Category: harm reduction

War on drugs, war on wolves

Wolves in cage

Have you ever heard of compound 1080? No? I’m not surprised. Illegal in most countries, this poison (sodium monofluoroacetate) is used to kill wolves in Canada. Read more about a recent visit to the Northern Lights wolf centre near Golden, BC, that opened my eyes to the cruel practices of money and politics – the usual suspects from the war on drugs.

Caribou’s population in Western Canada is dwindling. Some Canadian provinces, like Alberta and British Columbia, have put in place aggressive measures to save Caribou.

wildlife logo wolves
photocredit: northernlightswildlife.com

Wolves are Caribou’s natural predators. To kill them seems logical in the fight for the Caribou’s survival. But only if we forget that Wolves are keystone species. “A keystone in anarch’s crown secures the other stones in place. Keystone species play the samerole in many ecological communities by maintaining the structure and integrityof the community.” This means that their killing will kick-start a chain reaction, leading to extinction not only of Caribou, but also other species and desolation of the land. The Yellowstone example is a worthwhile lesson: when the park eradicated the thriving predators, the antelopes overcrowded and nearly destroyed the grasslands. Predators have been reintroduced successfully.

“The recovery of the gray wolf after its eradication from Yellowstone National Park, almost ninety years ago, demonstrates how crucial keystone species are to the long-term sustainability of the ecosystems they inhabit.”

Drugs have predictable effects on people – the higher the dose, the more toxic they are. This is different from the addictive potential. Even the most dangerous of drugs – like heroin or cocaine – are used by millions of people relatively without problems and without addiction. Nobody becomes addicted after one dose. This means that we have been lied to about drugs and their effects.

Meanwhile, Canadian’s officials keep laying poisoned baits that will be eaten not only by the wolves, but by all other carnivore, such as, foxes, ravens, etc. The 24-hour delay of the poison kills not only the alpha-female, but her cubs too. When she comes back from the hunt, feeds them the food from her stomach, all of them will die. Seems effective. How come that this strategy won’t save the Caribou?

drug policy
photocredit: drugpolicy.org

Our strategy to solve the drug problem has been based on the lies about drugs’ effects. The war on drugs was declared as the most powerful strategy to eliminate them. Research has shown that it doesn’t work. Instead, wrong people are put to jail when the drug laws are enforced selectively. What’s needed is often viewed as bad by the general public. Clean needles, safe injecting rooms and prescribed heroin are seen as helpful to maintaining harmful behaviour of people with addiction. The opposite is truth. They save lives. Because it’s the public opinion, and not the science, that wins elections, politicians will selectively use to please the public and ignore the science in solving the drug problem. Too bad for people who use drugs, but who cares about them anyway?

Not only are wolves the keystone species, they also are not the reason for Caribou’s sudden decline. Who’s to blame? Firstly, it’s the oil and fracking industry. By taking the land where the old-growth forest hosts Caribou, the industry is pushing them out of their natural habitat. Secondly, Caribou thrives in old-growth forest only. It takes 80-100 years for the forest to grow back again. Finally, they’ll die before they could return back.

Most likely, the Caribou will disappear from Canadian’s landscape. People will say that they were destined to die. We have done everything we could. We even killed the wolves. Similarly, many people who use illicit drugs will die or go to prison. People will say that they lacked motivation or were beyond help. We have done everything we could to help them. We banned the drugs and enforced the law.

The bottom line: end war on wolves

 

“We need wolves to have a future; we need the to have water, air and biodiversity.” But they need your help and your voice. Vote! Contact the politicians and ask them about environmental issues. Likewise, people will continue to use drugs in future. We need an open and science-informed discussion about drugs.

Inspired about parallels between animal and addiction research? Read my blog about killer whales and researchers here.

Disclaimer: the organisations and individuals named in this article have not seen or reviewed this article. The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any agency mentioned.

