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Report and Exhibits

West Coast/East Coast/International: Drug Policy and Treatment State of the Art

California Society of Addiction Medicine
Invitational Conference on Drug User Activism
Drug Policy Alliance 2003 Biennial Conference

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Index

Introduction

California Society of Addiction Medicine conference

Stanley D. Glick, MD, PhD
Deborah C. Mash, PhD and Jeffrey Kamlet, MD
Dorit Ron, PhD
Office Based Treatment with Buprenorphine

Invitational Conference on Drug User Activism

Drug Policy Alliance 2003 Biennial conference

DPA Mission Statement
Conference Review

Plenary
Ibogaine Roundtable
Prescribing Heroin
Harm Reduction Psychotherapy
Methadone and Buprenorphine
Pain, Opiates and Opiophobia
Reverend Edwin Sander, II
Award Presentations

Exhibits

1. MP3 Recordings of CSAM presentations
2. California Society of Addiction Medicine (CSAM) web page
3. Brochure - Conference on Drug User Activism
4. Danish Drug Users Union web page
5. Drug Policy Alliance (DPA) Web page

Donations

Introduction

West Coast/East Coast took about a week to turn into West Coast/East Coast/International. Five days after initial letters requesting donations for the West/East conference project were posted Howard Lotsof, DWF's President learned of the Invitational Conference on Drug User Activism sponsored by the Danish Drug Users Union (BrugerForeningen) and the Dutch National Group of Drug Users ((Landelijk Steunpunt Druggebruikers).

The conference was unique in that it was sponsored and participated in principally by active drug users. As research and education in the field of chemical dependence and substance-related disorders are primary mission directives of this foundation, participation in the Copenhagen conference was of vital interest. From a research perspective no other conceivable situation existed where the drug user leadership from around the world would come together offering a unique opportunity to find out what was really happening in the world of drug use. From an educational perspective, Mr. Lotsof would present on The Legacy of Ibogaine, a brief historical review of the part played in ibogaine development by drug user activists.

West/East/International developed into a balanced series of three conferences. The west coast conference sponsored by the California Society of Addiction Medicine would lend itself to science. Copenhagen, the international element of our three conference project was sponsored by Dutch and Danish drug users unions and would review drug user activism, advocacy and organizing while concurrently providing insight to the state of drug policy, drug treatment and how users are effected individually and within the public health sector of their respective countries. Our final conference would be the Biennial Drug Policy Alliance 2003 conference to be held in early November in New Jersey that concerned itself with broad ranging drug policy issues, discussions and workshops. - return to Index

CSAM

The California Society of Addiction Medicine (CSAM) conference was held the second week of October in San Francisco where an afternoon would be devoted to ibogaine presentations by researchers Stanley D. Glick,, MD (Albany Medical Center), Deborah C. Mash, PhD (University of Miami School of Medicine) and Dorit Ron, PhD (University of California San Francisco). Jeffrey Kamlet, MD, an associate of Dr. Mash presented a clinician's point of view of ibogaine expanding the focus of the CSAM ibogaine sessions.

Stanley D. Glick spoke on Ibogaine Analogues: Drug Development for Addictive Disorders directed towards his second generation ibogaine-like drug, 18-methoxycoronaridine and the work of his development group to overcome objections that had been made to the ibogaine molecule including claims of neurotoxicity, cardiovascular effects and dreamlike visualization. Research in the animal model looks good. However, 18-MC has not yet been administered to human subjects and we will have to await clinical studies to determine exactly what the drug does and how effective it may be in treating chemical dependence. - return to Index

Deborah Mash, a molecular biologist and Jeffrey Kamlet, a medical doctor copresented on their finding of 276 patients treated with ibogaine at a St. Kitts facility. Patients were male and female between the age of 18 and 62. 202 were male and 74 were female. The principal treatment group was opioid dependent with lesser numbers treated for cocaine, amphetamine and primary alcoholism. Mash stated that ibogaine can be given safely based on her study of the St. Kitts patients. Bradycardia was seen in some cocaine dependent subjects due to volume depletion, a condition that was overcome by hydrating the patients. Mash then went onto a discussion of noribogaine an active metabolite of ibogaine and discussed her findings during which she indicated she believed ibogaine's long term effects were a response to noribogaine. - return to Index

