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  1. chillinwill
    AS a group of experts in the treatment of opiate-dependent people, we write to express our dismay about the continuing misrepresentation in the media of the evidence on the effectiveness of methadone treatment.
    The purpose of this treatment for the distressing condition of opiate dependency is perhaps misunderstood. People with serious addictions are at great risk of death from overdose and infection.

    This is nowhere more obvious than in Scotland where there has been an outbreak of infections and deaths caused by anthrax and where there were nearly 600 drug-related deaths last year.

    Methadone can prevent death, stabilise lifestyles and improve social functioning. It is remarkable to those of us who provide this life-saving treatment what improvement is seen when people start this therapy. Treatment has to be supported by a programme of psychological and social support, at least for the first few months, and has to be continuous. Some people will need long-term and even lifelong treatment.

    Compared to other essential medical therapies, methadone is not expensive. Most patients who benefit from methadone treatment can live otherwise normal lives.

    The media repeatedly report a view of methadone treatment that is simply contrary to the extensively documented worldwide clinical and research experience of many decades.

    Reliable and persistent research shows that methadone treatment substantially reduces deaths, crime, HIV infection and drug use while also assisting social functioning such as improved education, training, parenting and employment. Every £1 spent on methadone treatment saves between £4 and £7. Methadone treatment has been endorsed by three UN agencies: the United Nations Office on Drugs and Crime; the World Health Organisation and UNAIDS.

    WHO has also included methadone treatment in its "essential medicines" list and 70 countries in the world now provide methadone or buprenorphine treatment to an estimated one million patients.

    No treatment in medicine works every time with every patient, but methadone treatment has helped more people in the world overcome their problems with heroin than any other. This treatment should be readily available to every person using heroin that seeks help, accepts this option and meets national criteria.

    If policymakers were to heed the critics' advice to close down methadone treatment, or impose an arbitrary time limit on its administration, the community can anticipate more overdose deaths, more HIV and more crime. Surely this is not what the public want and deserve.

    It is essential that policy and treatment services are clear about the value and importance of methadone treatment.

    Dr. Roy Robertson FRCP(Ed) FRCGP,
    General Practitioner and Reader
    University of Edinburgh,

    Professor Sheila M. Bird
    MRC Biostatistics Unit
    Robinson Way

    Dr Malcolm Bruce MB,ChB, FRCPsych, PhD
    Consultant Psychiatrist in Addiction
    Community Drug Problem Service
    22-24 Spittal Street

    Dr John Budd
    GP with special interest in substance misuse.
    Edinburgh Access Practice

    Professor M.Patrizia Carrieri, PhD
    National Institute for Health and Medical Research
    UMR 912
    Dr. Timothy Christie, BA(hons), MA, MHSc, PhD
    Regional Director, Ethics Services, Horizon Health Network
    Adjunct Professor, Department of Bioethics, Dalhousie University
    Lecturer, Department of Languages and Humanities, University of New Brunswick
    Saint John Regional Hospital
    Saint John, New Brunswick

    Dr Lucinda Cockayne
    Lead Clinician, NHS Fife Addiction Services
    Consultant Psychiatrist
    Honorary Senior Lecturer St Andrews University
    Ward 11, Cameron Hospital
    KY8 5RR

    Andrej Kastelic
    University Psychiatric Hospital
    Zaloska 29, 1000 Ljubljana, SLOVENIA

    Nuno Portugal Neto Capaz
    Sociologist, Vice President of the Comissão para a Dissuasão da Toxicodependência de Lisboa
    Lisboa, Portugal

    Univ.Prof. Dr. Gabriele Fischer
    Medizinische Universität Wien
    Universitätsklinik für Psychiatrie und Psychotherapie
    Währingergürtel 18-20
    1090 Wien, Austria

    Douglas Gourlay MD, MSc, FRCPC, FASAM
    Medical Consultant,
    Centre for Addiction and Mental Health,
    Toronto, Ontario CANADA

    Dr Shay Griffin
    Consultant in Addiction Psychiatry
    Monklands Hospital
    Lanarkshire ML6 0JS

    Marc Reisinger, Psychiatrist
    European Opiate Addiction Treatment Association

    Professor Adeeba Kamarulzaman
    Professor of Medicine and Infectious Diseases
    University of Malaya
    Kuala Lumpur.

