Latest developments in effective medical
treatments for addiction.
The 3rd Berlin Stapleford International Addiction Conference.
Berlin. Weekend of March 18-20 th 2006.
Endorsed by: The University of Nijmegen , The Free University ofBrussels, The German Society of Addiction Medicine and ISAM – the International Society of Addiction Medicine.
Venue: Hotel Excelsior, Hardenbergstrasse. 14, 10623 Berlin.
Information, print-and-fax registration form, abstract
submissions etc at: http://www.stapleford-berlin2006.de
Registration: €500 before 30 Jan. €600 after.
MAIN ISSUES AND CONFIRMED SPEAKERS.
Anaesthesia vs light sedation in ROD/RAI (Rapid Opiate Detoxification /Rapid Antagonist Induction)
H Kleber, New York;
Cor de Jong, Nijmegen;
Catherine de Jong, Amsterdam;
J Currie, P Cox, Sydney;
G O’Neil, Perth;
N Maksoud, Cairo;
Update on naltrexone implants and depot injections in alcoholism and opiate dependence.
H. Kleber, New York;
G. Hulse, G O’Neill, Perth;
A Startosa (for Dr J Volpicelli) Philadelphia;
L Partecke, Berlin;
Clinical experience with rapid benzodiazepine detoxification using flumazenil.
G. O’Neill, Perth ;
Alternatives to methadone for opioid maintenance - depot buprenorphine (Probuphine) slow-release morphine.
G Fischer, Vienna . (Morphine) Probuphine speaker to be confirmed.
Disulfiram vs naltrexone and acamprosate in alcohol abuse.
H.Alho, Helsinki ; (possibly first presentation of the Helsinki randomised trial results.)
A de Sousa, Mumbai;
M Faiman, Kansas;
J Chick, Edinburgh;
H Ehrenreich, Gottingen;
C Brewer, London.
[Possible additional topics: Vaccines and agonist maintenance for cocaine/amphetamine dependence; Cannabis antagonists]
Presentations are invited on the above topics or closely related issues and poster facilities will be available. Abstracts should not exceed 250 words and should be received by Jan 13th for the best chance of oral presentation. Poster presentations can be considered up to March 8th. See website for sample layout and typeface.
In many clinics for abusers of alcohol, heroin and other drugs, there have been few really significant changes in treatment or outcome since the introduction of disulfiram in 1948 and methadone maintenance in 1965. In several countries, even methadone maintenance is not allowed. This situation is changing but still quite slowly and is in total contrast to the rest of medicine, where big changes and many improvements in outcome have occurred. One major reason for this contrast is that promising technologies and medications are quickly evaluated and often universally adopted in general medicine and surgery but not in addiction treatment. Especially in the US , addiction is still widely seen as a moral or ‘spiritual’ problem that requires exclusively spiritual and/or psychosocial interventions. This attitude does not co-exist easily with medical treatments. That is why, while recognising the importance of specific psychosocial interventions for many patients, the eight Stapleford conferences since 1989 have concentrated on how to get the best out of existing pharmacological interventions and on promising developments in pharmacotherapy and technology.
Even in the three years since the last conference in Nijmegen , there have been some important developments. First, the largely unfulfilled potential of oral naltrexone as a treatment for both opiate and alcohol abuse, because of poor compliance, is now being increasingly achieved by the use of implanted or depot naltrexone. The expected release of the first licensed depot preparation in mid-2006 represents real progress, albeit one for which the necessary technology had existed for decades and had been successfully used in other fields.
Secondly, it is now clear that the very low rates of successful opiate detoxification and naltrexone induction using conventional withdrawal techniques (typically 20-30% at most) can only be significantly improved at present by techniques that complete the process of withdrawal and induction within 24 hours, or at most within a few days. The argument has now shifted to the best methods for achieving this rapid transfer to naltrexone and in particular, the levels of sedation or anaesthesia that are necessary, and the risks that are acceptable, to maximise success and minimise distress, cost and dropout. In all of these areas, the leading researchers and commentators will be presenting their conclusions.
At the 1996 Stapleford conference in London , Prof Gilberto Gerra presented a paper on rapid benzodiazepine detoxification using the antagonist/inverse agonist flumazenil. This novel idea was taken up by some of those present and two Australian clinicians will be presenting data on several hundred procedures, showing that the technique is simple, effective, not distressing and apparently very safe. Certainly much safer than many people thought it could be. In conjunction with long-acting implants of flumazenil, this looks like being the next big treatment revolution in addiction.
Many people hope that the imminent release of depot naltrexone will bring about significant improvements in the effectiveness of alcoholism treatment. We hope so too, but speakers at previous Stapleford conferences have noted that the evidence-base for supervised disulfiram treatment is also strong. In 2004, the prestigious British journal ‘Addiction’ finally conceded that this was true, indicating that disulfiram has for long been undervalued or worse. Recent controlled studies have examined the relative effectiveness of supervised oral disulfiram, naltrexone and acamprosate and the latest results will be presented here. They confirm that disulfiram still has an important role in treatment.
Finally, we will discuss clinically important new techniques in a few other areas of treatment, including opiate maintenance - and possibly treatments for cocainism and surgery for resistant obesity as well. We look forward to welcoming you to the exciting and culture-rich city of Berlin and we hope you will return home after the conference feeling that addiction medicine need not remain stuck in a 1960s time-warp.
Dr Linde Partecke and Dr Colin Brewer.