Thursday, April 22, 2010

Retoxification?

Here is an interesting article from an English Newspaper.

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http://www.telegraph.co.uk/news/uknews/crime/7558955/Drug-free-inmates-put-on-methadone.html

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It turns out that for 5 years doctors and prison officials in England have been putting Heroin addicts on Methadone before their release from prison – a process some are calling “Retoxification”. The idea is that the prisoners won’t overdose and die when they get out of prison - I guess they usually relapse pretty quickly.

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This is obviously a pretty contentious program and a somewhat desperate measure. The positive of course is that it may cut down on fatal overdoses after prisoners leave the jail. The negatives include the fact that some prisoners may be fully detoxed and may be able to do very well in a drug free treatment program and for these people, getting them hooked on methadone is a real disservice. This is especially true since getting off methadone is actually a lot harder that getting off heroin. And, by the time they leave jail, many of these prisoners are completely drug free – they have been through their detoxification. The hard part is over.

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The other time I’ve heard of something like this is from some docs in Sydney, Australia. They were having a number of fatal overdoses actually inside the jails –the heroin addicts who were in jail had gone through their detox and so they would have lost their tolerance. When people lose their tolerance, even very small doses can be fatal. Enough of them were getting Heroin smuggled in and using it in the jail. This is dangerous enough on the street but even more dangerous in jail. In jail you have no idea of the purity of the Heroin, and the inmates would usually be under a lot of pressure to use quickly to avoid detection. Easy to make mistakes and take too much. So there were a lot of fatal overdoses in the jails. The Sydney doctors decided on a trial program where they put some of their opiate addicts on methadone while in jail – often even prisoners who had never been on methadone. In fact the program was successful in decreasing overdoses, but at the price of having all of those prisoners addicted to methadone when they left the jail.

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The truth is that fatal overdoses following a period of jail time are quite high. One study I saw a while ago had fatality rates as high as 4-5% in the first year.

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So what should be done? We believe that all patients (or prisoners) should be treated as individuals. We believe that being drug free is the best course, provided the patients are willing and able to make the necessary changes. So, jails should identify prisoners with substance abuse problems and start their treatment while they are a “captive audience”. Before the prisoner is released, they should have already received basic treatment and then a very comprehensive ongoing treatment plan should be in place. This treatment plan should include a suitable living arrangement, intensive therapy and support groups. It should also include job training, random drug screens and real consequences for lack of compliance. Here at the Coleman Institute we also recommend Naltrexone implants for at least 12 months to decrease cravings and prevent relapse.

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If this much attention is paid to each prisoner then the need for methadone in jails would either be eliminated or greatly decreased.

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Fortunately here in Virginia, as in many parts of the country, there are now many drug courts that are helping people recover from their addiction instead of just locking them up. At the Coleman Institute we believe that everyone, including prisoners, should have the opportunity to receive treatment for their disease. It is surely better to give prisoners treatment than just hope they “learned their lesson”

Dr Peter Coleman

3 comments:

  1. Any one that says "the hard part is over" when talking about an addict who has gone thru detox--obviously doesn't understand what addiction is--

    it's like telling someone with OCD that the hard part is over if they stop washing their hands uncontrollably for a week!

    It's like telling someone with lung cancer that the "hard part is over" because they stopped smoking!

    For addicts, the easiest part is getting "detoxed"...the hard part is living every day with an unquenchable thirst to use, depression and loss of hope and not giving in and doing the one thing that makes all those things go away.

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  2. ARM-ME couldn't have said it better. I'm glad
    to hear some doctors and prison officials in
    England have the degree of knowledge of the
    disease of addiction that allows them to developand facilitate "retoxification" programs. Sounds like we could learn something from them.

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  3. Thanks for the comments. In the big picture, detox is definitely the easy part - although having said that, many patients are unable to even get that far. What I do like is the idea that we can meet our patients where they are. For some this will be a drug free lifestyle with what I call full recovery. For some that may involve using controlled opiates. It is all about helping the patients.
    Dr Coleman

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