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Spain's opiate addicts to be given another choice
Leprosy patients demand compensation for former isolation policies
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emands for compensation for mistrea tment under the Japanese gov ernment’ s compulsory leprosy isola tion-polic y increased when 83 people who had leprosy joined a ¥14·7 billion (US$123 million) lawsuit on March 29. The suit, orig inally launched by 13 leprosarium residents in July, 1 9 9 8 , at the Kumamoto distr ict cour t in south Japan (see Lancet 1 9 9 9 ; 3 5 2 : 631) accuses the gov ernment of violating their constitutional rights by seg rega ting people with leprosy from society long after the discov er y of an effective treatment for the disease. The la test addition to the case brings the number of plaintiffs to 128, with each seeking ¥115 millioncompensation. In Japan, tens of thousands of people with leprosy were incarcerated in remote leprosariums under the 1953 Leprosy Prevention Law. Pregnant women were forced to have abortions and men had to
have vasectomies before they w ere allo wed to marry. Similar policies were abolished in most other countries during the 1950s and 1960s after dapsone became widely av ail able to treat leprosy and when studies sho wed that the disease was rarely contagious . However , Japan did not revoke its Leprosy Prev ention Law until 1996. The gov ernment has apologised to the residents of the country’ s 15 leprosar iums, but stopped short of accepting legal responsibility for the isolation policy, saying it was justified at the time. “By refusing to own up fully to its mistake, the gov ernment’ s ambiguous stance has allow ed social prejudice against leprosy sufferer s to sur vive”, said the
Spain’s opiate addicts to be given another choice he Spanish Ministry of Health approved dispensation of levo-␣acetyl-methadol (LAAM) to opioid addicts as a therapeutic alternative to methadone on March 30. This decision comes after encouraging results from a 3-month pilot study by the National Commission of Agonists (NCA) in 224 opioid addicts from 13 autonomous communities. NCA president, Guillermo Guigou said “LAAM offers some clear advantages over methadone”, namely: “higher comfort levels since patients have to go to the dispensing centres only two or three times a week and not on a daily basis; fewer physical withdrawal symptoms; fewer desires for consuming opioids; and a lack of significant side effects.” “LAAM treatment shows an 80% efficacy thus, it is fairly feasible that methadone-treated patients switch to LAAM”, added Guigou. The disadvantages of LAAM include contraindication during pregnancy and in patients with severe liver abnormalities, such as liver cirrhosis or chronic viral hepatitis. LAAM is also very expensive: it is estimated that 500 mL of LAAM costs US$330–500, about US$2 per dose. During the XVI Jo rn a d a s Nacionales Socidrogalcohol, a
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national symposium on drugs, alcohol, and society (Canary Islands, Spain; March 29–30) Walter Ling, from the University of California (Los Angeles, USA) emphasised the importance of LAAM.As a therapeutic alternative,LAAM gives patients a greater chance of social integration and offers an improved quality of life to the addicts and their families, he said Ling explained that once given, each LAAM dose is metabolised into two compounds, one of them having a potency six-fold greater than methadone. LAAM, a long-lasting -opioid agonist which blocks the effects of other opiates and prevents withdrawal, has effects which last 48–72 hours. The longer efficacy means the addict can undergo a quicker rehabilitation by being able to spend more time on activities,such as occupational workshops and psychotherapy classes. The Ministry of Health is providing training courses from May to raise awareness of LAAM amongst 500 health-care professionals who care for drug addicts. C u rr e n t l y about 58 000 people are receiving opiate-replacement treatment with methadone in Spain.
plaintiff ’s la wyer, Yahiro Mitsuhide. The 5000 or so remaining leprosar ium residents, having spent more than half their lives in leprosariums, have found it difficult to readjust to the outside world. Hajima Kagata, aged 78 y ear s and now president of the leprosar ium patient associa tion, spent half a century in a leprosarium on Nagashima island after his doctor tur ned him over to secret police in prewar times. Meanwhile, 21 people who had leprosy launched a separate la wsuit in Tokyo on March 29, accusing the government of negligence by f ailing to help them resume normal liv es. Jonathan Wat t s
News in Brief Investigation into “price fixing” The Competition Authority (CA) in Ireland is investigating price fixing involving insurance companies and agreements for the reimbursement of consultants’ fees. The Irish Hospital Consultants Association (IHCA) has been in negotiation with the Irish Insurance Federation and the country’s two main private health-insurers, VHI and BUPA, for 8 months on new professional fees and their reimbursement schedules. Those negotiations were suspended after officials from the CA visited the ICHA to examine files relating to the negotiations with the insurance bodies. Polio vaccination schedule The vaccination schedule for poliomyelitis has been amended, announced the Italian Ministry of Health on March 17.The first two doses of Sabin attenuated oralpoliovirus vaccine (OPV) given to children between 2–4 months of age will be replaced by two doses of (intramuscular) Salk inactivatedpoliovirus vaccine.These will be followed, as previously, by two doses of OPV at 15–18 months and at 4–6 years of age.
