Editor's Note:Dr Byrne (and his associates) advocate for better policies which are proven to reduce risks for drug users and the general community under a framework in parallel with Australia's official policy of harm minimization. The findings of the New South Wales Drug Summit recommend better access to methadone, detoxification and other dependency treatments. It also advised investigating alternative services such as supervised injecting centres, leading to the opening of the Sydney Medically Supervised Injecting Centre in 2001. Dr Andrew Byrne has been involved in opioid treatments from a primary care background for 20 years at the same site in Redfern, an inner suburb of Sydney. He is recognised worldwide as a specialist in the addiction field and was involved in the seminal stages of the Chapter of Addiction Medicine, Royal Australasian College of Physicians. He received the Dole-Nyswander award from the American Association for the Treatment of Opioid Dependence in April 2006. In this edition of i2P, Dr Byrne comments on " A randomized clinical trial of methadone maintenance for prisoners: findings at 6 months post-release. Gordon MS, Kinlock TW, Schwartz RP, O'Grady KE. Addiction 2008 103;8:1333-1342"
These researchers found, predictably, that offering methadone treatment to prisoners with a history of opiate addiction was feasible, safe and effective, just like it is in the community generally when done according to established guidelines.
They compared counselling with/without MMT, finding less heroin use and less criminal activity at 6 months after release in those offered MMT.
Treatment retention was also higher.
This is yet another example of American research which is decades behind other countries. And this is despite heroin addiction has been accepted as a ‘brain disease’ by the White House and methadone and similar registered treatments are proven effective approaches. However, for those in the US prison system these maxims do not apply for some reason.
Note that this study was not published in an American journal.
Almost uniquely, in New South Wales, prisoners have had access to methadone treatment for over 20 years.
It was initially introduced as a pre-release measure to address the high rate of overdoses in those recently released.
There is now a copious literature on the subject, largely very positive.
Methadone has now been introduced in many other jurisdictions, although rarely ‘across the board’ as occurs in New South Wales.
Thus a trial which gave some subjects no access to such treatment would be unethical, unnecessary and cruel in a normal country.
Yet in America, despite a large drug budget and constitutional protections, denying prisoners appropriate treatment seems to be ‘business as usual’, like Guantanamo Bay and capital punishment.
These researchers say that there is an “urgent treatment need” yet it is unlikely anything will be done in a hurry in the USA, despite persuasive research like this.
Comments by Andrew Byrne ..
Surgery web page: http://www.redfernclinic.com/
Opera blog: http://www.redfernclinic.com/opera/critique/blog/
New York in 2008: http://ajbtravels.blogspot.com/
New York in 1922: http://bpresent.com/harry/code/10b_bowery.php