Kamlet said he practiced emergency medicine and has six different certifications including ASAM certification for addiction medicine and is President Elect of the Florida Society of Addiction Medicine. Kamlet has treated 225 patients with ibogaine and indicated that for him, seeing was believing. His observations of patients treated with ibogaine placed them in a similar state as patients who had sixty to ninety days drug free rather than one or two days post ibogaine which was the real time situation. Kamlet went on to say that ibogaine eliminated 95% of opiate withdrawal and reduced craving to opioids and other drugs as well as, allowing the treatment of intractable patients. - return to Index

Dr. Dorit Ron, in her presentation "What Can Ibogaine Tell Us About the Underlying Mechanisms of Addiction" stated she studied alcohol addiction from the molecular signaling aspect. That she became interested in ibogaine with the initial aim to identify the molecular signaling pathways that may mediate these very important effects of ibogaine in the treatment of addiction. Before proceeding to determine the molecular pathways Dr. Ron wished to confirm the effects of ibogaine on ethanol self-administration and to determine that ibogaine would reduce ethanol self-administration. She found that rats injected with ibogaine showed a substantial reduction in alcohol self-administration. This was seen under a number of different study designs. In place preference testing Dr. Ron and her colleagues found that ibogaine was neither aversive or rewarding nor did it change the reward properties of ethanol but, did effect what Dr. Ron called relapse prevention in a lever pressing paradigm. When ethanol was reintroduced to animals trained to press levers to receive ethanol who had received ibogaine they showed a very significant decrease in lever pressing compared to saline treated animals. These studies were deemed interesting. Dr. Ron reported her team then went on to try to identify the signaling profile of ibogaine. From the signal transduction point of view acute exposure of a drug leads to changing the signaling pathways and eventually to changes in gene expression that can lead to chronic consumption and then consistent changes in gene expression that Ron referred to as the "disease of addiction". Ron's group wanted to know if ibogaine is changing very long term neuroadaptations that are associated with phenotypes associated with drugs of abuse and if ibogaine changes gene expression. She found ibogaine increases the level of a protein called GDNF in the midbrain dopaminergic neurons including the VTA that is part of a reward pathway and it is part of the neurocircuitry that mediates drug seeking behavior in general. In brief Dr. Ron and her colleagues found ibogaine to reverse certain effects of drugs of abuse. - return to Index

The scientific presentations are quite detailed and DWF is gratified that MP3 sound files of the presentations are available via links from the exhibits section  of this report as well as to the California Society of Addiction Medicine web page.

DWF also participated in a special preconference workshop: "Streamlining Office-Based Treatment with Buprenorphine". Presenters in that workshop were Donald R. Wesson, MD, Consultant, CNS Medication Development and Chair, ASAM Committee on Medications Development; Judith Martin, MD, Medical Director, 14th Street Clinic and East Bay Recovery Project, Oakland, CA; Deborah Stephenson, MD, Perinatal Substance Abuse Program, San Jose and; Walter Ling, MD, Integrated Substance Abuse Programs, UCLA.

The workshop was directed towards physicians using buprenorphine within office based practices and concerned itself with administrative and medical issues. One of the areas of discussion during this workshop concerned the matter of post operative analgesia for buprenorphine maintained patients. Buprenorphine is the latest opioid agonist medication and many doctors, including those working with the substance, are not familiar with methods of accomplishing analgesia for buprenorphine patients as the protocol for such analgesia has not been established. With more and more patients entering buprenorphine therapy the solution to this problem must be resolved and DWF will contact the manufacturer, Reckitt Benckiser in the hope that the company will respond to provide physicians and patients with an answer. The problem centers around the particular pharmacology of buprenorphine a mixed agonist/antagonist that will keep mu opioids that make up most of the pain killing narcotics from taking effect. Doctors not familiar with buprenorphine appear to be reluctant to provide appropriate analgesia in a post operative settings leaving patients to suffer pain and even doctors familiar with prescribing the drug view the area of post operative analgesia as somewhat experimental. - return to Index

Invitational Conference on Drug User Activism

The Copenhagen conference was actually a series of three events: The Invitational Conference on Drug User Activism took place on October 31, International Drug Users Day (IDUD) was celebrated on November 1 and the 10th anniversary of BrugerForeningen, the Danish Drug Users Union was on November 3rd.