X avier Bosch
THELANCET • Vol 353 • April 10,1999
D
emands for compensation for mistrea tment under the Japanese gov ernment’ s compulsory leprosy isola tion-polic y increased when 83 people who had leprosy joined a ¥14·7 billion (US$123 million) lawsuit on March 29. The suit, orig inally launched by 13 leprosarium residents in July, 1 9 9 8 , at the Kumamoto distr ict cour t in south Japan (see Lancet 1 9 9 9 ; 3 5 2 : 631) accuses the gov ernment of violating their constitutional rights by seg rega ting people with leprosy from society long after the discov er y of an effective treatment for the disease. The la test addition to the case brings the number of plaintiffs to 128, with each seeking ¥115 millioncompensation. In Japan, tens of thousands of people with leprosy were incarcerated in remote leprosariums under the 1953 Leprosy Prevention Law. Pregnant women were forced to have abortions and men had to
have vasectomies before they w ere allo wed to marry. Similar policies were abolished in most other countries during the 1950s and 1960s after dapsone became widely av ail able to treat leprosy and when studies sho wed that the disease was rarely contagious . However , Japan did not revoke its Leprosy Prev ention Law until 1996. The gov ernment has apologised to the residents of the country’ s 15 leprosar iums, but stopped short of accepting legal responsibility for the isolation policy, saying it was justified at the time. “By refusing to own up fully to its mistake, the gov ernment’ s ambiguous stance has allow ed social prejudice against leprosy sufferer s to sur vive”, said the
Spain’s opiate addicts to be given another choice he Spanish Ministry of Health approved dispensation of levo-␣acetyl-methadol (LAAM) to opioid addicts as a therapeutic alternative to methadone on March 30. This decision comes after encouraging results from a 3-month pilot study by the National Commission of Agonists (NCA) in 224 opioid addicts from 13 autonomous communities. NCA president, Guillermo Guigou said “LAAM offers some clear advantages over methadone”, namely: “higher comfort levels since patients have to go to the dispensing centres only two or three times a week and not on a daily basis; fewer physical withdrawal symptoms; fewer desires for consuming opioids; and a lack of significant side effects.” “LAAM treatment shows an 80% efficacy thus, it is fairly feasible that methadone-treated patients switch to LAAM”, added Guigou. The disadvantages of LAAM include contraindication during pregnancy and in patients with severe liver abnormalities, such as liver cirrhosis or chronic viral hepatitis. LAAM is also very expensive: it is estimated that 500 mL of LAAM costs US$330–500, about US$2 per dose. During the XVI Jo rn a d a s Nacionales Socidrogalcohol, a
T
1252
national symposium on drugs, alcohol, and society (Canary Islands, Spain; March 29–30) Walter Ling, from the University of California (Los Angeles, USA) emphasised the importance of LAAM.As a therapeutic alternative,LAAM gives patients a greater chance of social integration and offers an improved quality of life to the addicts and their families, he said Ling explained that once given, each LAAM dose is metabolised into two compounds, one of them having a potency six-fold greater than methadone. LAAM, a long-lasting -opioid agonist which blocks the effects of other opiates and prevents withdrawal, has effects which last 48–72 hours. The longer efficacy means the addict can undergo a quicker rehabilitation by being able to spend more time on activities,such as occupational workshops and psychotherapy classes. The Ministry of Health is providing training courses from May to raise awareness of LAAM amongst 500 health-care professionals who care for drug addicts. C u rr e n t l y about 58 000 people are receiving opiate-replacement treatment with methadone in Spain.
plaintiff ’s la wyer, Yahiro Mitsuhide. The 5000 or so remaining leprosar ium residents, having spent more than half their lives in leprosariums, have found it difficult to readjust to the outside world. Hajima Kagata, aged 78 y ear s and now president of the leprosar ium patient associa tion, spent half a century in a leprosarium on Nagashima island after his doctor tur ned him over to secret police in prewar times. Meanwhile, 21 people who had leprosy launched a separate la wsuit in Tokyo on March 29, accusing the government of negligence by f ailing to help them resume normal liv es. Jonathan Wat t s
News in Brief Investigation into “price fixing” The Competition Authority (CA) in Ireland is investigating price fixing involving insurance companies and agreements for the reimbursement of consultants’ fees. The Irish Hospital Consultants Association (IHCA) has been in negotiation with the Irish Insurance Federation and the country’s two main private health-insurers, VHI and BUPA, for 8 months on new professional fees and their reimbursement schedules. Those negotiations were suspended after officials from the CA visited the ICHA to examine files relating to the negotiations with the insurance bodies. Polio vaccination schedule The vaccination schedule for poliomyelitis has been amended, announced the Italian Ministry of Health on March 17.The first two doses of Sabin attenuated oralpoliovirus vaccine (OPV) given to children between 2–4 months of age will be replaced by two doses of (intramuscular) Salk inactivatedpoliovirus vaccine.These will be followed, as previously, by two doses of OPV at 15–18 months and at 4–6 years of age.
X avier Bosch
THELANCET • Vol 353 • April 10,1999