The therapeutic state's latest drug delusion By Nicolas S. Martin Executive Director American Iatrogenic Association http://www.iatrogenic.org This is a comment on an article appearing in The New York Times, 11 August, 2003. “Modern” people seem to have an endless capacity for self-delusion regarding drugs. Here we have a new substitute for heroin that is to be called a “treatment.” It is hoped that this will replace another substitute for heroin, methadone, which was supposedly better because it is a man-made narcotic. Heroin itself was once marketed as a substitute --a ”treatment”-- for morphine "addiction." This article is more flotsam in the polluted sea of pseudoscientific drug prohibition propaganda. There are, though, some telling points. “Unlike methadone,” it is said, “buprenorphine will not give an addict more than a mild high no matter how large the dose.” But take a look at one of the countless web references claiming to offer accurate drug info: http://faculty.washington.edu/chudler/hero.html. According to the page's author, Eric H. Chudler, Ph.D., Research Associate Professor, Dept. of Anesthesiology, University of Washington, “Methadone can be swallowed (rather than injected) and it blocks heroin withdrawal symptoms and does not have euphoric or sedative effects .” (Emphasis added.) Now we have a new drug substitute -- buprenorphine -- for an existing drug substitute -- methadone -- that provides a “high” that experts have claimed and continue to claim doesn’t exist. It does stand to reason since people take heroin for its euphoric effect that many would be content with a drug that provides a similar “high” but won't get them locked up in jail for 25 years. This Times article’s author notes -- with the obligatory groveling in the presence of medical authority -- that “experts and addicts say it [buprenorphine] has several advantages over the older drug, and the most important may be that a patient can get a supply, not merely a dose, with a visit to a doctor and pharmacy.” Do tell. And morphine and heroin (and cocaine, and marijuana) were once available without government restriction to any American who wanted to use them. Those Americans did not have to have the permission of a physician in the days before the therapeutic state took control of all aspects of life. That control wasn’t gained by coup d’etat; Americans were delighted to give away their right to self-medicate when they were told it would make them safer. Are we safe yet? The author further says, “The relative ease with which a supply of buprenorphine can be obtained is a radical departure from the use of methadone, which is tightly controlled by federal law and can be given only one daily dose at a time, in licensed clinics where space is limited.” This situation will last just as long as it takes for experts to discover, to their amazement, that “addicts” like this new drug because it makes them high! Then the supply will be severely restricted, docs will lose licenses for prescribing it when it is not “medically necessary,” the drug will become popular on “the street,” and the jails and “mandatory treatment programs” will make room for “buprenorphine addicts.” Researchers will eventually invent a substitute for heroin and buprenorphine, and the cycle will begin again. All this because some people don’t want other people to ingest chemicals that induce euphoria. It is of little importance to most Americans that we have turned the country into a therapeutic police state, causing immense suffering and death, in our quest to “say no” on behalf of people other than ourselves. Look at the portion of Dr. Chudler’s web page that lists the effects of heroin. Notice how he announces, in a bold, red font, that the chemical can cause DEATH. Can you imagine this sort of flagrant scare-mongering masquerading as science appearing on a page about diphenhydramine (Benadryl), which, as I remember, is the number two cause of (supposedly) accidental drug death in the U.S.? What about aspirin, which has killed many people? Heroin is well down the list of drugs with which people have killed themselves. And why does heroin kill? Dr. Chudler doesn’t say it, but his own web page reveals that heroin kills because it is illegal. It kills because people who take it cannot get it in exact, pure doses, as they would be able to do if it were legal. It kills because it is bootleg, and bootleggers often dilute their products and add impurities, as they did with moonshine during alcohol prohibition. It kills because the experts of the therapeutic state, have determined that Americans are not capable or deserving of the right to self-medicate. Is there an associate professor in a department of anesthesiology who is so ignorant that he thinks there is a drug that cannot cause death by ingestion? Perhaps we