Wednesday 27 July 2011

Amy Winehouse's death prompts review of drug rehab waiting times

The star’s father claimed to mourners at her funeral yesterday that addicts face a two-year wait for rehab on the NHS.
In an emotional eulogy to his 27-year-old daughter, Mitch Winehouse said he hoped her death would prompt greater awareness of addicts’ plight.
Keith Vaz, chairman of the Home Affairs Select Committee, today pledged to back Mr Winehouse’s campaign and investigate the speed of access to rehab.
Paying tribute to his daughter yesterday at Edgwarebury Cemetery, north London, Mr Winehouse, 58, said: “Three years ago, Amy conquered her drug dependency, the doctors said it was impossible but she really did it.
"In this country, if you cannot afford a private rehabilitation clinic, there is a two-year waiting list for help. With the help of Keith Vaz MP, we are trying to change that."

Mr Winehouse gave evidence to the Home Affairs committee two years ago on the cocaine trade, claiming that many drug users were so desperate for treatment that they committed crimes so they would be fast-tracked into rehab.
Mr Vaz said today: “Mitch Winehouse gave powerful evidence to the Home Affairs Select Committee during our inquiry into drugs in 2009.
“Drawing on his personal experience he highlighted the long delay in accessing treatment for those with addiction. Two years on we need to revisit this issue to see if anything has improved.
“I am very happy to help Mitch in any way I can with his important campaign to help rehabilitate those most vulnerable in our society."
The claims over waiting times are disputed by the National Treatment Agency for Substance Misuse (NTA), which is part of the NHS.
It claims that in 2009/10, 94 per cent of patients waited less than three weeks for drug rehabilitation.
During that period, the NTA dealt with nearly 207,000 addicts, official figures show.
Winehouse was admitted to private rehabilitation clinics on a string of occasions during her battle with alcohol and drug addictions. The Grammy-award winning singer was found dead at her home in Camden, north London, on Saturday.
At a private funeral for close friends and family yesterday, Mr Winehouse said the singer was the happiest she had been for many years in the run up to her death and had managed to stop drinking.
"She said, 'Dad I've had enough of drinking, I can't stand the look on your and the family's faces anymore'. She was not depressed,” he said.
Referring to the night she died, he added: “She was in her room, playing drums and singing. As it was late, her security guard said to keep it quiet and she did.
“He heard her walking around for a while and when he went to check on her in the morning he thought she was asleep. He went back a few hours later, that was when he realised she was not breathing and called for help.
"But knowing she wasn't depressed, knowing she passed away, knowing she passed away happy, it makes us all feel better.
"I was in New York with my cousin Michael when I heard and straight away I said I wanted an Amy Winehouse Foundation, something to help the things she loved – children, horses, but also to help those struggling with substance abuse.”
Among the guests at the service were her boyfriend Reg Traviss, stylist Alex Foden, who has been credited with creating Winehouse's trademark beehive hairdo, producer Mark Ronson and singer Kelly Osbourne.
Following the service, Winehouse's body was taken to Golders Green Crematorium, where her grandmother was cremated in 2006.
A spokesman for the family said he understood Winehouse's ashes would be placed next to those of her grandmother. The singer had a close relationship with her grandmother and had a tattoo of her name – Cynthia – on her right arm.
The family began Shiva – a traditional period of mourning in the Jewish faith – after the service.
Relatives and friends congregated at the Southgate Progressive Synagogue in north London last night.
The funeral comes after police revealed they will have to wait up to four weeks for the results of toxicology tests to establish her cause of death.
A post-mortem examination has proved inconclusive and an inquest has been opened and adjourned with no cause of death given.
Mr Winehouse told the Home Affairs committee in 2009 that addicts he had interviewed a television documentary claimed they waited a year on average for rehab.
He said: "People are definitely committing offences so they can have a chance, and it's only a chance, of receiving treatment.
"The biggest impact on families is that there is very little help available to them, especially if their relative is a non-offending addict.
The problem we found in our research in London is that it's a year before any treatment can be given. It's very difficult and the reason for this is the majority of funding is taken up by the criminal justice system."

