6 April 2011

Letter from New York ...

Dear Colleagues,

I have had the privilege of spending time in Manhattan meeting up with colleagues, mostly of like minds, on issues of mutual interest.

At the same time, Americans are often also interested in the drug situation in Australia including related viral diseases, public health and the various studies being reported. Of course I was most interested in innovations here in America, including the buprenorphine film/wafer which has been mooted by the manufacturer for quite some years to overcome some of the problems with their SL tablets. See http://www.attorneygeneral.gov/press.aspx?id=6035 It is about ten dollars cheaper than the tablets according to a pharmacist I interviewed here which may account for its popularity currently. It also has some disadvantages it would appear.

Other highlights: ‘MOTHER’ study presentation: http://methadone-research.blogspot.com/2011/04/mother-study-was-really-looking-babies.html This issue became a front page New York Times item last Sunday (links on request).

I visited the Drug Policy Alliance where there is a team of dedicated workers intent on improving harm reduction services in the United States and beyond. They are always keen to hear of progress in Australia, needle programs, injecting facilities, etcetera. Several of their workers have been to the Beirut Harm Reduction Conference earlier this month where they met up with numerous Australians.

Across the road in West 36th Street I met up with Lynn Paltrow at the National Advocates for Pregnant Women. We heard of tragic cases of ignorance in certain states where women on methadone were charged with ‘supplying a drug to a minor’ and being separated from their children as a result. While we all appreciate the great advances undertaken in the United States but it is also clear that there is a Neanderthal side to their approach to drugs and drug use (see warnings on every bottle of alcohol sold in the US but note there is no alcohol percentage noted, even on Fosters!). Their system just seems rigid and less flexible than in other places like Australia.

Grand Rounds at Bellevue Hospital had an interesting presentation on the use of peer mentors for alcohol and drug affected patients. Dr Kathlene Tracy had done two studies, one in the Veterans Administration and one at NYU, looking at attendances for appointments before and after engagement of a mentor (who had been carefully chosen and vetted as being at least 6 months ‘clean’. This ‘buddy’ engagement improved compliance substantially at very modest cost and deserves closer examination, especially for severely disrupted patients with no homes, telephones or other means of support. The staff members at Bellevue were most obliging and invited me to lunch where we had on-going discussions led by Dr Marc Galanter who is their senior D&A specialist.

I give Journal Club at Rockefeller University (Kreek Labs) on Tuesday before returning home for Easter and my father’s birthday on Lord Howe Island (he is 84!).

There is a meeting with the newly formed users’ group here which is lobbying for better access to treatment for hepatitis C. At present the only ‘mandated’ intervention is an antibody test at entry to methadone treatment. For buprenorphine even that can be overlooked.
Best wishes from Manhattan.

Andrew Byrne ..