could ask Dr. Chudler to produce pages warning of the dangers of water and fire so that we could behold the bold and bright font he could employ to alert us to the DEATH and DESTRUCTION each has caused. Is there no end to the madness of letting Americans light fires, and to drink and bathe in water? They even put their children directly into deadly water without the oversight of a physician! Heretics! Murderers! Water addicts! This drug prohibition nightmare is one of the two the most important medical errors of our time. (The other, not coincidentally, is the the metastasized myth of mental illness.) Not only does it harm (and imprison) the people who use prohibited drugs, but it prevents proper treatment of pain, restricts access to the overwhelming number of drugs that do not make people high, drastically escalates the cost of medical care by requiring doctor visits merely to get prescription refills, and causes other chillingly adverse effects. In the therapeutic state the word “patient” is redundant. We are all patients all the time, and Big Brother is, man or woman, a physician. Postscript (17 Aug 2003) I thought I might have to wait a bit longer for my buprenorphine scenario to play itself out, but that is only because I missed thie following article in Australia's Herald and Times Weekly, a newspaper of wide circulation. If, as the Times, reports, "Unlike methadone, buprenorphine will not give an addict more than a mild high no matter how large the dose," then why is it that in Australia it is "being sold and injected by desperate users on Melbourne streets," and the "potential for diversion was higher than methadone"? Can we not infer that there is a demand for buprenorphine because it does, in fact, give people the high they seek? And if the "potential for diversion" is greater than for methadone, does that not suggest that the drug offers a better high than methadone, and possibly some other benefits? The Times tells us that "The relative ease with which a supply of buprenorphine can be obtained is a radical departure from the use of methadone, which is tightly controlled by federal law and can be given only one daily dose at a time, in licensed clinics where space is limited." Meanwhile, in Austrialia the unapproved use of buprenorphine has led to to "National clinical guidelines requiring careful supervision by health care professionals and restrictions on take-away doses were in place to minimise the risk with buprenorphine." This article from 2002 shows that the gist of the Times piece is nonsense and that the American "drug abuse experts" are again pulling a fast one in their quest to maintain the prohibition industrial complex from which they profit so handsomely and disreputably. As the noose of socialized medicine tightens around the compliant popular neck, there will be no escape from this sort of state controlled "help" that strangles personal responsibility, smothers liberty, and drops medical quality down the hatch. Heroin drug switch warning http://heraldsun.news.com.au/printpage/0,5481,5589739,00.html 01 Dec 02 MARY PAPADAKIS AN oral drug which fights heroin addiction is being sold and injected by desperate users on Melbourne streets . Drug experts fear the misuse of buprenorphine will increase the risk of infection and other major health problems and create an underground trade in the methadone alternative. Turning Point Alcohol and Drug Centre research found a third of 156 drug users surveyed had injected the prescribed drug which, under supervision, is supposed to be dissolved under the tongue. Senior research fellow Craig Fry said it was believed some users were surreptitiously removing buprenorphine tablets from their mouths, risking a range of infections if the pills were later dissolved and injected. "We need to find out how users are diverting their dose and what is happening in the pharmacy or clinical setting which is making the diversion of the tablet possible," Mr Fry said. Buprenorphine became available in Australia in April last year and was placed on the Pharmaceutical Benefits Scheme four months later. Victoria has 60 per cent of those on buprenorphine treatment, about 3000 people. The drug is supposed to be delivered to users in a crushed form and placed under the tongue to be dissolved, normally in the presence of a pharmacist. Mr Fry said tighter controls and supervision may be required. He said injecting buprenorphine was extremely dangerous, with the potential for serious vein damage or blood clots. Victorian Department of Human Services drugs policy director Paul McDonald said he was aware of the issue. He said the potential for diversion was higher than methadone and the department was "very keen" to ensure this practice was minimised. Mr McDonald said bu prenorphine, sold under the trade name Subutex, was an