Thursday, February 25, 2010

Making the Case for More Detox Beds

The Northern Echo (UK)

“Massive” shortfall in the number of detox beds available says the private Huntercombe Group's Mick Davies
THERE is still a “massive” shortfall in the number of detox beds available to treat alcoholics in the region, it was claimed last night.

Speaking on the eve of a conference in Durham City about facilities for problem drinkers, Mick Davies, addiction services manager with the private Huntercombe Group, said despite the high demand and extra NHS investment there was still a “massive under-capacity of provision” in terms of inpatient detox beds in the region.

This was despite a report last year that found detox facilities in the North-East have improved in recent years, taking the region from the worst in England to being above average.

Mr Davies, whose organisation runs a 14-bed detox clinic in Sunderland, said despite increasing numbers of people in the region needing treatment, there was still no Government directive to ensure that local health authorities invested in more detox facilities.

While some parts of the North-East are investing heavily in a range of treatment, including detox beds, this is not matched in other parts of the region, he added.

“It varies much more than in drug treatments, yet detox programs are the frontline treatment for people with the most serious alcohol problems,” he said.

Mr Davies said detox was a highly effective treatment that works in most cases and which can be carried out for less than £1,000 per head.

He said there was evidence that some people who would benefit from treatment died on waiting lists before getting treatment.

Kevan Martin, a former alcoholic who set up the North East Regional Alcohol Forum to support problem drinkers trying to give up, praised NHS South of Tyne and Wear for investing £5.6m in alcohol treatment programs, contrasting this with a lack of investment in the rest of the region.

“They have put their money where their mouth is. We would like to see other PCTs in the North-East do the same,” he added.

Today’s conference, which is partly sponsored by NHS South of Tyne and Wear, is called Alcohol Detox: Opening the Door to the Treatment Journey.

Tuesday, February 16, 2010

Hard Fight to Kick Heroin Behind Bars

Seattle Post-Intelligencer

LONGVIEW, Wash. -- On Dec. 22, police came to Drew Waldo's Kelso home, arrested him on a warrant, and took him to jail. Waldo, who had used heroin just before his arrest, rode the high through the night, laying on a mattress on the floor of a medical ward cell occupied by six other inmates.

By 6 a.m., he was sweating, waves of hot and then cold washing over him. An hour later, he was crawling across the concrete floor to throw up in a metal toilet in the corner.

"Your body aches. Your bones hurt," Waldo said. "You feel like your legs are growing like you're having growing pains."

He recalls thinking: "I wish I was dead."

The resurgence of heroin addiction has brought an increasing number of detoxing inmates like Waldo into the Cowlitz County Jail's medical unit. The jail books between eight and 12 inmates each week who will become severely ill as they quit heroin and sometimes alcohol the drugs that create the most complications when people stop using them.

The problem has consequences for the jail and society: Withdrawal can spark arguments and fights as jittery withdrawing prisoners stink up cells with vomit and feces and pace through he night. Detoxing inmates sometimes refuse to go to court because they feel too sick to move. Some smuggle in drugs in an effort to avoid the pain altogether. And a few offenders overdose shortly after their release because they are no longer used to high heroin doses.

The jail also regularly admits inmates who are high on methamphetamine, corrections officials said. But in most cases those offenders merely sleep for several days. Heroin and alcohol detoxers are the most tricky, according to jail staff. Their muscles cramp. They sweat. They vomit. They have diarrhea over several days.

"It's just nasty," Marin Fox Hight, the director of the county's Department of Corrections, said of watching an inmate come off heroin.

Withdrawal is the creeping, sinking sensation a heroin addict fights like mad to keep at bay. Break the car window to get the wallet to get the money to score the heroin to stop the withdrawal. Slip the DVDs under your coat and walk out of the store to trade them for heroin to stop the withdrawal. And on it goes.

Invariably they get caught, and they end up facing the thing they hoped at all costs to avoid - this time in a loud, concrete cell with a single toilet, no privacy and no hope of stopping it.

"Jail's the only place I've ever been able to stop using. You know you can't get it." said Kevin Kennedy, 27, of Longview, who detoxed in the lockup last month after being arrested on suspicion of prowling cars and using stolen credit cards to buy thousands of dollars in electronics.

The jail's medical unit can provide detoxing inmates with array of prescription drugs Methcarbamol (a muscle relaxant), Bentyl (for relieving spasms in the digestive system), and Promethazine (to control itching and relieve nausea.) But really, Fox Hight said, there's little the jail's small medical staff can do. The detox simply needs to run its course.