 

Wednesday 20 July 2011

Successful lab tests on a potential vaccine for heroin addiction

Scientists are reporting development and successful initial laboratory tests on the key ingredient for a much-needed vaccine to help individuals addicted to heroin abstain from the illicit drug. Their study appears in ACS' Journal of Medicinal Chemistry.

Kim D. Janda and colleagues note that heroin use cost the United States more than $22 billion in 1996 annually due to medical and law enforcement expenses and productivity loss. Although behavioral therapy and certain medicines help heroin-addicted patients, many experience relapse, lack access to treatment, or develop unwanted side effects from the treatments themselves. To overcome these challenges, the researchers made and tested a new vaccine formulation that might serve as an additional tool in helping addicts maintain abstinence. Janda's team previously reported development of vaccines for cocaine, methamphetamine, and nicotine.

Thus with laboratory rats that were given the vaccine they showed less willingness to self-administer heroin and other signs of its effectiveness. The report explains why the potential new vaccine is an improvement over previous experimental vaccines. "In conclusion, a vaccine for heroin addiction could prove to be a useful tool for combating heroin addiction, wherein it exploits a motivated recovering addict's own immune system to blunt heroin's psychoactive effects in the case of relapse," the researchers say.

 

Thursday 14 July 2011

Rethinking Addiction’s Roots, and Its Treatment

There is an age-old debate over alcoholism: is the problem in the sufferer’s head — something that can be overcome through willpower, spirituality or talk therapy, perhaps — or is it a physical disease, one that needs continuing medical treatment in much the same way as, say, diabetes or epilepsy?


Dr. Christine Pace helps Derek Anderson manage his heroin addiction at Boston University Medical Center. With the help of medication, Mr. Anderson has been clean for six years.

Increasingly, the medical establishment is putting its weight behind the physical diagnosis. In the latest evidence, 10 medical institutions have just introduced the first accredited residency programs in addiction medicine, where doctors who have completed medical school and a primary residency will be able to spend a year studying the relationship between addiction and brain chemistry.

“This is a first step toward bringing recognition, respectability and rigor to addiction medicine,” said David Withers, who oversees the new residency program at the Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, Pa.

The goal of the residency programs, which started July 1 with 20 students at the various institutions, is to establish addiction medicine as a standard specialty along the lines of pediatrics, oncology or dermatology. The residents will treat patients with a range of addictions — to alcohol, drugs, prescription medicines, nicotine and more — and study the brain chemistry involved, as well as the role of heredity.

“In the past, the specialty was very much targeted toward psychiatrists,” said Nora D. Volkow, the neuroscientist in charge of the National Institute on Drug Abuse. “It’s a gap in our training program.” She called the lack of substance-abuse education among general practitioners “a very serious problem.”

Institutions offering the one-year residency are St. Luke’s-Roosevelt Hospital in New York, the University of Maryland Medical System, the University at Buffalo School of Medicine, the University of Cincinnati College of Medicine, the University of Minnesota Medical School, the University of Florida College of Medicine, the John A. Burns School of Medicine at the University of Hawaii, the University of Wisconsin School of Medicine and Public Health, Marworth and Boston University Medical Center. Some, like Marworth, have been offering programs in addiction medicine for years, simply without accreditation.

The new accreditation comes courtesy of the American Board of Addiction Medicine, or ABAM, which was founded in 2007 to help promote the medical treatment of addiction.

The board aims to also get the program accredited by the Accreditation Council for Graduate Medical Education, a step that requires, among other things, establishing the program at a minimum of 20 institutions. The recognition would mean that the addictions specialty would qualify as a “primary” residency, one that a newly minted doctor could enter right out of school.

Richard Blondell, the chairman of the training committee at ABAM, said the group expected to accredit an additional 10 to 15 institutions this year.

The rethinking of addiction as a medical disease rather than a strictly psychological one began about 15 years ago, when researchers discovered through high-resonance imaging that drug addiction resulted in actual physical changes to the brain.

Armed with that understanding, “the management of folks with addiction becomes very much like the management of other chronic diseases, such as asthma, hypertension or diabetes,” said Dr. Daniel Alford, who oversees the program at Boston University Medical Center. “It’s hard necessarily to cure people, but you can certainly manage the problem to the point where they are able to function” through a combination of pharmaceuticals and therapy.

