By Bruce Hershfield, MD
[Winter 2006; Vol. 32, No. 2; Pg 4]
On October 1, 2005, more than 125 MPS members (and others) attended the showing of Stephen J. Szklarski’s documentary, “Union Square”, at Goucher College in Towson. Afterwards, Eric C. Strain, MD of Johns Hopkins updated the audience about the prevalence, diagnosis, and treatment of heroin addiction and then he, Richard Prodey (a drug and alcohol counselor) and Mr. Szklarski answered questions.
The film, which is about seven homeless people with heroin addiction who live in Union Square Park in New York, is divided into 12 chapters (“family”, “compulsion”, detox”, etc.). Mr. Szklarski told the audience what has happened to these people since he filmed them several years ago. It was clear from their comments that the audience members had become interested in the characters by that point in the morning and that they hoped that these people had been able to overcome their problems.
Dr. Strain
began by pointing out that drug abuse is “a form of enslavement...governed by
internal and external factors...tough but not impossible to treat”. He
described the difference between “physical dependence” and “pathological
use” and said that the defining feature of the dependence syndrome is the
inability to control use. Treatment, which can be highly effective, works
best when the addict is ready for it, he commented. Self-help programs
have been “an important and valuable resource,” he said, but counseling,
although it is useful, has not been shown to be cost-effective. Detoxification
does not work any better than assignment to a waiting list, but he believes
that it can be useful if it is closely linked to follow-up care.
Methadone, which is very effective–-more so if combined with
non-pharmacological treatment–-is only available through a clinic system.
He then went on to describe the proper use of buprenorphine (combined with
naloxone, to decrease the possibility it will be misused), noting that at least
40,000 patients are taking it (compared to 200,000-250,000 on methadone).
Discussion topics included the comorbidity of unipolar depression with heroin
addiction, the cost of methadone maintenance (about $70-80 per week, including
counseling), and the need for a spectrum of services that includes case
managers and halfway houses. Mr. Szklarski said that he thought that he
had failed when he had finished the six months of filming, but now he realizes
that the movie has been successful as an educational tool.
Every town
has a “little Union Square”, he commented.
His use of the camera, which enabled us to briefly enter the tragic lives of the heroin-addicted homeless, combined with Dr. Strain’s thoughtful summary of what we know about addiction, made for a moving and educational morning.