The events were sponsored by two drug user organizations: The Danish Drug Users Union (BrugerForeningen) known by their acronym BF and the Dutch National Group of Drug Users ((Landelijk Steunpunt Druggebruikers) known by their acronym LSD. The Danish group hosted this year's activities in their complex of twenty-four offices that included an auditorium capable of seating over a hundred people. These were modern offices, computer equipped and managed by both staff and very hard working volunteers who kept the events well organized and the guests well cared for. BF receives support from the Danish Ministry of Cultural Affairs as well as, other governmental and private sources. It's President Joergen Kjaer is a very dynamic and politically knowledgeable individual who was in fact recognized for his leadership in drug user activism as the recipient of this years Dr. Alderwright Award for outstanding work in the field of drug user activism. This was the first time the award presented outside of the Netherlands.

Participants at the Invitational Conference were from Denmark, Netherlands, United Kingdom, United States, Ireland, Russia, Bulgaria, Romania, Czech Republic, Macedonia, Lithuania, Croatia, Finland, Sweden and Norway.

Three workshops were scheduled and were to be repeated during the day. Workshop A: Drug User activism in the Digital Age was presented by Ossi Viljakainen of the Finnish Association for a Humane Drug Policy and Eliot Ross Albert of the UK based Methadone Alliance. Workshop B : Obstacles and challenges to user organizations, directed towards organizational networking and run by Tommy Larkin from the Union for Improved Services, Communication and Education (UISCE) out of Ireland and Workshop C: Lifting activism to a professional level was conducted by Alan Joyce also from the Methadone Alliance in the UK.

I was to present on ibogaine during the closing plenary. Sixty persons attended the session. There were serious questions from the floor as to safety, dose and availability. Of interest were three persons attending my presentation, one from Netherlands, one from Denmark and one from Croatia who had been administered ibogaine. My presentation was a historical review of the part that drug users and drug user activists had played in the development of ibogaine. An abstract is available in the Conference Brochure. - return to Index

The second day began with a social reception to allow the representatives of the various organizations to network and discuss issues in greater detail than may have been possible in the workshops. Thereafter, and in keeping with the eighth annual celebration of International Drug Users Day (IDUD) we all boarded a bus to plant a tree at the memorial for deceased drug users. The site was in a small park in central Copenhagen and was an inspiring experience for all of us. We were fortunate enough to participate in the actual planting of the Paradise-apple tree on November 1st , the date on which International Drug Users Day is celebrated each year. The speech presented by BrugerForeningen's President, Joergen Kjaer at the dedication of the memorial earlier in the year during July, 2003, follows.

From international collaboration, we learned that some user groups had their own memorial sites. Four years ago, we decided to find a public park for a permanent memorial site. We looked, asked here and there, it was not easy, and no location was obvious. The only solution we found was to buy a normal grave, at the local graveyard. That was neither central, nor relevant to our wishes, and the time went by.

Now, last autumn we heard that the place with the 2nd W.W. bunker - (literally a bit of the open drug scene) was going to be leveled, and rebuilt, as a new “polished” city-garden. The “bunker” for many years served as a common gathering and rests place, a hideout and injection site for many drugs users - some users even took their last injection, and lost their life here.
In the start of March, we had a meeting with the city-garden designer, a very user-friendly person. He instantly liked the idea of a permanent memory site for diseased drug users. He immediately accepted our wishes, and offered to pay the engraving; “Here we memory deceased drug users” in the surrounding cliff wall, and even added to the garden plan a wood-bench for profounder thoughts. BrugerForeningen was permitted to plant a Paradise-apple tree; we will do that at the optimal time, just before the winter.

In an interview on Copenhagen Local Radio last week, I was asked who I thought would use the new memorial site. I replied, “Probably primarily drug users”. Later I revised that belief, because I came to think about, how many friends and relatives, which have had drug-using friends, who left their lives without any chance to say farewell.

Everyone can and may use this memorial site.

I will end thanking each and everyone who came by today - we will meet here again next year.

Joergen Kjaer/president
BrugerForeningen

http://www.brugerforeningen.dk/

Tree Planting Celebration - Nov. 1, 2003

Joergen Kjaer planting the Paradise-apple tree during the memorial service for deceased drug users.

(from left to right) Howard S. Lotsof, Stan Ritzer, Norma Alexander Lotsof, Joergen Kjaer, Theo van Dam, and Joycelyn S. Woods.

After the tree was planted and photographs taken, we boarded the bus and as part of our tour drove past methadone and heroin sales sites on the streets - we passed the Danish parliament and some landmarks on the way to Christiania, a sort of free state within Copenhagen where hashish and marijuana are openly sold unlike the rest of Copenhagen where heroin and methadone are sold furtively in some neighborhoods just as in New York City and elsewhere.

