Among subjects with prior criminal charges, initiation of office-based buprenorphine treatment did not appear to have a significant impact on subsequent criminal charges.

The paper gets a little says that this lack of effect includes drug charges. I’m no fan of buprenorphine maintenance and even I’m surprised.

Related articles

• Buprenorphine Maintenance and Health Care Professionals (addictionandrecoverynews.wordpress.com)
• Top Posts of 2011 #2 – Dawn Farm’s Position on Buprenorphine Maintenance (addictionandrecoverynews.wordpress.com)

Mayo Clinic Proceedings (Photo credit: Wikipedia)

Mayo Clinic Proceedings published a new article entitled, Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals Returning to Clinical Practice: A Hidden Controversy.

From the article:

When considering all of the aforementioned issues with buprenorphine diversion, it does not seem reasonable to prescribe this medication to an HCP (Health Care Professional) with a history of opioid addiction. After carefully considering the evidence, we believe that opioid-substitution therapy with buprenorphine is not a reasonable choice for this particular patient population. HCPs are engaged in safetysensitive work that requires vigilance and full cognitive function. We therefore recommend abstinence-based recovery until studies with this specific HCP population performed in a simulated health care environment document that highly safety-sensitive tasks can be performed without deterioration in performance.

They also published an editorial that had a couple of complaints about the article but said:

Hamza and Bryson recommend against buprenorphine maintenance for HCPs with opioid dependence. Instead, they support abstinence-based recovery consistent with the current standard utilized by PHPs. With such standards, several PHPs have demonstrated the lowest relapse rate ever reported in the literature.¹⁰ Such high success rates among HCPs are related to multiple factors, including the individual’s motivation to maintain licensure and professional practice, the extensive treatment provided to this group, and the long-term monitoring established by state PHPs.¹¹ In fact, one can clearly make the argument that reported success rates are so high that introducing opioid maintenance to this paradigm would not be appropriate. Individual and large collaborative studies of state PHPs have demonstrated that under ideal circumstances, 80% of physicians being monitored for the 5 years after abstinence-based, 12-step treatment do not have a single relapse.¹² Will an institutional review board ever approve a study comparing buprenorphine maintenance with this form of treatment? Can buprenorphine maintenance be justified in the face of such data?

…

We agree wholeheartedly with Hamza and Bryson that caution is needed in decisions associated with the use of buprenorphine maintenance among HCPs returning to the health care workplace. The foundation information required to make good decisions regarding this medication in this population working in safety-sensitive positions is lacking. The use of a medication that has the potential to undermine cognitive function in HCPs working in an emergency or critical patient care setting cannot be supported at this time, given the lack of evidence of efficacy in this population and the absence of adequate national standards for its use.

Related articles

• Top Posts of 2011 #2 – Dawn Farm’s Position on Buprenorphine Maintenance (addictionandrecoverynews.wordpress.com)
• effective…as long as it is maintained (addictionandrecoverynews.wordpress.com)
• Should HCPs In Pharmacotherapeutic Treatment For Opioid Addiction Be Allowed To Return To Clinical Practice? (medicalnewstoday.com)

POST Press Release (for all the information about the situation in Russia and the protest, click here)

On World Aids Day, 2011,  our women’s group (renamed from Glada Womens voices to Women Of Substance) pulled off coordinating an amazing global protest! We liaised with organisations led by people who use drugs and were supported by the International Network of People who Use Drugs(INPUD) -and together we gathered outside Russian embassies in cities across the world in the largest ever global show of solidarity by and for people who use drugs.

The protests, entitled ‘Shame Russia Shame’, was directed at Russia’s highly controversial drug policies which are believed to be driving the EEC regions HIV and TB epidemics. Injecting drugs with contaminated equipment is driving Russia’s HIV epidemic, now the fastest growing in the world and it is reflected in the numbers; as many as 80% of new infections are occurring amongst people who inject drugs (PWID), in a total HIV positive population of approx 1.3million. With this in mind, recent projections forecast an additional 5 million people could become infected with HIV in the near future, unless Russia drastically transforms the way it is dealing with its HIV pandemic.

INPUD member Erin O’Mara says Russia’s drug policies are ‘brutalising’

Erin O’Mara, (chair of Women Of Substance and editor of UK’s Black Poppy Magazine / INPUD member) who spearheaded the global protest said the human catastrophe unfolding in Russia is almost indescribable in its brutality and neglect.”Russia has more heroin users than anywhere in the world yet because they offer no safe alternatives such as methadone or buprenorphine, and corruption has driven the price of heroin above what many Russian users can afford, new home made concoctions like desomorphine (nicknamed krokodil) are gaining ground, with devastating health consequences for the user”. Erin adds, “To scratch the surface of Russian drug policies, you find some of the most brutalizing policies in the world; where their should be harm reduction, regulation, treatment and support, there is neglect, abuse, imprisonment, disease and death.”

