6 May 2008

Manhattan in April - drug matters - cherry blossoms a bonus!

Dear Colleagues,

Like the Pope I found myself in Manhattan in April. Because of the prevailing official attitude of government, funding agencies and health authorities generally, medical matters are rarely predictable in America. Yet it is always instructive to compare and contrast matters from an Australian perspective.

My first day 'on the hustings' found me at a drug policy institution learning serendipitously about 'snus', so-called Swedish 'chewing' tobacco. In fact it is not 'chewed' at all but placed in the gums as a miniature, stringless 'tea-bag' which delivers substantial amounts of nicotine without polluting the lungs with soot, carbon monoxide, tar and other pollutants. In America there appears to be no licensing system for 'snus' but it is openly sold with attached large-letter warnings: "This product is not a safe alternative to cigarettes" (this is probably incorrect); "This product may cause gum disease and tooth loss"; "This product may cause mouth cancer" (warnings which are probably reasonable, up to a point).

I was referred to a well known city tobacconist near Grand Central Station where I purchased 4 packs of different brands and flavours for about $20 total. I was told that they send mail-orders around the world, including Australia, and as long as it is for personal use this was considered 'legal'. When I asked if they also sold nicotine patches I was told: "Sir! Nicotine patches go against everything we stand for!" [web site on request] My interview with a single snus user was glowingly positive.

It is my belief that this 'snus' product should be studied urgently to see if it is a viable intervention in stemming the huge toll from tobacco. The evidence from Sweden, where about half the tobacco is consumed in this way, is apparently mostly good with far less lung cancer. However, there is a down-side which needs elucidating (an increased rate of mouth cancers and tooth decay).

Other matters dealt with on my American visit included Hep A, B and C in injectors (up to 85%), buprenorphine treatment with and without supervision, transfers between methadone and buprenorphine, cocaine trials using disulfiram (Antabuse), the elusive but much publicised cardiac complications of methadone, addictions in patients with disabilities, publishing in the internet age, amongst other things.

Comments by Andrew Byrne .. http://www.redfernclinic.com/