Central to the understanding of addiction as a physical ailment is the belief that treatment must be continuing in order to avoid relapse. Just as no one expects a diabetes patient to be cured after six weeks of diet and insulin management, Dr. Alford said, it is unrealistic to expect most drug addicts to be cured after 28 days in a detoxification facility.

“It’s not surprising to us now that when you stop the treatment, people relapse,” Dr. Alford said. “It doesn’t mean that the treatment doesn’t work, it just means that you need to continue treatment.” Those physical changes in the brain could also explain why some smokers will still crave a cigarette 30 years after quitting, Dr. Alford said.

If the idea of addiction as a chronic disease has been slow to take hold in medical circles, it could be because doctors sometime struggle to grasp brain function, Dr. Volkow said. “While it is very simple to understand a disease of the heart — the heart is very simple, it’s just a muscle — it’s much more complex to understand the brain,” she said.

Increasing interest in addiction medicine is a handful of promising new pharmaceuticals, most notably buprenorphine (sold under names like Suboxone), which has proved to ease withdrawal symptoms in heroin addicts and subsequently block cravings, though it causes side effects of its own. Other drugs for treating opioid or alcohol dependence have shown promise as well.

Few addiction medicine specialists advocate a path to recovery that depends solely on pharmacology, however. “The more we learn about the treatment of addiction, the more we realize that one size does not fit all,” said Petros Levounis, who is in charge of the residency at the Addiction Institute of New York at St. Luke’s-Roosevelt Hospital.

Equally maligned is the idea that psychiatry or 12-step programs are adequate for curing a disease with physical roots. Many people who abuse substances do not have psychiatric problems, Dr. Alford noted, adding, “I think there’s absolutely a role for addiction psychiatrists.”

While each institution has developed its own curriculum, the basic competencies each seeks to impart are the same. Residents will learn to recognize and diagnose substance abuse, conduct brief interventions that spell out the treatment options and prescribe the proper medications. The doctors will also be expected to understand the legal and practical implications of substance abuse.

Christine Pace, a 31-year-old graduate of Harvard Medical School, is the first addiction resident at Boston University Medical Center. She got interested in the subject as a teenager, when she volunteered at an AIDS organization and overheard heroin addicts complaining about doctors who could not — or would not — help them.

This year, when she became the in-house doctor at a methadone clinic in Boston, she was dismayed to find that the complaints had not changed. “I saw physicians over and over again pushing it aside, just calling a social-work consult to deal with a patient who is struggling with addiction,” Dr. Pace said.

One of her patients is Derek Anderson, 53, who credits Suboxone — as well as a general practitioner who six years ago recognized his signs of addiction — with helping him kick his 35-year heroin habit.  

“I used to go to detoxes and go back and forth and back and forth,” he said. But the Suboxone “got me to where I don’t have the dependency every day, consuming you, swallowing you like a fish in water. I’m able to work now, I’m able to take care of my daughter, I’m able to pay rent — all the things I couldn’t do when I was using.”


 

Illegal drink theory in fatal blast

Investigators are today trying to find out if an industrial unit where five men were killed in an explosion was being used to brew alcohol illegally.

Firefighters found the men inside the unit after the blast at the Broadfield Lane industrial estate in Boston, Lincolnshire, yesterday evening.

A sixth man was taken to hospital suffering from severe burns.

Teams of emergency workers were scrambled to the 30ft by 15ft unit shortly before 7.30pm after several 999 calls from members of the public.

Firefighters found the casualty outside, but had to cut their way into the unit after intense heat melted its doors.

Police, who last night said five men died in the explosion, would not confirm reports that the explosion occurred because of illegal alcohol brewing, but said investigators were keeping an "open mind and following up all relevant lines of inquiry".

A police spokeswoman said: "There has been all sorts of rumours along those lines. It is far too early for us to speculate."

She said the sixth man was taken to Boston Pilgrim Hospital with serious injuries, before being transferred to the Queen's Medical Centre in Nottingham.

