AlexMax
01-11-2003, 11:13 PM
http://www.canada.com/vancouver/news/story.asp?id=60C7EFF1-F269-4036-A8F9-AC4069EFE680
lol.....
LOCAL NEWS
Prescribe heroin, coke to addicts: mayor
Larry Campbell believes it's an option when methadone and abstinence fail
Jeff Lee
Vancouver Sun
Thursday, January 09, 2003
CREDIT: Peter Lauth, Vancouver Sun
According to Dr. Jurgen Rehm, director of a Zurich addiction institute, two-thirds of Swiss opiate users are in treatment.
ADVERTISEMENT
ZURICH -- Mayor Larry Campbell wants Vancouver to copy a controversial but successful Swiss program of prescribing heroin to hard-core addicts.
In fact, if he had his way, they'd get cocaine prescriptions too.
When social workers and drug addiction counsellors talk about the model for treating the hardest of hard-core addicts, for whom abstinence or methadone programs do not work, they all look to Switzerland for advice. That's because for the last eight years the country has operated a prescription heroin program with relative success.
Under the program, the only one of its kind in the world, addicts who have failed at other attempts to kick their habit can receive daily doses of pure heroin, which is produced by a Swiss pharmaceutical company. They can either inject the drug or take it orally, and in Zurich those on the program are allowed up to nine injections daily.
The program is only one part of a broad package of addiction treatment programs available to heroin addicts, and that's what attracted Campbell's attention most this week as he met addiction treatment specialists in Zurich.
"I can see this kind of a program operating in Vancouver," Campbell said.
"It's an effective way of treating a small but very resistant group of people addicted to heroin. In fact, by rights we should be offering prescription cocaine to the hardest addicts, because they often are hooked on both."
Campbell is on a whirlwind fact-finding tour of several Winter Olympic sites, including a diplomatic visit to the International Olympic Committee headquarters in Lausanne where today he will deliver a copy of Vancouver's bid for the 2010 Winter Games.
In advance of that visit, the mayor took two days to tour supervised drug injection facilities in Zurich in the hope of learning more about how other cities treat their drug addicts.
Switzerland's heroin maintenance program is separate from city-based safe injection programs, and is a response to a small but persistent core of deeply hooked addicts.
Dr. Jurgen Rehm, director of the Zurich-based Addiction Research Institute, said the prescription program isn't the be-all, end-all solution to drug treatment.
In fact, most of Switzerland's estimated 30,000 heroin addicts will never see the inside of a prescription treatment facility.
"It's not appropriate for most heroin users," Rehm said. "But about five to 10 per cent of the population should be in heroin maintenance."
According to Rehm, two-thirds of Switzerland's opiate users are in some form of treatment. More than 18,000 are on methadone. Another 1,000 are prescribed buprenorphine, a drug shown to be more successful in treating new and young addicts. Another 1,500 are in abstinence-based programs.
Only 1,169 addicts are in the heroin prescription program, which is administered at 21 centres across Switzerland.
Unlike the safe-injection sites in Zurich, where no scientific trials or data collection were undertaken before opening the facilities, the heroin maintenance program has been heavily scrutinized by researchers.
Results published by the Addiction Research Institute and the Swiss Federal Office of Public Health show that in the first six years of operation, 70 per cent of patients in the program remained in treatment for more than a year.
They also found that the longer the patient remains on the program, the more likely he or she is to make a successful transition to other treatment programs such as abstinence.
Other benefits documented were increased physical and mental health of the addicts and a decline in criminal behaviour.
The addicts have also recognized the value of the program; in the first four years of operation, an average of one-third would drop out in the first four months of treatment. That figure has been cut in half. At the other end of the scale, the number of "treatment terminations" after two or more years in treatment doubled from 21 per cent to 42 per cent.
That's in part because addicts in the prescription program are forced to leave if they choose to go into some other form of treatment, Rehm said.
Most of those enrolled do not have jobs and live on federal social assistance or disability cheques. They live a life scheduled around multiple daily treatment times. But the longer the addict remains in treatment, the more likely he or she is to become stable and want to explore starting a new life, Rehm said. Consequently, those wanting to do things like go back to work have to use other forms of treatment, such as abstinence or methadone.