Does alcohol use change after shift to Methadose?

alcohol drink, methadose
Do people drink more when they switch to Methadose? It is 10 times more concentrated than methadone –  proven treatment of opioid use disorder. We did not find more drinking after the switch. But others found changes in opioid use patterns coinciding with the change.

switch
We talked to 787 people receiving methadone for opioid use disorder in Vancouver, Canada.  Our new study followed them as they switched from methadone (1mg/mL) to Methadose (10mg/mL). We asked whether their drinking has changed after the switch – between 2013 and 2015. 16% said they drank too much at least once in the last six months. Those who drank too much were not more likely to do so after the shift to Methadose. The Substance Use& Misuse journal has published the study this week. 
Persons on methadone for opioid use disorder may report going through opioid withdrawal and increasing their illicit opioid use when switched to Methadose. We need to understand impacts of these changes on other forms of drug use. Careful and planned information about upcoming changes may help people cope with the potential risks better.

Conclusion

In sum, change is the law of life. Those who do not change do not survive in nature. For complex systems, such as health care, change management is the key to success. Healthy, happy and satisfied patients are healthcare’s success best proof. If they self-report negative experiences following methadone changes, their opinions should inform change management in order to build a better, patient-centered care. Their opinions, together with our findings, could help future formulary decisions in addiction treatment. Various methadone formulations may have little short-term impact on heavy alcohol use. Let’s evaluate the long-term impact.

Two birds with one stone: physicians training in research

Combined training in addiction medicine and research is feasible and acceptable for physicians – a new study shows; however, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required.

Addiction care is usually provided by unskilled lay-persons in most countries. The resulting care is inadequate, effective treatments are overlooked and millions of people suffer despite recent discovery of new treatments for substance use disorders. In rare instances when addiction care is provided by medical professionals, they are not adequately trained in caring for people with substance use disorders and, therefore, feel unprepared to provide such care.  Physician scientists are the bridge between science and practice. Despite large evidence-base upon which to base clinical practice, most health systems have not combined training of healthcare providers in addiction medicine and research. 
In recent years, new programmes have emerged to train the comprehensive addiction medicine professionals internationally.

We undertook a qualitative study to assess the experiences of 26 physicians who completed such a training programme in Vancouver, Canada. They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software. We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training.  Competing priorities, to include clinical and family responsibilities, hindered training.

Read more here: http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0862-y
Klimas, J., McNeil, R., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., Small, W. (2017) Two birds with one stone: Experiences of Combining Clinical and Research Training in Addiction Medicine. BMC Medical Education, 17:22

Annual review: Summaries, essays and productive conferences

The post on 27 deaths out of 100 people receiving methadone in primary care over 17 years was the most frequently visited of the year but also the gloomiest.
I’ve had an inspired year here at the Be-seen, with a brilliant string of posts about new research articles ranging from a progressive post from the Irish Journal of Psychological Medicine on improving writing groups for addiction researchers, to emerging treatments for cocaine addiction, and along the same theme a series covering my topic of interest in drinking by people who also use other drugs. Here’s the list of new paper summaries in chronological order:
Summaries of new papers 
* First or senior author papers
In sum, the main themes of this year were not only summaries of new papers but also essays on writing and conference reports.
Conferences April-June

With three new entries on academic and cultural meetings, these may be of great interest to my readers fascinated by communication in science and art and blending the boundaries between the two disciplines:

Write well
The fastest start is to listen to patients’ stories – make evidence based responses part of your toolkit, whether it’s responding to the iatrogenic overdose epidemic or writing effective paragraphs.  Secondly, consider making scientific writing something that sticks to the brain. Have a try at writing groups or writing classes – they can help. Have the courage to promote simplicity of writing in your field. I’m positive this is not all that I will have to say on the topic – watch this space.
Essays