The spokeswoman said inquiries were ongoing and would involved a "full forensic examination of the unit" and finger-tip searches of the cordoned-off unit to establish what was inside.

Ian Nuttall, 42, who lives 200 yards from the scene, said he noticed a commotion and smoke coming from the "lock-up" at about 7.30pm.

He said he did not know anyone who used it, or the other units, or what they used it for, but said: "There was a rumour going round that it was some Polish nationals who have been brewing their own vodka which is a bit of a problem around here at the moment."

Earlier this year, raids by HM Revenue and Customs, police and Lincolnshire trading standards seized goods including fake vodka from six international stores in the town.

HMRC said forensic testing of the counterfeit alcohol, seized in March, showed it contained chemicals often unsafe for public consumption.

Since then, at least one store has had its alcohol licence revoked by the council, and another has had it suspended.

Police and fire investigators are expected to continue searching the unit today for evidence of the cause of the blaze.

Steve Moore, area manager from Lincolnshire Fire and Rescue Service, described the incident as one of the worst he had seen in his 28-year career.

"It was a really hot, intense fire," he said.

The officer said the fierce flames set alight a car outside the unit and also buckled its roller shutters, meaning crews were forced to use hydraulic equipment to cut their way into the block.

Mr Moore said six firefighters wearing breathing apparatus searched the unit and found five more casualties.

"As far as the crews I have spoken to, its the single greatest loss of life in fire in their experience," he said.

Boston Central councillor Peter Bedford said he was shocked by the news.

"I don't know the cause or even which unit it was in but this is a real shock. We don't expect that kind of thing to happen in Boston. It's a small market town, predominantly agricultural.

"There is heavy industry in that industrial estate, there's a scrapyard, there's joinery works, it's a real mix."

Boston East councillor Mike Gilbert added: "I'm very anxious to find out exactly what's happened. It's a lot of people dead and a great tragedy.

 

Monday 4 July 2011

cannabis social clubs in Spain

The room looks like the office of any small membership organisation: old worn furniture, jammed bookshelves, promotional posters, dented filing cabinets, random boxes of materials that have never been filed. What stands out, though, is the cloying smell of marijuana that permeates the room of the Pannagh Association in the city centre of Bilbao in northern Spain. Pannagh’s president, a young, energetic Martín Barriuso Alonso, brings out the source of the odour from the locked filing cabinets. Inside metal boxes are neatly labelled plastic bags: Critical Mass, White Widow, Medicine Man, New York Diesel, Aka 47, all ready for distribution.

It’s six o’clock on a Thursday, and soon Pannagh’s members start arriving to pick up their bags. The first is Miguel Angel, who has HIV and recently underwent a liver transplant. Then Javier, who just consumes because, hey, he enjoys it. Pannagh (which means cannabis in Sanskrit) has 300 members who each pay 40 euros a year membership and then four euros per gram, about half the rate on the black market. Some take a bag of five grams, others 10. The maximum allowed is 60 grams per month.

Legal grey area

The existence of Pannagh and up to 300 similar clubs throughout Spain is down to a quirky grey area in Spanish law. It is also the product of a determined group of activists who have pushed at the openings in the law to try to formalise their existence. In 1974 the Spanish supreme court judged that drug consumption and possession for personal use was not a crime, while still deeming drug trafficking an imprisonable offence. This created a jurisprudence in which providing drugs for compassionate reasons, and joint purchase by a group of addicts – as long as it did not involve profit-seeking – were not crimes either.

It was in 1993, however, that the law was really put to the test, when the Asociación Ramón Santos de Estudios Sobre el Cannabis (Ramon Santos Association for the Study of Cannabis, ARSEC) caught the media spotlight by publicly and openly growing cannabis for 100 of its members. The crop was confiscated, only for the provincial court to acquit those involved before the supreme court eventually ruled that although it was clear that ARSEC did not intend to traffic drugs, the cultivation of cannabis was dangerous per se and therefore should be punished.

This legal cat-and-mouse game continued as other marijuana associations forced a series of contradictory legal decisions, sometimes leading to arrests and at other times prompting no legal intervention. In the case of Pannagh, Martín Barriuso and two other members of the association were detained for three days in 2006 and had their crop confiscated.