Kennedy, who spent about a week coming off heroin following his arrest, said he avoided the jail's medical unit, which is staffed by a nurse and provides liquids and mild medications to help with muscle cramping and nausea.

"It really doesn't do anything for you," he said.

Instead, Kennedy chose to detox among the jail's general population, where sympathetic inmates who have been through the same thing might help. For the first three days, he said, he couldn't eat, so he gave away his meals. In exchange, inmates provided candy - which detoxers crave to replenish blood sugar. They also shared their coffee, which "is a big thing if you're coming off heroin," he said.

When he was released more than two weeks later, Kennedy said, "I still wanted to use. I wanted to use more than anything in the world."

Kennedy is expected to appear in court on the prowling and theft charges later this month.

"A lot of them are pretty needy," said Maureen Clement, 52, of Kelso, who has worked as a corrections officer at the jail for two decades. "It's sad. They really suffer a lot. The crazy thing is they keep coming back on the same thing."

Some inmates, she said, die of overdoses shortly after they're released, probably because their bodies are no longer accustomed to the high doses of heroin they were taking before incarceration. Others, Clement said, smuggle drugs in to avoid the pain of withdrawal. Corrections officers, she said, sometimes find drugs stuffed into inmates' orifices.

Asked how much heroin and other drugs are being smuggled into the jail, she said, "We have no idea. My personal opinion is there's more than we can imagine."

Detoxing inmates that have been allowed into the jail's general population are sometimes moved into the medical unit because other inmates complain. Clement recalled a woman coming off heroin who lost control of her bowels in the shower. The other inmates "got real angry and made sure that we got her out of there," Clement said.

Offenders in the general population "don't want someone in there that's real sick because it smells and they're locked in there with them," she said.

Waldo, who detoxed in the jail last month, said cell mates become angry quickly as sleepless, detoxing inmates pace through the night and repeatedly get sick.

"People get pissed off. Arguments it leads up to fights. You're still throwing up and everybody's getting mad at you," said Waldo, who said he's been clean for nearly two months after using heroin for seven years.

Alcohol detox is almost as hard as for heroin, jail staff said. Take the example of Colby Harris, who was arrested after witnesses reported seeing him naked, covered with blood and feces and stealing neighbors' mail, as well as a checkbook and car stereo faceplate in September of 2008.

"I was just blacked out on drugs and alcohol," Harris said. "I don't remember walking around naked with crap all over me, but I can't deny it either."

He said he was so drunk police had him checked out at St. John Medical Center before he was booked into the jail. In the medical ward, he said, his blood pressure spiked. He thought he'd have a heart attack.

"It was horrible. Absolutely horrible," said Harris, who is 39 and drank and used meth until just more than a year ago. "Nightmares. Sweats. It's indescribable. I can't tell you how bad it is. ... You can't stay still and you can't stay warm. They give you a blanket and the mattresses in there are just like a sheet. They're all worn and flattened down."

Harris, who used to work on fish and crab boats in Alaska and now studies journalism at Lower Columbia College, said time lost all meaning as he was "stuck in a concrete box with no clock."

Corrections officers said they check on detoxing inmates about once each hour, depending on how sick they are. But Harris said he wondered if anyone would be there to help him if his body failed.

"Sheer loneliness," he said. "You go through a lot of mental anguish. It's a part of the process. It can last three or nine days. Horrible nightmares. Depression. Vomiting. Nausea. Cold sweats. Heart palpitations. Fear. And then on top of that being confined."

When Harris got out he enrolled in the county's Drug Court program. He said he relapsed on New Year's Eve 2008, then, still drunk, turned himself in five days later. He had to detox in the jail all over again.

"By the third day I was on my knees praying: This is enough for me, God,'" he said.

Wednesday, February 10, 2010

Foot Pads: a Sticky Issue

The Wall Street Journal

Just put a white adhesive pad on your foot and go to sleep. And overnight, the detoxification foot pads soak up toxins from your body and purify it, resulting in myriad health benefits, according to companies that sell the pads. Scientists say there is no credible evidence the pads are effective, and the Federal Trade Commission has charged one company with deceptive advertising.

Detoxification foot pads, sold by a variety of companies under many brand names, typically contain vinegar, a ground-up gem called tourmaline and often a mix of plant and herbal substances. Cost varies, ranging from about $15 for a packet of 14 to high-end pads costing $5 each.

Typically, sellers claim the pads give off infrared energy, which improves circulation and stimulates release of toxins from the body. Several marketers show pictures of dark, blackened pads after a night's use, claiming this is evidence that impurities were removed.

