Heroin Addiction and Related Clinical Problems 2000; 2(1):1-8
Women, pregnancy and methadone
Finnegan L. P.
National Institute of Health, 9000 Rockville Pike, Bldg 1, Room 201-Bethesda, MD, 20892-0161, USA
Summary: The abuse of psychoactive drugs by women of childbearing age has placed an untoward burden on the fetus, new-born and child. This included: marijuana-2.9%; cocaine-1.1%; with lesser percentages of other illicit drugs. Effective methadone maintenance prevents the onset of opioid abstinence syndrome for 24-36 hours, reduces or eliminates drug craving, and blocks the euphoric effects of illicit narcotics. Because of the extremely high risk environment of the pregnant drug-dependent woman, her infant is predisposed to a host of neonatal problems. Infants exposed to methadone in-utero, with mothers receiving prenatal care, generally have higher birth weights and a decreased incidence of premature birth and other medical complications. Infant medical complications are usually influenced by maternal prenatal care, incidence of maternal complications, and multiple drug use by the mother causing an unstable intrauterine milieu complicated by withdrawal and overdose. Infants exposed to methadone generally have a higher incidence and a longer duration of abstinence. The majority of this increased cost has stemmed from drug-affected infants born with significant/major medical needs and premature delivery related to maternal drug abuse. Over three-fourths (77%) of drug-affected infants have had significant/major medical needs compared with 27% of all new-borns. Seventeen per cent of drug-affected infants were born prematurely, compared with 6% of all new-borns. The total cost in 1997 for longer, specialised, and more intensive medical care for Florida's drug-affected infants is estimated at $ 6.7 million.
Publication Type: Clinical Practice
Heroin Addiction and Related Clinical Problems 2000; 2(1):9-14
Sexual dysfunction associated with methadone maintenance: Treatment with bromocryptine
Shinderman M. S., Maxwell S.
Center for Addictive Problems-609 N. Wells Street, Chicago, IL , 60610 USA
Summary: Sexual dysfunction, a side effect of methadone maintenance treatment, may be caused by opioid-induced hyperprolactinemia; on this basis, a dopamine agonist could reverse the effect. We treated 34 (23 male; 11 female) patients with bromocryptine, 2.5-10mg/d. 65% of males and 36% of females reported a positive response. Responders and non-responders had a similar age (44 Vs 40 yrs), time in MMT (45.5 mos), and use of serotonergic antidepressant therapy (21.1% Vs 26.7%). Responders took higher doses of methadone (220.3 Vs 165.6 mg/d), and were more likely to be taking bupropion or methylphenidate (42.1% Vs 26.7%). Alternative therapies with other dopaminergic agonists are discussed
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2000; 2(1):15-21
Attitudes and Beliefs towards Methadone of staff working in substance abuse treatment
Vossenberg P.
IVD Deventer, Brink 40 7411 BT Deventer, The Netherlands
Summary: This study investigates the possible use of the Abstinence Orientation Scale (AO-scale), which has been developed to study the impact of attitudes towards methadone maintenance treatment (MMT) on treatment retention.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2000; 2(1):22-22
Is prescribing higher doses of methadone likely to promote elevate drop-out rates? [Letter]
Vetere C.
UNICRI, Via Giulia, 52-00186 Roma, Italy
Summary: Not available
Publication Type: Letter to the editor
Heroin Addiction and Related Clinical Problems 2000; 2(1):23-31
The Pacific Drug Policy Institute and research findings that led to its founding
Smart D. C.
The Pacific Drug Policy Institute, Inc. - 2744 Lakeview Drive, San Leandro, CA, USA
Summary: The failure of currently employed drug control measures is caused by what I call the “drug/crime subsidy”. Because the drug/crime subsidy is caused by our government’s $17 billion investment (per annum) in drug control measures. Apologists for the war on drugs argue that the illegal drug could be controlled, if we would just enforce the drug laws. As well as being the primary victims of the drug/crime epidemic, drug users are also major carriers in the contagions of drug use and addiction. Experts estimate that addicts consume 80% of illegal drugs. An estimated 20% of illegal drugs is consumed by recreational or casual drug users. We could eliminate 20% of the drug/crime subsidy by serving the drug-related needs of these users
Publication Type: Proposals
Heroin Addiction and Related Clinical Problems 2000; 2(1):32-32
Methadone treatment: an interesting analogy [Letter]
Newman R. G.