A few months later, however, the courts ruled that there had been no crime as ‘it concerned consumption between addicts in which there was no transmission to other parties’ and ordered the police to return the confiscated plants. Seventeen kilograms of marijuana that had been rotting behind bars was returned. Although completely unusable, Barrioso still has it, a decomposing trophy of his minor victory against the system.

The legal uncertainty is far from over, as arrests of members of cannabis clubs continue to occur from time to time. However, decisions by the supreme court in October 2001 and July 2003 contradicted its initial ARSEC judgement and established that possession of cannabis, including large quantities, is not a crime if there is no clear intention of trafficking. This has made possible an explosion of cannabis user associations.

Clubbing together

Due to the lack of clear regulation, associations have had to improvise and invent solutions in order to standardise their activities. The main pioneering groups came together in 2003 as the Federation of Cannabis Clubs (FAC), which initially included 21 clubs. All are non-profit and member-run, and most have similar guidelines, keeping strict and thorough records of cultivation, distribution and costs in case there is any investigation.

As Barriuso recounts, fear of arrest is still there, but most cannabis user associations are now more afraid of thieves stealing their valuable stocks. Some even have their building alarms linked up to the local police station.

There are still many unresolved questions in terms of regulation. Nevertheless the gradual normalisation of these clubs has already marked out Spain as different to that other bastion of European drug liberalism, Holland. As Tom Blickman, a drugs policy researcher for the Transnational Institute explains: ‘The unique nature of cannabis social clubs is that they have legalised both production and consumption of cannabis within a closed club and non-profit system.

Dutch liberal cannabis policy may have minimised criminalisation of users, but it has not resolved the core contradiction known as the back door problem: coffee shops are allowed to sell up to five grams of cannabis to consumers (the front door) but have to buy their stock on the illegal market (the back door). To draw coffee shops out of the criminal sphere entirely, the cultivation of cannabis needs to be regulated.’

The grey area of the law in Spain has led to the development of an economic and social model for drug consumption that might offer a more economically and socially just alternative to market legalisation. ‘I used to think our clubs were just one step towards full legalisation, but now I am not so sure,’ says Martín Barriuso. ‘When the debate is polarised between total prohibition and almost total liberalisation, it seems people have not stopped to think that there are other ways of doing things.’

Legalisation debate

The legalisation of drugs has moved from a fringe demand to an increasingly mainstream concern over the past decade. Advocates of legalisation range from ex-Home Office minister Bob Ainsworth to the former president of Mexico to the Economist. A referendum to legalise cannabis in California in November 2010 was only narrowly defeated.

However the case for legalisation has often been pitched as bringing drugs into the capitalist open market – in the words of some advocates, to start selling heroin as if it was Coca-Cola. Yet that would turn drugs into commodities, subject to the same manipulations and abuses of the international market as other legalised drugs, such as alcohol. A legalised cannabis market, driven by profit, would soon lead to drugs supply controlled by a few, driven by profit, involving unethical promotional practices and with little concern for the health of its users – in many ways a mirror image of the illegal drugs market.

As Martín Barriuso argues, cannabis social clubs provide a viable alternative not just to the illegal but also a legalised ‘free market’ in drugs. ‘What we have found is that the limits imposed by the current legal framework, in particular the obligation to produce and distribute within a closed circle, the control of all production by members, and, above all, the absence of profit, has created a framework of relations that is different and, for us, fairer and more balanced.’

Alternative economy

Barriuso points to the way that direct contact between producers and consumers has made it easier to find a balance between dignified salaries and reasonable prices, replacing competition with a desire for mutual benefit. Direct control of production means that members have full control of the origin, quality and composition of what they are consuming, while generating legal economic activity and tax collection. Accountability within the group means that health concerns (and many of Pannagh’s members consume cannabis for health reasons) are primary.

Given those results, it is not surprising that Barriuso concludes, ‘Now that we have succeeded in obtaining our supply directly and under better conditions, why would we fight for a capitalist market for cannabis, where the power of decision is once again in the hands of a few people and where we no longer control how substances we consume are produced?’