Switzerland's decision to proceed with a heroin maintenance program was not nearly as controversial as one might imagine. In fact, prescribing heroin to addicts is less of an issue than a national referendum being contemplated on the legalization of marijuana, according to Rehm.
"In this country, referenda continually show there is a steady 55 to 60 per cent support for heroin trials. But on cannabis, most people are in support of liberal laws, but they vary to different degrees, so one can never know if a law on that will be passed."
Money also talks when it came to proving the heroin maintenance trial was worth doing. Studies show the program costs the equivalent of about $60 Cdn per addict per day, a little more than half what it costs taxpayers to deal with untreated addicts in terms of health issues, policing, courts and imprisonment.
The Swiss government recently went one step further, ordering health insurers to cover 75 per cent of the cost of the program. Switzerland has a universal health-care system. Rehm said it made sense for health insurers to cover the equivalent of about $45 Cdn of the daily cost to each addict because it is directly a health issue.
Under the agreement, addicts are expected to pay the remaining $15 per day, but local authorities will cover that cost if the patient doesn't have any money.
Some doctors have said the program's success leads them to believe a cocaine prescription program should also be started.
In an interview last year with Swissinfo, a national news agency, Dr. Daniel Meili, chief medical officer for Zurich's heroin prescription program, said it is difficult to properly treat some hard-core addicts who are hooked on both drugs.
"We need more options. We are still too restricted in what we can do and we are not reaching all the people who need our help," he said. "Most addicts like the combination and can't or don't want to give up cocaine. And since we don't have many options for treating cocaine addiction, it is difficult to reach these addicts."
Last year Zurich's city-run drug treatment programs expanded to include "inhalation" rooms in two of the four supervised injection facilities it operates. Users can enter the well-ventilated rooms to smoke crack and heroin. The room at the city's busiest facility on Selnaustrasse gets an average of 40 "consumptions" a day.
Campbell said he knows he faces an uphill battle in getting a heroin prescription program running in Vancouver. But it will eventually be necessary if the city is to provide a broad spectrum of treatment options for its addict population, he said.
"I estimate five to 10 per cent of our addicts are hooked hard and need to be on prescription heroin," he said. "It's not hard to see we need that kind of a program if we believe in treating all addicts."
lol.....
LOCAL NEWS
Prescribe heroin, coke to addicts: mayor
Larry Campbell believes it's an option when methadone and abstinence fail
Jeff Lee
Vancouver Sun
Thursday, January 09, 2003
CREDIT: Peter Lauth, Vancouver Sun
According to Dr. Jurgen Rehm, director of a Zurich addiction institute, two-thirds of Swiss opiate users are in treatment.
ADVERTISEMENT
ZURICH -- Mayor Larry Campbell wants Vancouver to copy a controversial but successful Swiss program of prescribing heroin to hard-core addicts.
In fact, if he had his way, they'd get cocaine prescriptions too.
When social workers and drug addiction counsellors talk about the model for treating the hardest of hard-core addicts, for whom abstinence or methadone programs do not work, they all look to Switzerland for advice. That's because for the last eight years the country has operated a prescription heroin program with relative success.
Under the program, the only one of its kind in the world, addicts who have failed at other attempts to kick their habit can receive daily doses of pure heroin, which is produced by a Swiss pharmaceutical company. They can either inject the drug or take it orally, and in Zurich those on the program are allowed up to nine injections daily.
The program is only one part of a broad package of addiction treatment programs available to heroin addicts, and that's what attracted Campbell's attention most this week as he met addiction treatment specialists in Zurich.
"I can see this kind of a program operating in Vancouver," Campbell said.
"It's an effective way of treating a small but very resistant group of people addicted to heroin. In fact, by rights we should be offering prescription cocaine to the hardest addicts, because they often are hooked on both."
Campbell is on a whirlwind fact-finding tour of several Winter Olympic sites, including a diplomatic visit to the International Olympic Committee headquarters in Lausanne where today he will deliver a copy of Vancouver's bid for the 2010 Winter Games.
In advance of that visit, the mayor took two days to tour supervised drug injection facilities in Zurich in the hope of learning more about how other cities treat their drug addicts.
Switzerland's heroin maintenance program is separate from city-based safe injection programs, and is a response to a small but persistent core of deeply hooked addicts.