A test of three pads for this article, however, found all turned black or grey as soon as they were placed under running water. One pad, worn overnight, did darken—but was identical in color to a pad stuck on leftover Chinese food and left at room temperature overnight. Two pads attached overnight to a countertop and an apple remained white.

Natural Standard Research Collaboration, a Cambridge, Mass., scientist-owned group that evaluates natural therapies, reviewed the scientific evidence for detoxification foot pads for this article. The group concluded there is a "lack of reliable data" on the pads.

"The bottom line is there is not high-quality scientific evidence supporting its use," says Catherine Ulbricht, co-founder of Natural Standard and senior attending pharmacist at Massachusetts General Hospital in Boston. Risks include possible skin irritation from the adhesive or allergic reactions to one or more of the ingredients, she adds.

Several companies claim the source of the infrared radiation—and some of the health benefits—is the tourmaline. While all materials emit infrared, or heat, energy, tourmaline isn't known to do so any more than anything else, says Darrell Henry, a professor of geology and geophysics at Louisiana State University in Baton Rouge, La. He says he isn't aware of any "legitimate research" that shows any health benefits for the gem.

Early last year, the FTC charged Xacta 3000 Inc., of Lakewood, N.J., with deceptive marketing of Kinoki-brand detox foot pads. In its response to the pending suit, filed in U.S. District Court in New Jersey, Xacta said it hadn't done anything unlawful. A pending class-action suit by purchasers, filed in the same court, seeks monetary damages from Xacta and another distributor for alleged fraudulent marketing of the product. A lawyer for Xacta, which filed for Chapter 7 bankruptcy in January, didn't return calls seeking comment.

Other marketers of foot pads say the Kinoki pad has given them a bad name, and at least two have done at least small studies that purport to show their own products work. The Wall Street Journal's search found no large, well-controlled trials on foot-detoxification pads published in any major scientific publication.

Japan's Kenrico Ltd., which sells pads world-wide, says it uses high-quality ingredients not used by some U.S. makers. Kenrico posts several human studies on its Web site, which it says were done by an independent Japanese lab, including two that show reduction in toxins such as lead, mercury, aluminum and arsenic as measured by a hair analysis after three months' use. However studies are small. Kenrico also says data on its pads have been published in a medical journal, but the company declined to provide a copy.

Monday, February 1, 2010

Volunteers Canvass East Boston to Fight Drug Abuse

The Boston Globe

Information packets hung from doorknobs of three-deckers up and down Saratoga Street in East Boston as volunteers canvassed the neighborhood yesterday, knocking on some 8,000 doors to distribute substance abuse information and ask residents about the health of their community.

Dr. Barbara Ferrer, director of the Boston Public Health Commission, said the undertaking was the largest single-day campaign to get public health information from any neighborhood in Boston. Mayor Thomas M.
Menino’s office teamed with the public health department to launch the effort after the arrest last month of John M. Forbes, Menino’s East Boston liaison, on charges of dealing prescription painkillers.

“The mayor’s committed to making sure out of this comes real problem-solving and real solutions,’’ Ferrer said.

The information on the hundreds of completed surveys will be compiled and presented at a city-organized community summit in two weeks. The quick turnaround will provide residents with up-to-date information for dealing with substance-abuse issues - the most recent data the BPHC has is from 2007, Ferrer said.

“This is not a one-time thing,’’ she said. “We’re here today to start learning.’’

Bundled up against temperatures in the teens, volunteers Rita Nieves and Haidy Pena worked their way up Faywood Avenue in Orient Heights. They stopped at each house and apartment, taking notes on residents’ concerns. Though the survey was initially designed to cover drug abuse, the volunteers noted everything from trash pickup to flu vaccinations to potholes.

Pena, who lives in Mattapan, said she came out because she wanted to help people struggling with drug problems, no matter where they live.

“If we can do anything to help, give information, save one life, it makes me feel better,’’ Pena said.

East Boston resident Abdel El-Andelesy talked with volunteers outside a coffee shop on Bennington Street. He said he knows the city has resources to help addicts, but the people he sees doing drugs don’t care.

“If we leave these kids taking drugs, it will not go away,’’ he said.

Andelesy, who has two young children, said surveys like this one open up a conversation so the whole community can deal with the issues it faces. “With this, you get my opinion and you get everyone’s opinion so we can talk about it,’’ he said.

Ferrer said face-to-face interaction builds trust and strengthens the community, helping aid the effort to curb drug use through substance abuse treatment.

“It tells people how much we care,’’ she said. “That’s a powerful message, not only for people with substance abuse problems but for people who want to know that we’re here to help.’’