While the future of the Spanish model of cannabis social clubs is by no means guaranteed, it is an idea that is spreading. The Dutch city of Utrecht announced in early 2011 that it plans to experiment with a closed club model for adult recreational cannabis users and other Dutch municipalities have expressed interest in doing the same.

The European Parliament recently heard proposals for an extension of cannabis social clubs across Europe. Pannagh presented evidence, based on its own financial records, that this could create 7,500 direct jobs and around 30,000 indirect jobs in Spain alone. At a European level, it could create 8.4 billion euros additional income for member governments, an attractive proposition at a time of austerity budgets.

‘It could hardly have been expected,’ says Martín Barriuso smiling, ‘but by some strange legal fate, the global prohibition of drugs applied by the Spanish courts has given place to a strange protectionist market for cannabis, where there is economic activity but no profit, entrepreneurs but no businessmen, consumers but no exploitation of producers, and the existence of a legal economy entirely separate from the major distribution outlets and the mainstream economy. In a society such as Spain, facing a deep economic and social crisis after years of speculation, extreme consumerism and easy money, this parallel economy seems now more of an advantage than a disadvantage.’

Martín Barriuso Alonso’s briefing, Cannabis Social Clubs in Spain: a normalising alternative under way, is available at www.tni.org

Fifty years of the ‘war on drugs’

2011 marks the 50th anniversary of the 1961 UN Single Convention on Narcotic Drugs, the agreement that cemented global drug control into an international legal framework that has remained largely unchanged to this day. The subsequent ‘war on drugs’ has led to most countries worldwide using largely military and criminal-justice means in a completely unrealistic attempt to eradicate drugs use.

A coalition of international organisations, including Transform UK, the International Drug Policy Consortium and the Transnational Institute, have joined forces to launch a ‘Count the Costs’ campaign. They argue that while it was no doubt implemented with good intentions, it is now possible, reflecting on the experiences of the past half-century, to conclude that the policy has failed to achieve its goal of reducing or eliminating drug production, supply and use. In fact, drug supply and use has risen dramatically. It has also come at great social costs, fuelling conflict and insecurity in many countries, criminalising vulnerable groups of users and growers, diverting massive resources away from proven public health interventions, and rewarding violent criminal groups.

They campaign is calling on all UN member governments to make a proper assessment of the costs of the ‘war on drugs’ and to use the 50th anniversary to radically reform UN drugs conventions to focus on evidence-based drugs policies that minimise harm for drug users and do not infringe human rights.

 

The number of drug deaths in Britain is among the highest in the world, new figures show.

llegal substances killed 2,278 people in a year, according to the United Nations Office on Drugs and Crime.
It ranks Britain sixth in the world, with only the US, Ukraine, the Russian Federation, Iran and Mexico having more.
Most of these deaths were caused by opioids, such as heroin, followed by sedatives, cocaine, amphetamine-type stimulants and ecstasy.
The  report also warned that, while drug use across the world remained stable, ‘demand soared for substances not under international control’ – so-called legal highs.
It added: ‘These markets continue to evolve and every year new products are manufactured to supply an increasingly diversified demand for psychoactive substances.’
The figures are from the year 2008 and the UN says drug deaths are recorded differently in different countries.
The British deaths are among a population of 61million and compare to 1,638 deaths in Spain, which has a population of 46million, 1,449 in Germany (population 81million) and 484 in Italy (population 60million).
The US, home to 308million people, had 38,396 drug-related deaths.
Britain, the Russian Federation, Ukraine, Spain and Germany account for 80 per cent of all drug-related deaths in Europe, the report shows.
Crime prevention minister Baroness Angela Browning said in the year to March officials seized 1,951kg of cocaine or crack, 473kg of heroin, and 1,012kg of other class A drugs.
‘This report demonstrates the need for a renewed focus in dealing with the global drugs market to properly protect our communities,’ she added.
Michael Linnell, from the drug and alcohol charity Lifeline, said he had seen a ‘dramatic’ fall in the number of young people taking heroin.
He added: ‘Most of the people who are heroin addicts are in middle age and have been taking the drug for many years which takes its toll on their health and kills them.
‘But by far the biggest problem we face is from alcohol, both from the number of deaths and the impact it has on society.’