Injecting Drug Use and Harm Reduction

I was recently quoted, along with a colleague and some of our out-reach workers in an article on increased levels of injecting drug use in the Western Cape.

The message is important, and unless substitution therapies are introduced it is likely that there will be a significant increase in overdose deaths and a spread in HIV and other infectious diseases.

This article was originally published on Ground Up and then on allAfrica. The article is by Ian Broughton, and the photo is by Andrea Schneider.

Healthcare workers worry injecting heroin on increase

Sunday 31 August was International Overdose Awareness Day. Health workers in Cape Town have warned of a possible increase in drug overdoses and the spread of infectious diseases, including HIV, if the use of needles to inject drugs increases.

October 2013 Newsletter

It's almost the end of the year. In our setting, because we are moving into summer and festivities, this usually sees a drop in those seeking help for their substance use issues, but often their is a brief spike shortly after new year as resolutions are made and the after-effects of the partying are felt! I recently attended the Dan Siegel Interpersonal Neurobiology workshop that was held in Cape Town, hence the photo. In this month's edition of Addiction Information we hope to spark some thought around some controversial topics, but one topic that should become less controversial is that of opioid substitution therapy, for which their seems to be mounting evidence as a stand-alone treatment modality.

We look at: An opioid addiction switch, Behavioural Interventions and Buprenorphine Maintenance, Chronic Care, Remission Rates, Choice and Will Power, Dr Dan Siegel and the Mind & Life Conference.

June 2013 Newsletter

After a busy two months I have finally managed to produce a newsletter. I recently gave a talk on the emerging divide between those who believe that opioid substitution is a treatment in itself, and those who believe that it is not really recovery. My talk, Opioid Substitution Therapy: Treatment vs. Recovery can be found here. This was prior to me being aware of the DSM qualification of "on maintenance therapy" for those in remission from Substance Use Disorders. I think we will see this argument developing in the States, and opinions will remain polarised. Hopefully we will see a more balanced approach in the South African setting. Comments are most welcome.

In this month's newsletter we talk about: Agonist Therapy for Stimulant Addiction, Is addiction a Disease?, The Anti-Reward System, Stimulant Addiction and Gray Matter, The Most Important Treatment Studies Matrix, Chris Arnade, Mindfulness and Improved RCTs in addiction.

Opioid Substitution Therapy: Treatment vs. Recovery

Introduction

Opioid Substitution Therapy has been a controversial topic. Somehow it is easier for the addiction recovery industry to accept medications such as Disulfiram with its aversive effect or acamprosate which does not carry the risk of approximating the state of alcohol intoxication and because studies have suggested that it is only effective in conjunction with psycho-social interventions. OST, on the other hand, uses opioid agonists or partial agonists that act in similar ways to the drugs of dependence, albeit without the same quality of high, and this, some have suggested, shifts the addiction from opioid dependence to another dependence and may be of more harm than good to the addict.

Addiction Information March 2013 Newsletter

This month we celebrated Human Rights Day in South Africa. I was given the opportunity to share my opinion on why those suffering from addiction are seldom afforded the same rights as others. A copy of my speech can be found here: Human Rights Day: Addicts are also Human. This month saw the first International Conference on Behavioral Addictions taking place in Budapest and so it is fitting to talk a bit about gambling addiction. Also in this issue: 

The DeltaFOSB Feedforward Loop, Drug Court, The Portuguese Drug Policy, Russel Brand on Addiction, Discontinuation of Sublingual Buprenorphine and Possible Approval for Buprenorphine Implants

Addiction Information January Newsletter

Introduction

Welcome to the first Addiction Information Newsletter. The object of this newsletter is to give you a monthly overview of what is happening in the world of addiction across a number of fields. You can subscribe to this newsletter and receive an e-mail version by joining our mailing list. Your suggestions are most welcome, and articles for the website or that you would like to have linked to this newsletter can be directly submitted to me by e-mailing shaun.shelly@yahoo.com.

In this issue:

The Motivated Addict, Dual-process models, CBT Ineffective?, Drug Policy, Brain Structure, Meth Psychosis, Transcriptional Mechanisms, Nepicastat & 18-MC Trials, Neuroscientist Marc Lewis, Dr Frankenstein's Cure and "beating addiction"

CBT Doesn't Work for Heroin Addiction?

Study Suggests Buprenorphine is enough. I Disagree.

In the January 2013 edition of The American Journal of Medicine there is a clinical research study conducted by members of the Yale University of the School of Medicine entitled: A Randomized Trial of Cognitive Behaviour Therapy in Primary Care-based Buprenorphine. (Fiellin, et al., 2013). In the abstract for the study, the stated objective was “To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence.” The abstract concludes: “Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioural therapy.”