Literary editors who helped
Adam Nanji, Vancouver is Awesome http://vancouverisawesome.com/
Tara Siebarth and Ashleigh VanHouten, University Affairs www.universityaffairs.ca
Stephen Strauss, Canadian Science Writers http://sciencewriters.ca/4072583
Journal editors who helped
Twelve addiction journal editors helped with publishing 16 papers:
Roger Jones, BJGP www.bjgp.org
Jeffrey Samet, Addict Sci& Clin Practice https://ascpjournal.biomedcentral.com/
Richard Saitz, J Addict Medicine www.journals.lww.com/journaladdictionmedicine/Pages/default.aspx
Richard Pates, J Substance Use www.tandfonline.com/loi/ijsu20
Tim Rhodes, J Int Drug Policy www.ijdp.org 
Michael Morgan, Addiction www.addictionjournal.org
John Lyne, Irish J Psychol Medicine www.journals.cambridge.org/article_S0790966700017535
Pedro Ruiz, Addict Disorders& Their Treatment www.journals.lww.com/addictiondisorders/Pages/default.aspx
Donata Kurpas, BMC Family Practice www.bmcfampract.biomedcentral.com
Axel Klein, Drugs and Alcohol Today www.emeraldinsight.com/toc/dat/15/4
Wim van den Brink, European Addict Research www.karger.com/EAR/
Jelle Stoffers, Eur J Gen Practice www.tandfonline.com/loi/igen20
In the meantime, I also continued to write in Slovak magazines and in my community of writers. In Slovak, I wrote for Slovo and Zpravodaj edited by Jozef Starosta and Marta Jamborova, respectively.
Early in the January and late in December, I wrote poems with my community of writers from the Thursdays Writing Collectivefacilitated by the fantastic Elee Kralji Gardiner and Amber Dawn. During the year, I wrote with the writers from the Writer’s Studio. Some of those poems landed on stage of the Vancouver Poetry Slam and on their video channel.
Thanks to all of my readers. It’s been over four years for the Be-seen blog now and I owe a lot to the editors and readers. I hope readers will continue to feel that this is a resource for them to visit and engage with.


Heroin on prescription: patient stories

The hard science behind heroin-assisted treatment says: it’s save, effective and saves money. If this was a treatment for cancer or diabetes, we would give it to all for free. It would be the first line treatments for everyone. The medical insurance companies would reimburse it. But what are the patients’ stories behind this mountain of evidence? What do they think of heroin on prescription?


Story from:

Andrew Duffy: Clinic prescribes medical-grade heroin to chronic addicts. Published in Ottawa Citizen on: June 22, 2016

Story from:

Ellis, Erin: Injecting common painkiller an alternative to heroin, study finds. Published in Vancouver Sun on: April 7, 2016



“Dave Murray is a plaintiff in a legal challenge that seeks to legitimize prescription heroin. In a signed affidavit, he explains the sort of addict for which heroin maintenance could be deemed an appropriate treatment. “I have been injecting heroin and other opioids for approximately 42 years,” it reads. “I estimate that I have attempted methadone maintenance treatment (“MMT”) for my addiction at least 10 times over my life. Each of those times MMT has been ineffective for me and I returned to injecting illicit street heroin.”
“Dianne Tobin, a long-time opioids addict, suggested heroin maintenance can be especially beneficial for female addicts. “The women aren’t working the streets anymore,” she said. “I bet you 90 per cent of the women who came into the program were working (as prostitutes) or were dealing … They were mistreated and beaten up and all that by their pimps or whoever. And now they are working in the community instead.”

“Kevin McGarragan recounted how he lost his arm. He was the passenger in a car being driven to a drug buy when the driver fell asleep. “Car accident in 1993,” he said, looking at where his arm used to be. “Heroin was behind it.”
McGarragan said today, he recalls those stories as if they were from another life.”
Story from
Travis Lupick: Heroin prescriptions help addicts rebuild their lives. Published in the Star, Feb. 17, 2016


“If you met Lisa James, chances are you’d never guess she injects herself with heroin twice a day. “I did my shot an hour ago,” James says. “Do I look high? I am just normal.”
“Nobody knows I am an addict,” James says. “I share with some people and they are always shocked. ‘You’re an addict? Really? A heroin addict?’ They would just never know. And that’s a nice feeling.”
“My relationship with my daughter is better than it’s ever been,” “We appreciate the little things together,” “We all need our moms,” she says. “I am able to be her mom.”

Story from: 
Nick Purdon, Leonardo Palleja: Free heroin enables addicts to ‘have a meaningful life again,’ co-ordinator says. Published in CBC News on Sep 28, 2016