permit, they'll have about a year before they have to shut down, Kiff said.

The proliferating homes have generated controversy for years, with one citizens group bemoaning the traffic, noise, secondhand smoke, profanity and other problems they said the recovering addicts bring to the densely populated oceanfront neighborhood.

"We do not think that the city went far enough," said Denys Oberman, chief executive of Concerned Citizens of Newport Beach, the nonprofit activist group that's been fighting the sober-living homes.

According to Oberman, these businesses "are saturating and institutionalizing the residential neighborhood." The group's lawsuit against the city and program operators is one of several suits filed on the contentious issue after the ordinance was passed.

Sober Living by the Sea, with about 35 centers, expects to spend as much as $75,000 per group home on new sprinkler systems to meet city standards, said John Peloquin, vice president of operations for CRC Health Group, the parent company.

"If you need a fire clearance in there, what about all the summer rentals?" Peloquin said. "We feel that that's again evidence of being discriminatory to us."

A spokesman for Balboa Horizons Recovery, which treats fewer than a dozen women for drug addiction, said the business viewed the application process as onerous and the fee as more than they could afford, and was filing an application "under duress."

Officials at Pacific Shores Properties, another treatment company, are "examining our legal options" regarding the application requirements and the city ordinance, said attorney Steven Polin.

Several of the facility operators have submitted complaints to the U.S. Department of Housing and Urban Development for review.

The judge's preliminary ruling also upheld a prohibition on treatment facilities opening in single-family homes; instead, they must be in areas zoned for apartments or condominiums, Kiff said.

The judge did, however, strike down one part of Newport Beach's regulation, barring the city from aggregating several adjacent facilities of six or fewer people into one larger center, which would have subjected them to the city's rules.

Though the legal challenges have yet to play out, Kiff is optimistic that the city will prevail:

"We're certainly hopeful that the judge will continue to see our ordinance as . . . just a practical way of dealing with the secondary impacts of too many group homes."
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source: Los Angeles Times