extremely effective treatment. He said a new buprenorphine and narcan combination, to be injected, would be submitted to the Therapeutic Goods Administration for approval by Christmas. Buprenorphine manufacturer Reckitt Benckiser said in a statement all prescribed opiate dependency treatments were at risk of misuse and diversion. National clinical guidelines requiring careful supervision by health care professionals and restrictions on take-away doses were in place to minimise the risk with buprenorphine. The New York Times August 11, 2003 New Drug Promises Shift in Treatment for Heroin Addicts By RICHARD PÉREZ-PEÑA Alex is still a 34-year-old recovering addict, trying to measure what he lost to heroin. He is still building a new life in Manhattan, repairing frayed relationships and an interrupted career in the entertainment industry. He is still reliant on a substitute drug to get him through the day. But three months ago, he switched substitutes, and his life changed for the better. Alex —  he told his story on the condition that his full name not be used — stopped taking methadone, since the 1960's the standard treatment for people trying to quit heroin.  Instead, he takes buprenorphine, a drug newly approved by federal regulators to treat addiction to heroin and other opiates, including prescription drugs. For many addicts, though not all, buprenorphine does what methadone does, blocking the addict's craving for a high, but experts and addicts say it has several advantages over the older drug, and the most important may be that a patient can get a supply, not merely a dose, with a visit to a doctor and pharmacy. Like methadone, buprenorphine (pronounced byoo-pre-NOR-feen) is addictive, but the risk of overdose is much lower. Unlike methadone, buprenorphine will not give an addict more than a mild high no matter how large the dose, and it cannot be combined with opiates or other narcotics to get higher still. Users suffer fewer unpleasant side effects, and milder withdrawal symptoms when they stop taking it. Alex said methadone, which he took for five years, allowed him to finish college and resume working, but that buprenorphine was a big improvement. "I'm more clear-headed than I've been in years," he said. "I feel better physically. For the first time in a long time, I can see myself getting off everything in a way that's not going to rip a hole in my life and leave me only partially functioning." The relative ease with which a supply of buprenorphine can be obtained is a radical departure from the use of methadone, which is tightly controlled by federal law and can be given only one daily dose at a time, in licensed clinics where space is limited. Experts say the advent of buprenorphine could triple the number of people in serious treatment for heroin addiction. "My hope and my expectation is that buprenorphine will revolutionize heroin treatment in the United States," said Dr. Herbert D. Kleber, a professor at Columbia University's College of Physicians and Surgeons and a leading authority on heroin and buprenorphine, who was deputy director of the Office of National Drug Control Policy in the first Bush administration. Other experts see the change as more evolutionary than revolutionary, warning that much remains to be learned about buprenorphine, and that methadone, too, was once seen as a wonder drug. But they are enthusiastic, saying that since doctors began prescribing buprenorphine in October, the experience has been overwhelmingly positive. "Buprenorphine is no panacea," said Dr. Lawrence Brown Jr., president of the American Society of Addiction Medicine, and an associate professor at Weill Medical College of Cornell University. "But it is a fantastic opportunity for us. We need to encourage more physicians who are outside addiction medicine to take up this treatment." For many addicts, merely not having to go to a methadone clinic is an enormous advantage. "A lot of middle-class people are just not going to walk into a methadone clinic and stand in line every day," Alex said. "You're standing in line there with the same group of addicts every day, a lot of them talking about how they're going to get high. It's not a good head to be in if you're serious about quitting." He said he lived with constant worry that the methadone would jeopardize his job: the fuzzy-headed feeling it often induced might overtake him in the afternoon, his reliance on the clinic's hours might interfere with his work, a colleague might discover his routine. "With bupe, all of that's gone." New York City has an estimated 200,000 heroin addicts, and only 38,000 methadone program slots. Nationally, there are 800,000 to one million heroin addicts and about 180,000 methadone clinic spaces, and addicts outside major cities often live nowhere near clinics. Experts say that