The status of Christiania's independence is at risk today as it is valuable land with a lot of waterfront access and real-estate interests would like to obtain it for profit. After a brief tour of the area lasting about an hour darkness set in. We were off for a real surprise as BF had organized a wonderful dinner at Spiseloppen, a restaurant in Christiania renowned for its international cuisine. Initially I was somewhat suspect as the restaurant was in a rather ordinary brick building hidden away behind an anonymous door. On entering Spiseloppen we were greeted by the warm wooden interior with massive beams supporting the room. The food was exceptional. - return to Index

Our Copenhagen adventure closed on November 3rd with the celebration of the BrugerForeningen's 10th Anniversary. The celebration started with a welcome speech by Joergen Kjaer. Afterwards Mr. Peter Ege, city doctor of Copenhagen who was the recipient of the previous year's award spoke as a part of the traditional ceremony of honor, during which Charlotte Fich received the current Users Friend of the Year Award. Mrs. Fich is a pioneer and was Copenhagen's first street-nurse providing care and information to the active drug using community. This was BF's seventh annual award and incidentally the first time the award was presented to a woman.

The award ceremony was followed by a party. The affair was attended by a number of leading conference participants, representatives from the Danish ministry of Social Affairs, Copenhagen City Council, health community advisors, political supporters of BrugerForeningen including parliamentarian Sophie H. Andersen who is among the young politicians, a Social Democrat, who is willing to listen to the opinion of drug user activists and in a position to respond

A month after returning from Denmark we received the disappointing news that ibogaine has been placed on a list of restricted substances in Denmark thus negatively influencing the possibility of drug users and drug user self-help groups obtaining therapy with iboga alkaloids that were available in Denmark prior to the change in regulations. DWF has initiated an inquiry to determine the reason for the change of ibogaine's status in Denmark. - return to Index

The Dora Weiner Foundation gratefully acknowledges the contributions of the Danish Drug Users Union and the Dutch National Group of Drug Users to allow our attendance at the Invitational Conference on Drug User Activism.

Drug Policy Alliance 2003 Biennial Conference

"The Drug Policy Alliance envisions a just society in which the use and regulation of drugs are grounded in science, compassion, health and human rights, in which people are no longer punished for what they put into their own bodies but only for crimes committed against others, and in which the fears, prejudices and punitive prohibitions of today are no more. Our mission is to advance those policies and attitudes that best reduce the harms of both drug misuse and drug prohibition, and to promote the sovereignty of individuals over their minds and bodies. Specific issues advocated by the Alliance include marijuana decriminalization; treatment instead of jail for nonviolent offenders; and needle exchange to reduce the spread of HIV, Hepatitis C and other infections diseases. More information about the Drug Policy Alliance can be found at www.drugpolicy.org." (source, DPA eNewsletter, 12/8/03)

While the DPA was the last conference on our three-conference agenda that we attended, it was the first conference for which DWF began planning. In June 2003, DWF's President, Howard Lotsof, learned that the Drug Policy Alliance was considering an ibogaine workshop for their Biennial conference. Lotsof emailed Ethan Nadelmann, the DPA'S Executive Director and informed him that he would like to present at the workshop. Nadelmann responded by asking for suggestions of presenters for the workshop. As Mr. Lotsof was no longer actively involved in ibogaine development and could not assess the field well enough to respond at that time he did not do so.

In August, Jennifer O'Neal, DPA’s Director of Special Events contacted Mr. Lotsof to inform him that there would be a Roundtable on Ibogaine and asked if he would like to present. DWF's President informed Ms. O'Neal he would be delighted to present. And as he no longer had any obligations concerning commercial development of ibogaine would present on the topic of Returning Control of Ibogaine to Drug Users and additionally suggested that someone from the Iboga Therapy House be invited to speak as well. Eventually, Sandra Karpetas, the Project Coordinator of the Vancouver based Ibogaine provider organization was selected.

The Roundtable would eventually consist of Howard S. Lotsof, Kenneth R. Alper, Dana Beal, Patrick Kroupa, Daniel Pinchbeck and Sandra Karpetas. A review of the Ibogaine Roundtable follows but, let us not get ahead of ourselves as there was an Opening Plenary that set the tone for the conference - return to Index

The Opening Plenary focused on the alarming assault on our civil liberties that was set in motion by the Patriot Act. Anthony Romero of the ACLU noted that since 9/11 our civil liberties have been waning. Attorney General Ashcroft is against 1st amendment rights, accusing those who stand up for civil liberties as being supporters of the enemies of our country. Warrants executed under the Foreign Intelligence Secrecy Act are concealed from the press and public, even from congress.

