Europad 8 Kempinski Hotel Zografski Sofia Bulgaria Conference Report
The eighth Europad congress took place in Sofia between 29 and 31 May, as scheduled, with the participation and contribution of extra-European speakers. Collaboration between scientific communities is currently moving forward to achieve the common purpose of spreading the principles of evidence-based opiate addiction treatment. In line with the Europad tradition, special emphasis was placed on the classic issues of opiate addiction treatment, and the need to promote scientific knowledge in a way that will succeed in attracting the attention of politicians and the public. Adequate dosing and the concept of treatment as a long-term strategy to control a persistent brain disorder were widely discussed, together with the importance of a setting that is able to combine patient-centred goals with a disease-centred method.
	An entire session was dedicated to the issue of alcohol abuse in individuals using heroin; Dr. Ulmer again explained the clinical use of opioid agonists in the treatment of pure alcoholics or polyabusers, whereas data from Italy strongly suggested a link between poor treatment history for heroin addiction and a subsequent switch to alcohol abuse, possibly indicating a common vulnerability of the brain. The same issue was, to some extent, anticipated by the introductory lecture about GHB use in polyabusers, with special regard to methadone maintenance. Another session dealt with the issue of dual diagnosis, and several questions were put about the need to discriminate syndromes comprising psychopathological symptoms from actual mental disorders that run parallel to drug abuse. Lecturers agreed on the fact that many of the symptoms that are commonly found in treatment-seeking patients may simply represent the mental part of the general impairment produced by addiction, as independent mental disorders are a minority. The medical risk of addiction treatment was discussed comparatively, with special reference to the latest warnings about heart safety and the misuse of medications through injection. The first longer-term data collected in various countries on the advantages of buprenorphine-naloxone were displayed; they confirmed the effectiveness of this combination in countering abuse trends in the early stages of treatment. The clinical foundations for buprenorphine use were widely examined through a session of presentations, and the advantages offered by it in achieving a better quality of life were underlined.
Political issues comprising waiting lists, the structuring of nationwide programmes that aim to enrol as many patients as possible, and the relationship between high- and low-threshold interventions were other topics that were debated in great detail. The history of opiate use and misuse was brilliantly summarized by Dr. Joseph in a session dealing with the use of opiates in patients experiencing pain: we hope that this will serve as a kind of ‘back to the future’ hint for researchers and opinion leaders in the field. Lecturers and participants had the chance to visit a Bulgarian clinic, which is inspired by a correct concept of ‘integrated’ treatment. Its patients seemed to be personally involved in their rehabilitative process, which has been designed to develop around the maintenance of medical treatment. Those settings reminded us that it is crucial that patients should live through the re-building of their lives on a day-to-day basis, and that this should happen in a natural, non-judgmental context. Increased participation from eastern colleagues, consistently with this year’s location, brings with it the hope that scientific meetings such as these will enhance and drive medical interventions which have only a short history of treating narcotic addictions, but, in some cases, may be an indispensable resource in facing an epidemic phase of the phenomenon.