for every heroin addict, there are two people addicted to prescription opiates, drugs like oxycodone, hydrocodone, codeine and morphine, and that buprenorphine can be effective for them, as well. New York City's Department of Health and Mental Hygiene has embraced buprenorphine, urging doctors to learn about it and begin prescribing it. "We're looking at being able to increase the number of people in treatment to 100,000 by 2010," said Dr. Lloyd I. Sederer, executive deputy commissioner for mental hygiene. Last week, the department and the federal Center for Substance Abuse Treatment, part of the Department of Health and Human Services, held a forum in Manhattan to educate about 150 doctors and drug counselors about buprenorphine. Speakers included New York and New Jersey state officials, who spoke approvingly of the new treatment. Buprenorphine will not work for all addicts, and will not completely replace methadone. Some people simply will not respond well to it, which is true of almost any drug. Dr. Kleber said that half the people on methadone take such large doses that they could not change to buprenorphine without going through painful withdrawal. Some will be able to wean themselves to moderate doses and then switch, he said, and some will not. He said heroin users should be able to switch to buprenorphine, regardless of their doses. Jerry, 39, an addict living in Brooklyn, said he lowered his methadone dose by almost half, then moved to buprenorphine in June, transitions he described as "a little rocky, but not bad." Like Alex, Jerry, a building maintenance worker who insisted that his last name not be used, said he found that low doses of methadone lasted a little less than 24 hours, so he would awake every morning nauseous from the early stages of withdrawal. "On bupe, my head's good and my stomach's good," he said. Buprenorphine has been used as a painkiller for many years, and a few researchers, including Dr. Kleber, were permitted to make limited use of it for addiction treatment. In general, though, for decades federal law has prohibited use of any drug but methadone for heroin addiction. After a long lobbying campaign by treatment advocates, Congress loosened the law in 2000, and last October, the Food and Drug Administration ruled that doctors could prescribe buprenorphine in their offices for addiction treatment. To prescribe it, a doctor must first take an eight-hour course and register with the federal Drug Enforcement Administration. Because buprenorphine  is addictive and has a potential black market, federal law prohibits a doctor from prescribing  to more than 30 patients at a time.  Still, even with those limits, in theory there are more than enough family doctors and psychiatrists in the country to treat all those who seek treatment. Since October, about 2,000 doctors nationally have been cleared to prescribe buprenorphine for drug treatment, including 218 in New York State and 62 in New Jersey, according to Dr. H. Westley Clark, director of the federal substance abuse center. People in the drug treatment field say there are no more than a few thousand people around the country taking buprenorphine. New York State has decided that Medicaid, the health plan for the poor, will cover buprenorphine, but most states and most private insurance plans do not. Doctors say the retail cost is $5 to $10 a day. Advocates say buprenorphine should be given as part of a wider array of support services, including counseling. Dr. Kleber said Columbia planned to open the nation's first center to help addicts make the transition from methadone to buprenorphine, and then refer them to doctors for long-term maintenance. France allowed general practitioners to prescribe buprenorphine in 1996, and has reported a sharp drop in fatal overdoses. New York City alone has about 200 heroin overdose deaths each year. Buprenorphine latches onto the same receptors in the brain as heroin, methadone and other opiates, but more aggressively and effectively. A person already on buprenorphine who took another opiate would feel no effect, because the second drug would be unable to push the buprenorphine out of the way and latch on. Buprenorphine stays in the system longer, so many people can take it every other day, rather than every day. Buprenorphine is also unlike the others in having a "ceiling effect;" that is, beyond a certain dosage, taking more does not make the person any higher, or depress breathing any more. That reduces the risk of both abuse and overdose. There is another advantage. "The withdrawal from bupe is much easier and faster than that from either methadone or heroin, so it's easier to get off it," Dr. Kleber said. "I think it's going to become the preferred drug not only for getting people off heroin, but for withdrawing them from drugs entirely."