Continuum Health Partners, Inc. 1st Avenue at 16th Street, New York, NY, USA
Summary: Not available
Publication Type: Letter to the editor
Heroin Addiction and Related Clinical Problems 2000; 2(1):33-38
Take-home and compliance with methadone maintenance treatment
Pani P. P., Pirastu R.
SerT AUSL 8, Cagliari, Via dei Valenzani, 21-Cagliari, Italy
Summary: One of the most important restrictions placed on patients during methadone treatment is the need for daily attendance at the outpatient unit providing the medication. While this may be obvious for patients beginning the treatment, many patients stabilized on appropriate doses of methadone complain of its interference with their activities (home, work, leisure). To see if take-home methadone promoted the retention of patients in treatment, we compared, on the basis of various demographic and clinical characteristics, the patients enrolled in the take-home programme with those attending the clinic daily. The opportunity to broaden the investigation by including the relationship between take-home policy and retention in treatment partly derwed from the law which, between 1991 and 1993, prohibited the take-home option. The comparison of patients with and without the take-home advantage seems to show a longer retention in treatment for the first group, without specifying anything about the role of take-home in promoting retention. Our clinical practice suggests that when sufficient guarantees as to the reliability of the patient exists, take-home methadone practice may be a useful tool for promoting compliance and improving the retention rate of patients in treatment
Publication Type: Clinical Practice
Heroin Addiction and Related Clinical Problems 2000; 2(1):39-46
Maremmani I., Canoniero S., Pacini M.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Via Roma, 67-56100 Pisa, Italy
Summary: We studied 71 opioid-dependent subjects, 19 with additional DSM-IV diagnosis of Bipolar I disorder and 52 with no psychiatric comorbidity. There were significant differences between these two groups regarding the methadone dose required for clinical stabilization, but not in the rate of retention in treatment. Patients with bipolar I psychiatric comorbidity required an average stabilization dose of 146±80 of methadone, compared with 99±49 mg/die for patients whose only Axis I diagnosis was Opioid Dependence. In the 990-day period considered there were no significant differences between the two groups of patients in terms of retention on treatment; even so, bipolar I heroin addicts patients tend to be less compliant to treatment
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2000; 2(1):47-48
Discontinuation symptoms are not addiction/dependence [Letter]
Newman R. G.
Continuum Health Partners, Inc. 1st Avenue at 16th Street, New York, NY, USA
Summary: Not available
Publication Type: Letter to the editor
Heroin Addiction and Related Clinical Problems 2000; 2(2):1-18
Menaging benzodiazepine withdrawal
Frare F., Perugi G.
Department of Psychiatry, neurobiology, Pharmacology and Biotechnologies - University of Pisa, Via Roma 67 -56100 Pisa - Italy
Summary: The long-term use of Benzodiazepines (BZs) is currently a source of growing concern, owing to increasing doubts about their efficacy, and evidence of important adverse effects, including physical dependence and neuropsychological impairment. The long-term use of BZs in patients with anxiety and mood disorders calls for special concern; in these patients, in fact, interepisodic chronicity and residual symptoms often appear to be related to inappropriate long-term use of BZs. The problem of dependence on benzodiazepines has been aggravated by iatrogenic physiological dependence on these medications and by polysubstance-abusing patients using them in addition to other agents, in particular opioids or cocaine. A safe, rapid, and effective way to detoxify patients from benzodiazepines is of prime importance in facilitating further treatment of their psychiatric or substance use disorder. Correct withdrawal strategies should combine gradual dosage reduction, psychological support and adjuvant medications in selected patients. The tapering schedule should be individually titrated and adjusted according to the patient’s reactions; substitution with a long-acting BZ is often useful. Psychological support should include information about BZ withdrawal, general encouragement and the correction of misconceptions about discontinuing medicines; it should be available both during tapering and after withdrawal. Some antiepileptics and sedative antidepressants may be useful to mitigate withdrawal phenomena. Adequate dosages of antidepressants should be used to treat the re-emergence of an underlying mood or anxiety disorder. Success rates of withdrawal are high (54-92%); the follow-up studies, however, indicate that long-term discontinuation of BZ is a slow process, taking many weeks or months - in some cases years - with a protracted clinical course after drug cessation.
Publication Type: Review Article
Heroin Addiction and Related Clinical Problems 2000; 2(2):19-27
Addiction and methadone: One American's view
Newman R. G.