Dr. Jurgen Rehm, director of the Zurich-based Addiction Research Institute, said the prescription program isn't the be-all, end-all solution to drug treatment.
In fact, most of Switzerland's estimated 30,000 heroin addicts will never see the inside of a prescription treatment facility.
"It's not appropriate for most heroin users," Rehm said. "But about five to 10 per cent of the population should be in heroin maintenance."
According to Rehm, two-thirds of Switzerland's opiate users are in some form of treatment. More than 18,000 are on methadone. Another 1,000 are prescribed buprenorphine, a drug shown to be more successful in treating new and young addicts. Another 1,500 are in abstinence-based programs.
Only 1,169 addicts are in the heroin prescription program, which is administered at 21 centres across Switzerland.
Unlike the safe-injection sites in Zurich, where no scientific trials or data collection were undertaken before opening the facilities, the heroin maintenance program has been heavily scrutinized by researchers.
Results published by the Addiction Research Institute and the Swiss Federal Office of Public Health show that in the first six years of operation, 70 per cent of patients in the program remained in treatment for more than a year.
They also found that the longer the patient remains on the program, the more likely he or she is to make a successful transition to other treatment programs such as abstinence.
Other benefits documented were increased physical and mental health of the addicts and a decline in criminal behaviour.
The addicts have also recognized the value of the program; in the first four years of operation, an average of one-third would drop out in the first four months of treatment. That figure has been cut in half. At the other end of the scale, the number of "treatment terminations" after two or more years in treatment doubled from 21 per cent to 42 per cent.
That's in part because addicts in the prescription program are forced to leave if they choose to go into some other form of treatment, Rehm said.
Most of those enrolled do not have jobs and live on federal social assistance or disability cheques. They live a life scheduled around multiple daily treatment times. But the longer the addict remains in treatment, the more likely he or she is to become stable and want to explore starting a new life, Rehm said. Consequently, those wanting to do things like go back to work have to use other forms of treatment, such as abstinence or methadone.
Switzerland's decision to proceed with a heroin maintenance program was not nearly as controversial as one might imagine. In fact, prescribing heroin to addicts is less of an issue than a national referendum being contemplated on the legalization of marijuana, according to Rehm.
"In this country, referenda continually show there is a steady 55 to 60 per cent support for heroin trials. But on cannabis, most people are in support of liberal laws, but they vary to different degrees, so one can never know if a law on that will be passed."
Money also talks when it came to proving the heroin maintenance trial was worth doing. Studies show the program costs the equivalent of about $60 Cdn per addict per day, a little more than half what it costs taxpayers to deal with untreated addicts in terms of health issues, policing, courts and imprisonment.
The Swiss government recently went one step further, ordering health insurers to cover 75 per cent of the cost of the program. Switzerland has a universal health-care system. Rehm said it made sense for health insurers to cover the equivalent of about $45 Cdn of the daily cost to each addict because it is directly a health issue.
Under the agreement, addicts are expected to pay the remaining $15 per day, but local authorities will cover that cost if the patient doesn't have any money.
Some doctors have said the program's success leads them to believe a cocaine prescription program should also be started.
In an interview last year with Swissinfo, a national news agency, Dr. Daniel Meili, chief medical officer for Zurich's heroin prescription program, said it is difficult to properly treat some hard-core addicts who are hooked on both drugs.
"We need more options. We are still too restricted in what we can do and we are not reaching all the people who need our help," he said. "Most addicts like the combination and can't or don't want to give up cocaine. And since we don't have many options for treating cocaine addiction, it is difficult to reach these addicts."
Last year Zurich's city-run drug treatment programs expanded to include "inhalation" rooms in two of the four supervised injection facilities it operates. Users can enter the well-ventilated rooms to smoke crack and heroin. The room at the city's busiest facility on Selnaustrasse gets an average of 40 "consumptions" a day.
Campbell said he knows he faces an uphill battle in getting a heroin prescription program running in Vancouver. But it will eventually be necessary if the city is to provide a broad spectrum of treatment options for its addict population, he said.
"I estimate five to 10 per cent of our addicts are hooked hard and need to be on prescription heroin," he said. "It's not hard to see we need that kind of a program if we believe in treating all addicts."