http://exhibits.library.stonybrook.edu/mfp/files/original/dbeb0b9c5c9765c06e93fd9414f9a1bb.pdf 06e792d2b0c743534d8bfbe87d82e7e0 PDF Text Text August 9. 19Y2 Mrs. Roberte London Contemporary Drug Problems 515 Oxford Street Wentbury, flew York 11590 Dear'fira. London: The suggestions by Sennela, Hoehetetter. end the mittee (Contamporery Drug Problems) Lari? Con- for e heroin delivery experimflnt are well motivated, but they do not consider the severe practical problems posed by the suggestions. In selecting heroin. they select the drug with greatest risk (high lethality for dose), shortest do» ration (requiring moat repeated administrations) and least stability. They propose an experimental patients who have delivery in failed other treatment programx. livery is to provide all patients trial for heroin 100 to 200 The heroin de~ a method of engagement, and within the year, are to be admitted to other treatment programs, partic« ularly narcotic antesoniets, methedone, or drug-free. The principel benefits of the program will be the incorporetion of a small additional group of addicts into a prevailing treat~ meat regiment (which, presumably, they bed once before as a vague test of the British experience. rejected); and �.hm. uoberta London August 9, 1972 base proponents cannot be homework, for moving done for besides the questions that are raised moral, legal, and from the commended historical grounds, I would raise practical Ipharmccological) point of View. on their social, ethicnl, some questions Heroin, morphine, methadone, and levouethadyl represent feur compounds (Opioidsl they are most similar in on a continuum: their patterns of physiologic and behavioral effects it man and animals. They exuibit patterns of crosantolerence, for each can substitute for the other, and each achieve cos may be given by any bodily raute and still effects. Their principal difference lies in their dura- tion of action, with ueroin'e effects lasting the Shortest, usually from 3 to 6 hours, and levomethadyl the longest, from 36 to 48 flours. duration is important in selecting appropriate dosages, for with short acting compounds, physicians have the most difficulty in for their patients. Thus, in see stabilizing rue effecto they wish looting heroin. the authors opt for the most difficult and most ex‘ pensive delivery system. we and from it is have had extensive experience with heroin that experience and pleasant bodily effects. and unusual changes in recall it's other problems for heroin: We propenoity to produce a variety of unhave observed seizures (convulsions), heart rate, respiration. sufficient irregularity as to lead patients with caution. two stability, requiring careful handling for a compound of low sustained efficacy; can administration, us and senaorium with to administer heroin in our �Hrs. Roberto London prevailing A Anguet‘S, 1972 View of drug dependence emphasizes the signifi‘ cance of conditioning and learning theory an the basis for etiology and as a key to the alleviation of the In suggesting e here syndrome. i oin delivery system, the author! disregard this one method of cipel advantages of this paradigm have merit. methadone has been its However, should the authors wish repeated injections, adone, which select the edninietretion, the repeated intravenous, that will enhance dependence, should route. View and why One of the prin~ usefulness by the oral to engage their patients by have they not recommended intravenous meth- is achieving some vogue now in Brithin, and has the ad— vantege of a longer duration of action and less frequent administra— tion? Granting a successful delivery system for heroin to a select group of patients, what is the anticipated gain? That these patients will be available for after—care programs, of methadone and cyclazocinel If that is the real goal, to reduce crime by buying these patients to participate in the eyeten, would it not he more to the point to more adequately finance and increase the number of treatment programs so that more The patients can be more adequately reed selected by Samuel: and Hochetettcr is one that is easy to recommend, but for potholes. treated? Should this reader. their enthusiasm for one that is full of rut: engagement not they would consider the expansion of levonethedyl1 and pale, perhaps trials es e more �mw‘ are. Roberta August 9, 1972 London logical substitute for heroin for Don and methadone; or if their enthusiasm Quixote causes can be sustained, they coy investigate the evi~ dence for the development of a long acting narcotic antagonist.2 Such a development has theoretic, therapeutic, and prophylactic possibil- ities to commend from public it, and yet is receiving the bares: of attention authorities, while much eneggy is dissipated on the pro- motion of heroin delivery. Sincerely yours, flax Fink, 3.9. Professor of Psychiatry MF:13 1. Zaks, A., H. Fink, and i. E. Freedman: Treatment of Opiate Dependence. 2. Iink, H.: Treatment giarcotic Antagonists. Levomethadyl J.A.M.£., 220: in Heinteuance 811—813, 1972. and Prevention of Opiate Dependence with Contemp. mug Ptoblema. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. 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