Tuesday, 5 July 2011

News article last night about diamorphine prescribing in London


This news piece is actually pretty shockingly biased... for the BBC!

They quote the diamorphine prescribing had a 6% success rate in getting people clean versus oral methadone also at 6%!

Now I don't know where they're getting they're facts from but the accurate RIOTT results are here
and here

And to top it off, they wheeled out Anne bloody Widdicoombe to tell us that we shouldn't be giving junkies a free hit on the state! ... again .. by the same argument we should then not be giving smokers nicotine patches!

From the article:

Supervised administration of injectable ‘medical’ grade heroin leads to larger reductions in street heroin use in chronic heroin addicts who are failing on treatment, than does either injectable or oral methadone. The findings of the Randomised Injectable Opiate Treatment Trial (RIOTT )  trial are reported in an article in this week’s Lancet, written by Professor John Strang and colleagues from the  National Addiction Centre, Institute of Psychiatry (IoP), King’s College London (KCL).
At least 5–10% of heroin addicts fail to benefit from established conventional treatments but whether they are untreatable or just difficult to treat is unknown. A scientific evidence base is emerging to support the effectiveness of maintenance treatment with directly supervised medicinal heroin (diamorphine or diacetylmorphine) as a second-line treatment for chronic heroin addiction.
This randomised controlled trial looked at chronic heroin addicts who were receiving conventional oral treatment but continued to inject street heroin regularly. Patients were assigned to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three National Health Service (NHS) supervised injecting clinics in England (London, Brighton, Darlington). During weeks 14–26 50% or more tested negative for street heroin on weekly random urine analysis.
The researchers found that at 26 weeks, 80% of patients remained in assigned treatment - 81% on supervised injectable methadone, 88% on supervised injectable heroin and 69% on optimised oral methadone. Proportions of patients achieving 50% or more negative samples for street heroin were highest in the injectable heroin group (66%) followed by injectable methadone (30%) and oral methadone (19%).  The measure of measurable improvement, the pre-selected primary outcome, was that through Months 4-6, at least 50% of randomly collected urines tested negative for street heroin (from weekly random urine analysis).  The authors report on 'abstinence from street heroin' also, and a similar greater benefit of the supervised heroin treatment was seen, compared with the other two treatments.
The authors say: 'We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first 6 weeks of treatment.'
They conclude: 'Rolling out the prescription of injectable heroin and methadone to clients who do not respond to other forms of treatment’, is detailed in the UK Government’s 2008 Drug Strategy, subject to the results from this trial. In the past 15 years, six randomised trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK.'
Professor Strang said: 'Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward.  The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within 6 weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit.'
The National Addiction Centre is jointly run by the IoP KCL and South London and Maudsley NHS Foundation Trust (SLaM). Both are part of King's Health Partners, an Academic Health Sciences Centre (AHSC) for London, bringing together clinical and research expertise across both physical and mental health. For more information, visit www.kingshealthpartners.org.   
The article ‘Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial’ can be found here, along with a podcast featuring Professor Strang discussing the trial:  www.thelancet.com.  Professor Strang can be seen also on the new SLaM website talking about RIOTT: http://www.slam.nhs.uk/news/latest-news/treating-heroin-addiction.aspx.


Jackson_Lace said...

I dont think anybody can help us unless we help ourselves. Thats what I learnt so far in my life. If we earn respect then we will get it. Nobody forces us to do drugs and lead the life we do. We got to "WANT" to get off "WANT" to change. We may be humans but humans have also done lot of evil things and to the educated, civilized succesful folks we are just as worse as the evil people. I think because so many folks relapse or dont stick to their recover programmes that it makes keyworkers, doctors and society believe we are all the same. In hindsight we cannot really blame them. They would rather help people who need food on their table, a shelter over their head, an illness which is life threatining, people in deep poverty and war zones and others, so drug and opiate addicts are at the bottom of their list. Having said that we should be infact "LUCKY" we do have some sort of system in place in this country which can help us recover, many countries do not.

I have personally met people from 2nd and 3rd world countries who use to be on drugs and opiates and actually recovered by helping themselves as they did not get much support from socity or have any sort of recovery programmes. If they can do it then no reason why most addicts in their country and first world cannot recover. I think some addicts do take advantage of the recovery system in place, take advantage of support so thus believe we should be treated as any human and as Princes. It doesnt work like that am afraid. Who knows maybe if there was no such thing as substitues i.e methadone and subutex, if there were no recovery programmes then maybe we would recover? knowing we can only help ourselves. I think thats the way to go about it, by helping ourselves.

Its not like we will die if you quit our drug of choice, not like we will be disabled. I think some of us tend to be selfish and want equal opportunies but the fact is we choose to do drugs and opiates, well most of us did, and that mentallity needs to change, nobody supports that kind of mentallity, any sober educated succesful person will think we are below them and rightly so, they have no reason to help us, they can sure lay the foundations but you do have people such as key-workers going out of their way to help addicts, some even do this volutantarily, so lets not slag them off.

Lets look at ourselves first. Only then we may have a half chance of changing our lives for the better. I know 3 people who use to be heroin and methadone addicts and what worked for them was religon (Islam). Since then they have been clean, got their own houses, got married and have decent jobs, even going on vacations, and talking about folks who use to be hardcore addicts for a very long time, who were even homeless, so point is the Human mind is capabale of doing anything. We just need to find it in our heads.

We can choose to be strong minded and respectable then being weak minded and selfish. If we know it's embarassing leading the life we are and very degrading then we can learn to pick ourselves up. When on drugs and being an addict we are numb and dont see that, but thats where the test of character and strenght comes in, the test of the human mind and heart. Lets be Real men and women and beat this degrading life.

On ibogaine I was planning it but after reading some horror stories am not so sure now.

Gledwood said...

interesting that injectable heroin had a more than double success rate than injectable methadone... which surely says a LOT about methadone

my one question is why is it always always always someone ELSE, never me or you getting this decent stuff?

i'm into getting the hell OFF methadone as quick as possible, so injectable diamorphine isn't as much of an issue as it once was

but i spent YEARS hanging out waiting for injectable diamorphine to come in... years revelling in telling the clinic how badly I was doing so I'd be first in line when it finally arrived. No lying was involved and no exaggeration btw. Because most "service users" do lie through their teeth my case would have stood out...

now I'm actually motivated to give in clean samples so that my juice can get cut down faster faster faster

they won't consider a 1mg a day reduction (for no reason I can understand) so it's 10mg a week. if that ever gets too steep I'll just buy juice on the street to fill the gaps

i hope your mst treatment is going better

can i ask you something: did you used to have a higher or lower tolerance to street gear than average, or was it about the same?

only difference with me was my tolerance seemed to go up and down faster than other people's, which didn't bother me. i think that made detoxing easier

but I detoxed MYSELF. i found detox units and their staff-oriented timetables very hard to adapt to...

Anonymous said...

Wow!, this was a real quality post. In theory I'd like to write like this too - taking time and real effort to make a good article... but what can I say... I keep putting it off and never seem to get something done

Anonymous said...

Aw, this was a really nice post. In idea I would like to put in writing like this additionally - taking time and actual effort to make a very good article… but what can I say… I procrastinate alot and by no means seem to get something done.

Alex Quinn said...

Heroin addiction is a very sad and heartbreaking thing to watch a loved go through. I do not think most people understand how hard an addict life is. It is a very hard illness to overcome that needs a lot of determination and help from everyone. Once they become addicted, they become a different person and often lose many family and friends. Often they become homeless as their life evolves around trying to get their next high. Please do not ignore anyone with a heroin addiction or any other addiction, and help them get the treatment they need.