Another one for the triumph of idiotic, unsupported public policy "positions" over the science and on-the-ground clinical experience. Apparently we're all about the opiates, this week because today's discussion is once again on heroin addiction. The free weekly San Diego CityBeat has the call:
Last October, the same week wildfires broke out around San Diego County, a couple thousand doctors, nurses, drug counselors and public officials gathered at the San Diego Sheraton for the annual meeting of the American Association for the Treatment of Opioid Dependence (AATOD), the national trade organization for providers of what's known as medically assisted drug treatment. ... featured speakers comprised a who's-who of the drug-treatment world, from the current head of California's Department of Alcohol and Drug Programs to the director of the national Center for Substance Abuse Treatment. San Diego Mayor Jerry Sanders was scheduled to give a welcome speech, though he had to cancel because of the fires.
Whitmyer, who chaired the conference's hospitality committee, noticed an absence among attendees--no one from the County of San Diego, the region's overseer of public-health programs, signed up to attend.
"That was a national program that was attended by 2,000 people and there was no one from the county there, in our own backyard, to learn about the benefits of medically assisted treatment," Whitmyer said.
No one was there because medically assisted drug treatment, also referred to as narcotic-replacement therapy, is not a service the county provides.
Drug-treatment providers that get funding from the county operate under a drug-free model, also known as social-model treatment, meaning anyone enrolled in their programs must abstain from any substance that could result in dependence, even if that substance is helping them kick their habit. A person who enters a county drug-treatment program on methadone might as well have entered the program on heroin.
Why? Methadone for heroin addiction may not be a silver bullet but, dang, it sure helps. Well, maybe there just isn't anybody around to learn 'em about drug abuse, eh? Those were links I could quickly find but I know there are a few research scientists at The Salk Institute for Biological Studies and the San Diego Veteran's Administration hospital that work on drug abuse topics as well. Admittedly these folks don't all focus on opiates and there isn't really a big clinical research operation into heroin...but still. What's going on?
Politics and cost--likely more the former--appear to be the reasons why
Oh joy. And the good news just keeps coming in this article:
The drug-free treatment model carries over to the criminal justice system, too. San Diego County's Drug Court, a diversion program that offers nonviolent offenders the option to enter treatment rather than jail, forbids medically assisted treatment. And of the $9 million San Diego County receives annually to pay for Prop. 36--the statewide drug-treatment initiative that's based on the drug-court model but with more lenient probation rules--none of that money funds medically assisted treatment.
Well, at least they have an alternative to "lock 'em up".
Jail is where Elon Burns learned how to shoot heroin. He had been smoking the drug since he was 13 and was convicted for drug possession when he was 19. With no access to syringes, inmates fashion makeshift shafts to inject drugs. It was from one of these shafts that Burns contracted hepatitis C.
So who's to blame anyway?
A number of people CityBeat spoke to for this story pointed to the county Board of Supervisors as the reason why methadone isn't part of any county programs.
In a 2001 interview for a San Diego Magazine article on the rise in HIV infections in San Diego County, Supervisor Bill Horn, in response to questions about why the county doesn't fund methadone or needle-exchange programs, said his cousin died from a heroin overdose after a failed attempt at methadone treatment.
Okay, point is made. But really, go read the article. It's pretty meaty.
As I said at the outset, methadone is not perfect. It is an opiate, having properties much like heroin, morphine and the synthetic varieties. It is acutely reinforcing, causes dependence and abrupt discontinuation results in acute opiate withdrawal. It is a chronic medication and relapse rates after tapering off lengthy courses of methadone maintenance are quite high. Still, it can be an effective part of the public health toolkit.
I was alerted to this by someone who GivesACrap about local science/policy relationships. How about you DearReader? Do you know whether your local public health entities operate on science-based or political-opinion-based principles?