    Shui Shan Lee, MD, FRCP, FRCPA, FFPH
    Professor of Infectious Disease
    The Chinese University of Hong Kong
    205 Postgraduate Education Centre
    Prince of Wales Hospital, Shatin
    Hong Kong

    Dr. Garrett McGovern
    GP Specialising in Substance Abuse,
    HSE Addiction Services,
    Baggot Street Clinic,
    19 Haddington Road,
    Dublin 4, Eire

    Dr John Macleod
    Reader in Clinical Epidemiology and Primary Care
    Department of Social Medicine
    University of Bristol
    Canynge Hall
    39 Whatley Road
    BS8 2PS

    Thomas Kerr, PhD
    Director, Urban Health Research Initiative
    British Columbia Centre for Excellence in HIV/AIDS
    Assistant Professor, Dept. of Medicine
    University of British Columbia
    Michael Smith Foundation for Health Research Scholar
    St. Paul's Hospital
    608-1081 Burrard Street
    Vancouver, British Columbia
    Canada, V6Z 1Y6

    Bill Nelles
    Addiction Counsellor
    Beach Rd Medical Centre
    Qualicum Beach BC

    Dr. Robert Newman, MD, MPH, Director Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center
    555 W. 57th St.
    NY NY 10019, USA

    Kasia Malinowska-Sempruch
    Director, Global Drug Policy Program, OSI

    Dr. Marta Torrens
    Director of Addiction Department
    Institute of Psychiatry and Addiction
    Parc de Salut Mar
    Universitat Autònoma de Barcelona
    Prof. Ernest Drucker PhD
    Professor Emeritus of Family and Social Medicine
    Montefiore Medical Center/
    Albert Einstein College of Medicine
    Adjunct Professor of Epidemiology
    Columbia University
    Mailman School of Public Health, USA
    Matt Hickman
    Reader in Public Health and Epidemiology
    Department of Social Medicine
    University of Bristol
    Canynge Hall
    39 Whatley Road
    Bristol, UK

    Dr Jane Jay,
    Consultant Physician,
    Past Chair,
    National Forum Drug Related Deaths,

    Herman Joseph, Ph.D., Consultant,
    NYC Harm Reduction Coalition, National Alliance of Methadone Advocates Recovery (NAMAR) and National Development Research Institute, Inc. (NDRI), USA

    Kasia Malinowska-Sempruch
    Director, Global Drug Policy Program Open Society Institute,

    Mark W. Parrino, M.P.A.
    American Association for the Treatment of Opioid Dependence (AATOD)
    225 Varick Street, Suite 402
    New York, NY 10014

    Hans-Guenter Meyer-Thompson
    Professor John Strang
    Addictions Department
    National Addiction Centre
    Addiction Sciences Building
    4 Windsor Walk
    Denmark Hill
    London, UK

    Dr Chris Ford
    Clinical Director SMMGP & GP Principal
    Lonsdale Medical Centre
    24 Lonsdale Road
    London, UK

    Prof. Wayne Hall,
    NHMRC Australia
    Fellow UQ Centre for Clinical Research and School of Population Health,
    The University of Queensland,
    Herston Qld 4029,

    Dr Kennedy Roberts OBE,
    Medical Practitioner,
    Edinburgh Drug Addiction Study
    Muirhouse Medical Group,
    Edinburgh, Scotland

    Marc Shinderman, MD
    Psychiatry/Addiction Medicine
    Chicago IL

    Ian Stolerman
    Emeritus Professor of Behavioural Pharmacology
    Institute of Psychiatry P048
    King's College London
    De Crespigny Park
    London SE5 8AF, UK

    Em. Prof. Ambros Uchtenhagen, MD, PhD
    President, Research Foundation for Public Health and Addiction, affiliated with Zurich University, Switzerland

    Dr. Albrecht Ulmer,
    Specialist in HIV and Addiction Medicine
    Cofounder of the German Society for Addiction Medicine Stuttgart,

    Dr Richard Watson
    Clinical Lead Substance Misuse
    Royal College of General Practitioners (Scotland)

    Prof. dr. Wim van den Brink, MD PhD
    Amsterdam Institute for Addiction Research (AIAR)
    Academic Psychiatric Centre AMC-UvA
    room nr PA 1.188
    PO box 22660
    1100 DD Amsterdam
    The Netherlands

    Dr. Alex Wodak FRACP, FAChAM, FAFPHM, MB BS,
    Director, Alcohol and Drug Service,
    St. Vincent's Hospital,
    Darlinghurst, NSW, 2010,

    Kerry Wolf,
    Board of Directors,
    National Alliance for Medication Assisted Recovery,
    Austin, Texas

    Evan Wood, M.D., Ph.D.
    BC Centre for Excellence in HIV/AIDS &
    Associate Professor, Division of AIDS
    Department of Medicine, UBC

    Stephan Walcher, MD,
    Anesthesiologist, Internist, GP, Pain and Addiction Specialist
    CONCEPT, Outpatient Addiction Clinics in Munich

    April 5, 2010


  1. chillinwill
    A COALITION of world experts in drug abuse have defended the use of methadone to treat heroin addicts and warned that curtailing its prescription would bring about a spike in overdoses, crime and HIV.