Continuum Health Partners, Inc., 555 West 57th Street, 10019 New York, NY, USA
Summary: To refer to America’s “war on drugs” as a failure is overly generous. It is a disaster! Other nations should ignore what Americans say and consider instead the consequences of what they do. With specific regard to the treatment of addiction, all modalities that offer hope should be supported. None, however, approaches the proven ability of methadone maintenance to attract, retain and help addicts. Accordingly, the unique constraints on methadone’s availability must be removed, and the general practicing physician given the same authority to prescribe methadone as she/he has to prescribe any other medication.
Publication Type: Point of View
Heroin Addiction and Related Clinical Problems 2000; 2(2):29-33
Coppel A.
Institute Emergence Espace Tolbiac, 58-60 rue de Tolbiac, F-75013, Paris, France
Summary: This article discusses recent changes in France from what has mainly been a repressively oriented drug policy towards accepting and supporting a variety of harm reduction measures. The introduction of harm reduction in the early nineties proved to be very successful in terms of harm reduction and is already a reality. Most officials, however, are still reluctant to support this implicit policy change openly, or work coherently for a reduction of current inconsistencies or admit the overwhelming success those changes have brought about, so the author is afraid of a serious backlash. The positive effects may be threatened if the public is not adequately informed about the new situation and its positive effects. The government may be unwilling to continue supporting harm reduction in the face of increasing public criticism based on ignorance and an inadequate conception of how to preserve public order in connection with illicit drugs.
Publication Type: Policy Initiatives
Heroin Addiction and Related Clinical Problems 2000; 2(2):35-42
Opioids and cannabinoids abuse among bipolar patients
Maremmani I., Canoniero S., Pacini M., Lazzeri A., Placidi G. F.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Via Roma, 67-56100 Pisa, Italy
Summary: Substance abuse is known to be a risk factor for the development of some types of mental illness, especially in individuals with premorbid vulnerability or psychopathology, but the psychopathology itself may be a risk factor for addictive disorders or a modifier of the course of addictive disorders. In our clinical experience with heroin addiction, the prevalence rates for the bipolar disorder was quite high. More than 50% of the patients had an adjunctive diagnosis of bipolar disorders. In many cases they met the criteria for a diagnosis of bipolar I, bipolar II or cyclothymic disorder. So bipolar I and bipolar II disorders are more frequent than depressive ones. Bipolar patients are well represented among cannabinoid abusers, and schizophrenic spectrum patients among cannabinoid non-abusers. Interestingly, the number of bipolar patients who continued to abuse cannabinoids after the onset of the first episode was higher than that of schizophrenic spectrum patients. In conclusion, our data support the increasing evidence of high rates of co-occurring bipolar and addictive disorders.
Publication Type: Preliminary Communication
Heroin Addiction and Related Clinical Problems 2000; 2(2):43-50
Pregnant addict care in Methadone Treatment Programs
Bilangi R. J.
Connecticut Counseling Centers, Inc., 984 Southford Road, Middleburry, Connecticut 06762, USA
Summary: Since 1992 Connecticut Counseling Centers, Inc. has been providing two models of pre-natal and post-natal care, including obstetrical and gynaecological examinations, and patient education and care, to our pregnant opioid addicts in two methadone treatment programmes in Connecticut, U.S.A. Connecticut Counseling Centers, Inc.’s two pregnant addict care programmes provide a wealth of patient education, nutritional analysis and education, parenting skills training and pre-natal and post-natal medical care, along with comprehensive methadone treatment.
Publication Type: Policy Initiatives
Heroin Addiction and Related Clinical Problems 2000; 2(2):51-55
Aprohibitionism, a feasible way forward
Michelazzi A.
GIMGET-SITD, San Lazzaro, 19 - 34100 Trieste, Italy
Summary: Drug (ab)use is a phenomenon that has continued to advance in western and westernised society, starting at the end of the sixteenth century and the beginning of the seventeenth. In the same period a capitalist form of society developed out of a mercantile one. Psychiatric disease can be viewed as representing the failure of production based on the division of work; similarly, disease connected with addiction can be seen as representing the failure of reproduction resulting from work mechanisation.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2000; 2(2):57-58
Hepatitis C infected patients and higher doses of methadone [Letter]
Okruhlica L., Klempova D.
Centre for Treatment of Drug Dependencies, Hranicra 2, P.O. Box 51 - 82799 Bratislava, Slovack Republic
Summary: Not available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2000; 2(2):59-60
Introducing the European Collaborating Centres in Addiction Studies [Letter]
Schifano F.
SerT 1, Via Berchet, 2035100-Padova, Italy
Summary: Not available
Publication Type: Letter to the Editor