New York City groups Harm Reduction Coalition and Vocal NY, led the first of the World Aids Day demos, reading speeches and presenting a statement of demands to the Russian Embassy, which included the demand for Opiate Substitution Therapies (OST) such as methadone to be both legal and accessible to the 2 million or more injecting drug users in Russia.

Mexico lays its candlelight vigil in memory of those who have died of AIDS.

Mexico soon followed, again on the eve of World AIDS Day, with their protest led by Espolea, an organisation who’s young people delivered their heartfelt candlelight vigil to remember those who have died of AIDS and those with HIV facing so much oppression in the Russian Federation. It was a very generous tribute from our young colleagues in Mexico at a time in the drugs war when they are facing such enormous troubles of their own. (see video below).

As December 1st -and World AIDS Day dawned,  the global domino effect began and cities from Canberra, Edinburgh, Barcelona, Berlin, Bucharest, London, Paris, Porto, Stockholm, Tblisi, Toronto, delivered their protests, and a unified SHAME RUSSIA SHAME rang out in front of Russian Embassies across the world.

Londons’ Russian Embassy Protest

Speeches were given and a statement of demands were delivered to the Embassies which included demands to see the introduction of Opiate Substitution therapy (OST) and the scale up of needle and syringe programmes, which although currently funded by outside NGO’s and not by the Russian Government, numbers of services are still shockingly inadequate, with around 50 odd for the entire Russian Federation.

The city of Tblisi also took a brave step and protested outside their Swiss Embassy, which currently stands in for the Russian embassy which has been removed from Georgia for political reasons. Nevertheless, Georgians who have also seen the emergence of the drug Krokodil from across the Russian border were keen to show solidarity with their Russian drug using peers, as history has meant they were very aware of the might of the Russian police forces and their attitudes towards drug users. Georgians took a huge risk protesting in Tblisi but seemed buoyed by recent workshops in drug user organising and empowerment and peerwork with INPUD.

New Vector, in Tblisi in support of their Russian peers, and raising awareness of krokodil

Demonstrators had the special opportunity to read out a letter from Russia, from an INPUD member and drug user activist named Alex, who spoke directly to his peers across the world about Russia’s indifference and the strength he gains from a unified drug using community.

Alex writes: “To my despair, I live in a country where the means don’t justify the ends Where it’s easier to save the lives of healthy people by destroying those who are sick. Where ethics and humanity have given way to contempt and cruelty. Where they evaluate prevention not in terms of possibilities and outcomes but dollars and popularity. I express my deepest gratitude to all of you who share my protest.  For me, World AIDS Day does not exist in Russia. For me World AIDS Day in Russia means white carnations and condolence cards.I’m alive today thanks to your help and your faith in our united strength. I wish us resilient spirits, and that love fills all of our homes. I’m with you today.”

It was an exciting, moving and empowering event for all concerned, however everyone

The white slippers and carnations outside the Russian Embassy in Canberra, Australia

was acutely aware that Russian themselves were simply not safe enough to protest on World AIDS Day, no matter how peacefully. Although this protest had its roots in Moscow in 2009 on International Drug User Day, when 5 Russian activists were arrested after trying to lay red carnations and white slippers (the Russian symbol for the dead) at the steps of the Drug Control Service, the protest expanded on International Remembrance Day 2011. 3 countries took part and (Budapest, Berlin and Barcelona) remembered their peers outside Russian embassies, again laying the symbols of the protest. This world AIDS Day,was a call out to the world that we will not let our Russian peers be forgotten -that we will stand side by side them as we all fight to ensure that Russian citizens have the right to humane, evidenced based, enlightened drug policies and treatment.

For more information and/or quotes from INPUD members and city organisers, please do not hesitate to get in touch with INPUD.

Contact: INPUD Deputy Project Co-ordinatorL eliotalbers@inpud.net who can put you in touch with the right person or answer your questions.

NOTE: A huge thank you to the global coordinators based in London – Women of Substance, Black Poppy Magazine, and Ava Project (London)- -and our partners in Eastern Europe Andrey Rylkov Foundation, Eurasian Harm Reduction Network and all those organisations who took part in this event. INPUD members;  Plataforma Drogologica (Barcelona), Deutsch AIDS Hilfe (Berlin), Harm Reduction Coalition, Vocal NY (New York City) ,ASUD, Cannabis Sans Frontiere (Paris), AIVL, NUAA, CAHMA(Canberra)  CASOP (Porto) Association Intergration (Bucharest),Svenska Brukarforeningen (Stockholm), New Vector (Tblisi), CounterFit (Toronto) Chemical Reaction (Edinburgh) , Espolea (Mexico City)

Related articles

• Video of the Russian Embassy Protest Dec 1st 2011 (blackpoppymag.wordpress.com)
• Reuters Report from Russia (russianembassyprotest.wordpress.com)