    In a letter to The Scotsman, the group, comprising dozens of international specialists, have condemned the "continuing misrepresentation" surrounding the effectiveness of the heroin substitute and rejected claims that is too expensive.
    The defence of methadone by the coalition of GPs, psychiatrists, counsellors and epidemiologists comes in the wake of growing criticism of the treatment and accusations that the Scottish Government has become overly reliant on the drug.

    Last week, Professor Neil McKeganey, the director of the Centre for Drug Misuse Research at the University of Glasgow, argued that more effort was required to get Scotland's addicts off drugs through abstinence.

    However, the 43-strong expert group claim that methadone "has helped more people in the world overcome their problems with heroin than any other (method]".

    Amid established evidence asserting its effectiveness in reducing deaths, infection and drug use, the experts express "dismay" at the "contrary" view.

    The group includes Dr Richard Watson, clinical chief for drug misuse at the Royal College of General Practitioners Scotland, and Professor John Strang, director of the National Addiction Centre. They said: "If policy-makers were to heed the critics' advice to close down methadone treatment, or impose an arbitrary time limit on its administration, the community can anticipate more overdose deaths, more HIV and more crime.

    "Surely this is not what the public want and deserve."

    The group's leader, Dr Roy Robertson, a GP and honorary clinical reader at the University of Edinburgh, told The Scotsman he and his peers were increasingly concerned about the criticism of methadone.

    "There has been growing anxiety surrounding a view we don't agree with – one that is unhelpful, destructive and, at worst, likely to cost lives," he said.

    "Methadone works as just well as anti-cancer drugs and better than treatments used for depression, hypertension and diabetes. Yet it is sheer prejudice and politics that make people scrutinise methadone in a way other drugs are not."

    Last week, Prof McKeganey criticised Scottish Government policy over drug misuse and said the nation was "paying a massive price" for its drugs problem, warning a single addict set the country back more than £60,000 a year.

    He wrote: "At the moment, we have about 22,000 addicts on methadone in Scotland. When Scottish ministers are asked whether they have any plans for reducing that number, the typical answer is to say that prescribing methadone is the responsibility of individual doctors.

    "Our political leaders, surrounded by those who counsel them on the benefits of methadone, find themselves passing responsibility for our national methadone programme on to the shoulders of those prescribing the drug in the first place. This situation is going to get worse."

    He added: "If we are going to change the culture of acceptance around drugs, we need to do something that is almost beyond comprehension – we need to normalise abstinence."

    Dr Robertson, a former member of the Advisory Council on the Misuse of Drugs, acknowledged the arguments in favour of an abstinence-based solution, but said the seriousness of heroin addiction demanded different approaches, including methadone.

    "If it was my son or daughter, of course you'd want them to be abstinent. There isn't a GP in the country who doesn't want people to move towards abstinence," Dr Robertson said.

    "But we're talking about a very serious addiction problem that is causing people to die in large numbers. We see young people in our surgery dying from primitive diseases. It's breathtaking."

    The Scottish Drugs Forum has defended the use of methadone which, it says, has an important part to play in helping people stabilise chronic drug use. Sacro, the offenders' charity, believes total abstinence is a goal that should be worked towards, but warns that if methadone treatment is stopped overnight, it would bring about a "huge rise" in criminal activity.

    A Scottish Government spokesman said: "It is for individual clinicians, who follow UK-wide agreed prescribing guidelines, to decide on the most appropriate medical treatment for any person.

    "Our national drugs strategy sets out our commitment to reducing the damage drugs do to communities and individuals in Scotland. A key part of delivering this is making sure people can recover from their addictions and are able to access treatment and support when they need it.

    "That's why we are working closely with our partners to reduce waiting times for services and why we have, for the first time, a target to make sure the NHS reduce waiting times for drugs services – helped by record funding in frontline drug treatment services."

    What the letter said…

    "AS A group of experts in the treatment of opiate dependent people, we write to express our dismay about the continuing misrepresentation in the media of the evidence on the effective-ness of methadone treatment."

    "Compared to other essential medical therapies, methadone is not expensive."

    "Methadone treatment has helped more people in the world overcome their problems with heroin than any other."

    "If policy-makers were to heed the critics' advice to close down methadone treatment, or impose an arbitrary time limit on its administration, the community can anticipate more overdose deaths, more HIV and more crime."

    April 5, 2010
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