Protesters are having difficulties getting permits to demonstrate. Free speech zones are established wherever the President speaks preventing demonstrators from speaking anywhere authorities deem off limits. These actions are reminiscent of those ordered by former NYC Mayor Rudolph Guilliani. The Patriot Act, section 213, allows government agents to enter our homes, download information from our computers, search our personal belongings, etc. while we are away from our homes without informing us until authorities are ready to file charges against us. Regarding surveillance, new tools erode our rights to privacy; sec 215 of the patriot act allows the government to get our library records, genetic data, etc. Now librarians can be brought up on charges for informing us when the government has collected records of what books and other material we are reading. Due process rights are also being eroded. The Government insists that it have unilateral power to refuse to allow citizens to confer with their attorneys while holding/incarcerating them for indefinite periods. The war on drugs is a war on due process, free speech and civil liberties. The war on terror is a war driven by intimidation.

Kasia Malinowska-Sempruch of the International Harm Reduction Development Program provided some statistics on HIV infections; 10% of all new HIV infections around the world are among injecting drug users. In Russia 250K people are infected with HIV a rise of 92% over 1998 statistics. While we were at the Invitational Conference on Drug User Activism in Copenhagen, one of the Russian user activists indicated that needle exchange was not available in Russia. This was particularly discouraging as our friend and colleague Joey Tranchina had to the best of our understanding been provided with a grant funded by George Soros to educate and train Russians in needle exchange technology and practice. - return to Index

Ibogaine Roundtable

Howard Lotsof, President, Dora Weiner Foundation and Moderator of the roundtable opened the session with a brief overview of his serendipitous discovery of ibogaine’s ability to interrupt heroin withdrawal in the 1960’s and of later attempts to develop the treatment through FDA regulatory channels first via the philanthropic approach in the 1980’s, then via NDA International, Inc., a for-profit corporation in the 1980’s and 1990’s. He then turned the floor over to the other panelists, introducing each presenter in turn.

Dr Ken Alper, NYU School of Medicine, stated that ibogaine has previously been provided by a medical subculture. He as did Howard discussed Nico Adriaans's part in providing ibogaine treatments in the Netherlands during the beginning of ibogaine therapy’s international expansion. He talked about the lack of availability, cost and lack of legality of treatment in the US. He also discussed Act-Up’s disease specific political activist movement and the part that organization played in trying to move ibogaine’s development forward. Ken remarked on the pharmaceutical industry's lack of motivation to develop medicines for treating addiction and the fact that 90% of the world’s public sector funds for developing drugs to treat drug overuse comes from NIDA.

Dana Beal, Founder of Cures Not Wars, stated that there are limitations with a drug to treat chemical dependency; (1) addiction is one where providers are skeptical about people who abuse drugs says, addicts are considered to be liars. (2) Parents groups related to drug abusers are different from other parent groups; they are either abstinence proponents or accepting of approved medications i.e. LAAM, Methadone and so forth, where ibogaine comes out of the legalization movement of the 1980’s. He provided a general overview of the history of ibogaine’s development from the 1980’s, as he perceives it. There is a nexus between so-called soft drug and hard drug users he feels.

Sandra Karpetas, Project Coordinator of the Iboga Therapy House in Canada provided information about their screening process. She stated that addicts had an expectation of a “quick fix” and the fact that they often lie to get into treatment. Her organization recommends that people try other treatment options first before being treated with ibogaine. She and her colleagues feel that they must take time to get to know patients before treating them if possible. Some patients get annoyed by being asked so often during treatment about how they are doing. Sandra does not attempt to interpret the meaning of the visions patients experience. She mentioned that it is important to develop a follow up or aftercare protocol.

Patrick Kroupa, representing Healing Visions, Ltd. was introduced as someone who has been treated with ibogaine who said he began psychotherapy as a kid in school because his childhood was so screwed up. When he was 14, he had a friend whose uncle’s profession was being hit by cars for money. This was the man who introduced him and his friend (the man’s nephew) to heroin. Patrick said he didn’t get strung out until he was 20 or 21 years old. He married a woman who became a full blown schizophrenic-his life was falling apart while his company’s assets increased. He admitted that he was self-medicating to feel normal and that he was self destructive enough to go for ultra rapid detox twice. Patrick stated that he knew a heroin user who would go from being a junkie one day then take ibogaine and become completely clean for a period before going back to hanging out in shooting galleries. He credits this observation with having stimulated his interest in taking ibogaine and ibogaine for precipitating events that freed him from dependence to opioid narcotics.

