Europad 7 Radisson SAS Carlton Bratislava Slovakia Conference Report
Icro Maremmani, MD - President of Europad Matteo Pacini, MD - President of Europad-Italia
The 7th Europad Meeting took place, as scheduled, from October 6th to October 9th in Bratislava. The choice of Eastern Europe for this year's meeting was made along two main reasons. First, it was a way to testify and stress the contribution provided by Eastern Europe researchers and clinicians in the consolidation and expansion of the body of knowledge about addiction and related clinical problems. Second, this meeting symbolized the will and the hope that a scientific "soul" leads the practice and policies of Eastern countries in the field of drug addiction, and that Eastern Governments increase decisional weight of scientific boards in drug-related law-making, in order to grant their population with increasing standards of safety and health. We might say that Europad proposes itself as a watchtower to control the uniformity and consistency of approaches to addictive diseases in European countries.
	The importance of reaching all categories of addicted patients was underlined in different workshops, each dealing with a special setting or diagnostic category. Moreover, different speakers recalled the major effect of addiction treatment in increasing the therapeutic potential of other somatic treatments, such as those for HCV and HIV. Prevention campaigns and therapeutic appeals should always be tailored on the patients' behavioural trends in order to be actually accessible and thereby effective. Hence, since addicts are typically unreachable and lack compliance to any form of structured relationship, the enrolment into maintenance programs is crucial to empower health campaigns. Methadone and buprenorphine programs are also artificial means to create those "prevention prone addicts" which are so unlikely to be found in nature.
The global focus of the event was rather medical, so that the interest in psychosocial and psychological aspects was eventually empowered, rather than diminished, along out view that a medical-centred perspective of addictive diseases is the best viewpoint to for any field of practice (medical and non medical) to be meaningful and stimulating. As Dr. Gerra from Italy pointed out, we have never been closer to a medical approach, and the scientific level of reports is now similar to what one can witness in a congress of any other medical issue, differently from what used to be just two decades ago. Further research and clarification about methadone and buprenorphine safety were presented, in order to help clinicians to manage and prevent side effects, with special regard to cardiologic risks, endocrine normalization and cognitive functioning.
	As time goes by, experiences with the newer agent buprenorphine are becoming of longer-term, and allow clinicians to improve their capability to select patients for buprenorphine programs with a long-term perspective of achievable results. False myths about abuse liability and difficulty of transition were thus clarified, and improper switching from other successful programs was indicated as one of the causes of confounding negative results in local experiences with buprenorphine.
Polysubstance abuse was discussed both on epidemiological and pathophysiological grounds. Observations from German researchers about the use of dyhydrocodeine in the treatment of alcohol abusing former heroin addicts widened the perspectives for future research about the relationship between alcoholism and the opioid system, at least as far as heroin addicts are concerned, and added to previous suggestions about the possibility to use opioid agonists in the treatment of alcohol addiction.
	In the trail of studies about dual diagnosed addicts, primary psychotropic properties of methadone opioids were discussed by Dr. Deglon from Switzerland, and the potential of buprenorphine as a psychotropic drug was described by Dr. Maremmani from Italy. Such interventions were meant to encourage future research about opioids in mental illness and to highlight the therapeutic nature of methadone and buprenorphine as disease-modifying drugs in opposition to disease-inducing substances, for which they certainly represent no replacement.
Dr. Vincent Dole was commemorated by several speakers, and the philosophy and principles of his work were recalled and summarized by Dr. Herman Joseph. In the spirit of Dr. Dole's effort, it is our hope that the conception of the addict as an ill person with a brain metabolic disorder is always maintained as the main criterion for the measurement of treatment outcomes, and that any non-medical approach to the treatment of this brain metabolic disease is definitely left behind. With special regard to the situation of some countries of Eastern Europe, we hope that ignorance and prejudice do not pollute decision-making around addiction treatment, as it has happened both in the USA since the very beginning of the methadone era. Lastly, it is our opinion that the worst obstacle against the spreading of effective treatment is that kind of stigmatizing attitude which may come from some addiction practitioners themselves, and may be referred to as iatrogenic stigma. Such stigma is exactly represented by the common expression of "substitution treatment" or "replacement treatment", which is a medical term and it is bound to allow non-medical minds to develop the misbelief of methadone treatment as harm reduction or a legal administration of toxic narcotics in a therapy's disguise, and regard patients as maintained addicts. We remind that Dr. Dole never spoke about "substitution treatment" and that, in his experience, methadone was a behaviour-normalizing drug which would re-balance the endogenous opioid system persistently damaged by toxic narcotics, when administered as maintenance regimen.
Bratislava, October 8, 2006