Opiate Drugs Articles

Women Opium Addicts in Afghanistan: The Hidden Numbers

For a number of months now, news channels throughout the world have been reporting on the drugs problems running rampant in Afghanistan. We know clearly that this is a problem among men, both young and old. Now, a new Independent report highlights the hidden addicts – mothers.

Opium is readily available in Afghanistan and too often, individuals try and treat themselves when pain issues arise. Aside from legitimate use, however, a number of Afghanistan citizens pursue the use of opium drugs to escape life, or simply because they have nothing else to do.

It is estimated that one million Afghan adults are addicted to illegal drugs. This is the statistic available from the latest United Nations Office on Drugs and Crime survey. The statistic suggests that 8 percent of the adult population is addicted, which is twice the global average.

For mothers in Afghanistan, too many are dependent on outlawed and highly addictive painkillers because they cannot access medicines or medical help. Opium paste is often a target. While the substance is banned, it can be purchased under the counter at small shops in nearly every bazaar. The paste is used to treat pain such as that incurred during childbirth. Too quickly, addiction sets in.

Currently, Afghanistan is the largest opium producer in the world, producing 90 percent of the world’s supply of opium and heroin. Southern Afghanistan accounts for 87 percent of production in the country, with the bulk coming from Kandahar and Helmand provinces.

Throughout the country, opium use has increased by 53 percent since 2005 and the proportion of heroin users has increased by 140 percent due to the cheap availability of the drugs. The true number of addicted women is likely to be much larger.

Opioid Painkillers May Actually Increase Chronic Pain

A new study has found that repeated use of narcotic painkillers can actually increase chronic pain, instead of alleviating it. Opioid-induced hyperalgesia is associated with the continued use of opioids such as morphine, hydrocodone, oxycodone, and methadone. People taking these drugs on a long-term basis can become increasingly sensitive to noxious stimuli, even after a painful response to stimuli that was previous non-noxious. Some animal studies have shown that this can occur after one high dose of opioids.

Long-term use of opioids for chronic pain conditions can also increase people’s sensitivity to certain types of pain, called hyperalgesia. Researchers from the University of Adelaide in Australia discovered that hyperalgesia can develop in people who abuse methadone. For this reason, the researchers say that people may need to be weaned off of opioids completely, in a medically monitored way. For example, people taking opioids for migraine headaches could actually be increasing their pain by taking the opioids.

David Clark, MD, of the Palo Alto VA Health Care System in California, said that this study is important because it shows that patients with chronic pain who use opioids are equally at risk for this sensitization as addicts and drug abusers. He said that chronic use of opioids seems to sensitize patients to pain, suggesting factors that could limit the clinical use of using opioids for chronic pain control, as well as add to problems in people being treated for addiction.

Dr. Stephen F. Grinstead of Behavioral Health Central writes the the growing amount of people who are undergoing chronic pain management need safe, effective pain relief, which is leading to research for developing new treatment modalities. Because some patients don’t do well with opioid therapy alone, methods involving non-opioid and non-pharmacological treatment should be explored.

Source: MedScape Today, Janis Kelly, Long-Term Opioid Use May Increase Sensitivity to Pain

Most US Prisons Not Providing Opiate Replacement Therapy for Addicted Prisoners

Almost a quarter of a million individuals addicted to heroin are incarcerated in the United States each year. However, many prison systems across the country still do not offer medical treatment for heroin and opiate addiction, despite the demonstrated social, medical, and economic benefits of opiate replacement therapy (ORT).

According to new research from the Miriam Hospital, Brown University, and their affiliated Center for Prisoner Health and Human Rights, just half of all federal and state prison symptoms offer ORT with methadone and buprenorphine, and only in very limited circumstances.

Similarly, only 23 states provide referrals for some inmates for treatment upon release from prison. These policies are counter to guidelines issued by both the World Health Organization (WHO) and the Centers for Disease Control and Prevention, which say prisoners should be offered ORT for treatment of opiate dependence.

“Pharmacological treatment of opiate dependence is a proven intervention, is cost-effective and reduces drug-related disease and reincarceration rates, yet it remains underutilized in U.S. prison systems,” said Amy Nunn, ScD, the study’s lead author and an assistant professor of medicine at The Warren Alpert Medical School of Brown University. “Improving correctional policies for addiction treatment could dramatically improve prisoner and community health as well as reduce both taxpayer burden and reincarceration rates.”

“Opiate addiction, like all forms of addiction, causes long-term changes to the structure and functioning of the brain, which is why it is classified as a disease. Addiction requires treatment just as other chronic diseases, like diabetes and cancer, do. Unfortunately, there is a large gap between the number of prisoners who require addiction treatment and those who actually receive it,” added senior author Josiah Rich, MD, MPH, co-director of the Center for Prisoner Health and Human Rights at the Miriam Hospital and Alpert Medical School.

The U.S. has the world’s highest incarceration rate, with approximately 10 million individuals incarcerated each year. More than half of inmates have a history of substance use and more than 200,000 people with heroin addiction are incarcerated annually. Inmates face disproportionately higher burdens of mental illness, substance use, and infectious diseases, including HIV/AIDS.

For the past four decades, methadone has been the treatment of choice for opiate dependence. It prevents withdrawal symptoms and drug cravings, blocks the euphoric effects of other opiates, and reduces the risk of relapse, infectious disease transmission, and overdose death. The drug buprenorphine is a newer treatment for opiate replacement that has less likelihood of overdose and is associated with less social stigma. Like methadone, it prevents withdrawal symptoms when an individual stops taking opioid drugs by producing similar effects. Both methadone and buprenorphine are included in WHO’s “Essential Medicines” list of drugs that should be made available at all times by health systems to patients.

The Miriam/Brown research team surveyed the medical directors at the 50 state departments of corrections, along with the Federal Bureau of Prisons and the District of Columbia prison, about their facilities’ ORT prescribing policies and referral programs for inmates leaving prison. They received a total of 51 of 52 responses.

Although it appears that methadone is offered more frequently that buprenorphine, only 28 facilities (55 percent) offer it under any circumstances, although more than half of these provide it only to pregnant women or for chronic pain management. Approximately 45 percent of facilities provided some community linkage to methadone treatment post-release. Meanwhile, only seven prison systems (14 percent) offer buprenorphine in some circumstances, while 15 facilities (29 percent) offer referrals for some inmates to community buprenorphine providers upon release.

When asked why these treatments are not available in their prison system, the majority of facilities said they prefer drug-free detoxification over ORT. A number of prison systems also cited security concerns about providing methadone and buprenorphine to inmates. Interestingly, 27 percent of medical directors said they did not know how beneficial methadone is for treating inmates with opiate addiction, while half were unaware of the benefits of buprenorphine.

“In spite of overwhelming scientific evidence demonstrating that pharmacological treatment for addiction has greater health and social benefits than abstinence-only policies, many prison directors are philosophically opposed to treating substance use. Most prisons also do not provide referrals for substance use treatment for prisoners upon release,” said Nunn.

“These trends contribute to high reincarceration rates and have detrimental impacts on community health. Our interviews with prison medical directors suggest that changing these policies may require an enormous cultural shift within correctional systems.”