Daniel Pinchbeck, journalist and author of “Breaking Open The Head” stated that ibogaine is not just for addicts. Anyone can benefit from ibogaine he feels. Life severs us from God, ibogaine reconnects us to God. The shaman in Gabon he remarked was kind of a bastard, his second experience in Mexico was much more positive. He believes the providers in Africa beat the drums all night so people wont pay attention to the incredibly loud buzzing they hear under the influence of ibogaine. He recommends the experience not just for addicts. This is in keeping with the belief of Dutch addiction specialist Peter Cohen, of the University of Amsterdam who believes ibogaine should be taken for reasons other than chemical dependence and that the concept of addiction is an artifact of our society.

The question and Answer period began. The first question related to a comparison of ayahuasca and ibogaine. There was a comment from a participant about receiving ibogaine in a sterile white setting as not being preferable. Howard responded that he had administered ibogaine procedures in every possible venue from apartments to modern hospitals and felt that there was no better environment than a modern hospital with appropriate rooms and a trained medical staff to allow patients to feel safe and that patients he had observed regardless of their original opinion did feel most secure in a hospital setting as long as people familiar with ibogaine were on site. Daniel does not think the clinical approach will remain the primary method for taking ibogaine. Considering that the clinical approach is historically secondary to a long tradition of religious initiation in Africa and and as there is a lack of interest in ibogaine development on the part of either the pharmaceutical industry or Institutes of Health, Daniel may be right. However, the final answer, will probably be up to two persons who chose not to present at this conference. Deborah Mash, PhD, University of Miami and Stanley D. Glick, PhD, MD, Albany Medical Center both of whom are in the lead in scientific and medical development of ibogaine and second generation ibogaine-like medications.

Ibogaine however, was only a small part of the conference agenda. Among other workshops of interest to DWF's officers were those concerning Heroin Maintenance in Europe; Harm Reduction Psychotherapy; Pain, opiates, opiophobia; Financial Management for Emerging Nonprofit Organizations; Drugs and Reproductive Freedom; and Methadone and Buprenorphine - Maintaining Options. - return to Index

The workshop, Prescribing Heroin was a natural for our attendance. Having followed the development of heroin maintenance in Europe since the late 1980s when we had the opportunity to meet with Prof. Dr. Ambrose Uchtenhagen one of the developers of the heroin maintenance model in Switzerland. We had also met Peter Blanken during our period of ibogaine research in the Netherlands when he was an associate of Nico Adriaans and Charles Kaplan at Erasmus University Rotterdam.

The objective of the research Peter Blanken reported on was to determine whether supervised medical prescription of heroin could successfully treat addicts who do not sufficiently benefit from methadone maintenance treatment. 549 heroin addicts participated in the study conducted in methadone maintenance programs in six cities in the Netherlands.

The protocol design included two open label randomized controlled trials. The findings were that adherence was excellent with 12 month outcome data available for 94% of the randomized participants. 12 month treatment with heroin plus methadone was significantly more effective than treatment with methadone alone both in the trial of inhalable heroin and in the trial of injectable heroin. Discontinuation of the co-prescribed heroin resulted in a rapid deterioration in 82% (94/115) of those who responded to the CO-prescribed heroin. It’s important to note that the incidence of serious adverse events was similar across treatment conditions.

In conclusion, Peter and his team determined that supervised co-prescription of heroin is feasible, more effective, and probably as safe as methadone alone in reducing the many physical, mental, and social problems of treatment resistant heroin addicts.

We learned from Gerry Stimson that heroin has been prescribed in the United Kingdom since the 1920’s in fact until recently it was the only country in the world that allowed doctors to prescribe heroin for the treatment of opiate dependence. However, heroin prescribing is rare in the UK, few doctors do it and many of them prescribe it reluctantly. Methadone is the most common treatment for opiate dependence in the UK but as many of us in the treatment field know, not all opiate dependent people benefit from it, hence the developing interest in prescribed heroin. Large-scale trials conducted in Switzerland and the Netherlands with people with long-term heroin dependency have provided evidence that prescribing heroin can lead to health and social gains.

