Report on the 3rd EUROPAD-ITALIA Conference, held in Pietrasanta, October 27th to October 29th, 2007
The 3rd Europad-Italia Meeting took place, as scheduled, from October 27th to October 29th in its usual location. Lecturers participated from various European countries and the U.S.A. An organizational session was also called up, in order to discuss the opportunity to institute a world federation for the treatment of opioid dependence (WFTOD), to express the unity and homogeneity of positions of Europad and AATOD with regard to drug treatment policies. The intake of eastern professionals into the circuit of the Europad scientific community did thus proceed with the coalition with its Northern American equivalent, represented by its president Mark Parrino.
Photograph by Nando Melillo
In the tradition of Europad meeting, sessions about specific therapeutic topics were combined with positional lectures: in fact, advocacy and stigma were the main points of Dr. Robert Newman’s speech, who recalled the importance to make rooms for good clinical practice on cultural grounds first, in order not to waste the therapeutic potential of increasing knowledge in the field of addiction. Addiction and pregnancy and alcohol abuse were the main technical topics, matching Italian lecturers to foreign chairmen, or viceversa.
Interesting discussions took place about the presentations of eastern researchers, some of which just provided western countries with the proof of how unfunded political pressure can become an obstacle for good clinical practice to spread over the territory. Data about HIV epidemics and overdosing in countries standing as new comers into the field of addiction treatment are useful to remind everyone how strong is the need of worldwide standard practice.
Photograph by Nando Melillo
On the other hand, the importance of a patient-based clinical practice was also highlighted by Dr.Ulmer, from Stuttgart, Germany, who presented his case-reports and life-charts of alcoholics and heroin addicts treated by therapeutic opiates, especially dihydrocodeine. A sharp and clear message was given that any private practitioner may deal with a certain part of drug addicts, as long as working in the perspective of treating the patient for a disease, and not simply judging upon their behaviour or giving meaningless behavioural advice. Also, while illustrating to us a new therapeutic approach as that by dihydrocodeine, Dr.Ulmer stressed the concept of chronic-relapsing disorder as the main reason why patients deserve treatment, and why retention is not just a consequence of clinical improvement, but needs the gradual development of insight of the patients’ side, and sound knowledge on the physicians’. Unfortunately, the idea that no treatment is “enough” itself regardless of clinical response is not so rooted in a subgroup of practitioners, who still suspect of the patient’s motivation unless abstinence is easily achieved and maintained. Omitting automatical therapeutical moves, as dose-increase, or following a healing perspective were correctly labelled as physicians’ limitations, brought on by faulty expectations.
Photograph by Nando Melillo
Harm reduction was represented by the Italian Red Cross, running street unit activities in Rome suburban areas, aimed at the prevention of needle-exchange and overdoses. The common ground between the high-threshold approach of “waiting for the patient” and the harm reduction of “looking for the patient” was eventually discussed. In fact, like in the Italian Red Cross’s “multilevel” project, harm reduction is the first step to increase the likelihood for the street patient to enter a rehabilitative program of increasing responsibility. Such a model is an example of treatment-oriented harm reduction, which sharply differs from the wild harm reduction policies who eat room away to the detriment of rehabilitative perspectives.
The horizontal differentiation of treatment was also discussed upon, in order to clarify at which stage treatment may be personalized, and which requirements render patients able to benefit from personalized treatment options. The misleading first-line personalization of treatment was opposed to by the alternative approach of personalization as a late-stage, higher threshold goal of treatments, supported by the maintenance phase of standard, disease-centred treatment modalities.