The total number of problematic heroin users in the UK is thought to be around 200,000, but there is no way to confirm the accuracy of those statistics. Indicators suggest that the number of heroin users has increased. Although the UK was the first country to prescribe heroin there have been few studies and there is little research evidence on the effectiveness of prescribing heroin. In particular, it is unclear who might benefit most from this type of treatment, and in what circumstances. Therefore, any expansion of heroin prescribing in the UK needs a clear strategy for doing so, and a serious evaluation of its effectiveness. New guidance states that the prescribing of injectable opioid drugs may be beneficial for a minority of heroin mis-users, and gives guarded endorsement of this practice. However, the guidance is constrained by the lack of good UK research evidence and in itself is unlikely to encourage more doctors to prescribe heroin.

It appears to us that beyond US borders, prescribed heroin therapy to treat opioid dependence may be an important medical advance. Switzerland’s HAT (Heroin Assisted Treatment) program has been in place and experiencing success since 1994. We have heard that Spain, Germany and possibly Australia have either heroin trials or programs in place already or being planned. The Netherlands is conducting trials. The UK is considering expanding their heroin program, Canada is discussing heroin studies and while at the Copenhagen Conference we learned that the Danish government is also weighing the possibility of initiating heroin trials. But, the fear among the people we spoke to in Denmark is unless the Social Democrats win the next election there will be no heroin trials or heroin maintenance programs. - return to Index

We attended the workshop on Harm Reduction Psychotherapy for personal and professional reasons. Dr Andrew Tatarsky has been a friend for some years now but we had never had the opportunity to hear him present and wanted to become more familiar with his work. Andrew who is the author of the book “Harm Reduction Psychotherapy: The New Treatment of Drug and Alcohol Problems” noted in the treatment of people with alcohol and drug problems, one size does not fit all. Users must be engaged in treatment or they will not be treated successfully. Mobilize client’s strengths in the process of change. Provider and user must collaborate on the treatment. De-stigmatize substance users. Harm reduction puts the alliance between user and therapist first then works towards the goal of abstinence, moderation, etc. The ideal substance use plan also includes relaxation and other complementary therapies and techniques.

Dr Debra Rothschild struggled with what to call people who come to her for help, clients or patients. For this workshop, she decided to use the term client. She will not use the term substance user because it implies that all users need help. Thus, though substance abuse is considered politically incorrect she will use the term temporarily. She indicates that many therapists were practicing harm reduction psychotherapy long before the practice was given the name harm reduction. Many of these therapist were also treating substance abusers all though that was not their goal or intent. Harm reduction psychotherapy does not exclude abstinence. However, the focus is on the person in harm reduction psychotherapy not the substance as it is in traditional substance abuse treatment. Mutual exploration is an important tool in this approach to therapy. And it is very important to the relationship that there be open respect between therapist/counselor and patient to achieve any level of success.

Dr Stanton Peele, queried: finances-will there ever be enough? Efficacy-are we sure treatment will work? Matching-who will we treat; how will we treat them? What is the hardest drug to quit? Nicotine, was the audience response. On the subject of military personnel addicted during the war in Vietnam, Stanton noted that 12% became re-addicted later, 50% used narcotics stateside but only 25% used more than casually. Stanton uses what he refers to as the life process program, which is treating people where they are in the community.

From our perspective, ibogaine presents the most significant front-end treatment for chemical dependence one can imagine. But, there is significant patient and provider interest in a form of post-ibogaine therapy that might be equal to ibogaine in efficacy. And we were hoping that Harm Reduction Psychotherapy that appears to limit the stigma attached to chemical dependence might provide an effective form of aftercare following ibogaine therapy. - return to Index

The Methadone and Buprenorphine: Maintaining Options session included four presenters. Holly Catania, JD, Project Director of the International Center for Advancement of Addiction Treatment told us that her organization is working to get treatment throughout the prison system wherever it is needed. Thus far within the US, Rikers is the only prison that treats people coming in from the streets with opioid abuse problems whether they were on a methadone program or not before being arrested. Following the KEEP model established at Rikers Island in 1987, Puerto Rico is testing men arrested to see if they are positive for opioids in their systems and treats those that are. 50% of prisoners in PR test positive for HCV. There are only 5 programs on the island and approximately 170 thousand addicts. We also learned that worldwide there are only 23 countries that provide opioid agonist treatment in prisons/jails and that various medicines i.e. methadone, LAAM, heroin, etc. are used to treat or detoxify those who need it.

According to Dr Robert Schwartz, Assistant Professor of Psychiatry at the University of Maryland School of Medicine, they are trying to create a rational drug treatment system in Baltimore by attempting to get at least 50% of the abusing population into treatment. Public dollars support treatment, public support for treatment is therefore essential. Former Mayor Schmoke supports treatment although many other political leaders in the City do not.

The United Way has developed an advocacy program and is putting up billboards designed to encourage businesses etc. to support treatment. There is also an effort to encourage treatment programs to become involved in community organizations and local activities. Treatment programs have doubled in size therefore, using community health boards to provide treatment works. They’ve been measuring treatment retention in Maryland and find that the numbers are creeping up from month to month by approximately 5%. On the other hand, drug free programs have been flat for the last six months. The situation with buprenorphine is that each physician can only treat thirty patients per year however; a large facility like Johns Hopkins that has approximately 5,000 doctors can treat many patients per year.

Alice Diorio, of the Vermont Harm Reduction Coalition briefed the audience on the state of the treatment scene in the state of Vermont. At present she and the Vermont Harm Reduction Coalition are attempting to get patients medicated who’ve been put in jail. The State Supreme Court ordered prison authorities to medicate a prisoner but instead of giving the prisoner being advocated for his medicine prison authorities released the person rather than medicate him. She went on to note that public opinion and attitudes in Vermont are changing especially among parents with children with drug use problems. Alice also told us that they are finding that many of the physicians on the buprenorphine provider list just do not provide the treatment. - return to Index

Pain, Opiates and Opiophobia

Howard’s discussions with Siobahn Reynolds, founder of the Pain Relief Network and email discussions he had with DR Russell K. Portenoy concerning post operative pain management for buprenorphine patients attracted us to the workshop Pain, Opiates and Opiophobia. According to Doctor Portenoy of Beth Israel Medical Center, 37% of methadone patients suffer from pain, 30% or more Americans in general suffer chronic pain. 30-60% of chronic pain sufferers also suffer from depression. Additionally, there are approximately 100 different chemicals used to treat pain, yet 25% of nursing home residents indicating pain receive no analgesia. Chronic pain is a huge public health problem.

It was encouraging to hear of Siobahn Reynolds’ work with the Pain Relief Network as the stigma associated with narcotic pain medication spills into every area of medicine and adjunctly into broader drug policy issues. Reynolds told the workshop she never planned to become an advocate but did so because her husband suffered from chronic pain. She commented that the DEA and medical boards force doctors out of practice for treating pain patients and people are committing suicide all over the country. In fact, about five weeks before the conference she said her young son witnessed the suicide of a pain patient living in their building who jumped seventeen stories because she could not obtain pain medication and her son was so traumatized Siobahn is still trying to calm him down. - return to Index

We would like to thank the Reverend Edwin Sander, II for admonishing the DPA conference participants about the "baggage we all bring to the battle that stops us from cooperating with each other and getting the important jobs done." His message is universal to accomplishing objectives within alliances and associations of diverse groups and individuals and should be taken to heart to allow good works to be done. - return to Index

Award Presentations

DWF's President, Howard S. Lotsof and Vice President, Norma Alexander Lotsof were unable to attend the Drug Policy Alliance Awards Dinner but, would like to acknowledge two of the award recipients. Rick Doblin, PhD, President of the Multidisciplinary Association for Psychedelic Studies who has been a supporter of DWF projects received the Norman E. Zindberg Award for Achievement in the Field of Medicine. The award recognizes medical and treatment experts who perform rigorous scientific research and who have the courage to report their findings even though they may be at odds with current scientific or medical beliefs. We also wish to acknowledge Allan Clear, Executive Director, Harm Reduction Coalition, who has supported our mission for over a decade as the recipient of the Robert C. Randall Award for Achievement in the Field of Citizen Action. The Robert C. Randall award honors citizens who make democracy work in the difficult area of drug law and policy reform. - return to Index

The Dora Weiner Foundation gratefully acknowledges the scholarships provided by the Drug Policy Alliance to attend their 2003 Biennial Conference.


Exhibits


1. CSAM MP3 presentation recordings - return to report - return to Index

Donations make it possible for the Dora Weiner Foundation (DWF) to participate in conferences, symposia and forums and provide for the garnering and exchange of information between medical doctors, scientists and patients. We are able to bring you state of the art information by participating in conferences and forums and maintaining contact with patients being treated for chemical dependence. All of DWF's funding drives have been project specific allowing us to direct your gifts to projects for which donations have been solicited and to provide reports like this for your benefit.

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