Heroin Addiction and Related Clinical Problems 2001; 3(1):7-12
The promise of opioid receptor antagonist drugs in the treatment of neuropsychiatric disorders
Deltito J., Maremmani I.
7 Thomes Street, Rowaton, CT 06853 USA
Summary: The endogenous opioid system, either directly or through its influence on other neurotransmitter systems, has far-reaching effects on normal as well as abnormal (maladaptive) behaviours, thoughts and mood states. Altering this system through the use of an opioid antagonist medication may not only be useful in treating recognized psychiatric illnesses, but may also prove to be valuable in elucidating psychophysiological abnormalities that could contribute to the foundation of these disorders.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2001; 3(1):13-20
Scarlata S., Chiarotti M., Fucci N., De Giovanni N.
SerT, ASL Roma D, Via Vaiano 53, Roma
Summary: Therapeutic failures in MMP patients may be due to an inadequate oppioidergic replacement effect of the drug on specific receptors for endogenous opiates. Even with oral doses considered adequate in the current literature, haematic levels may be low, due to genetic or induced over-metabolization of the drug; in addition, even when haematic levels are high, the results may be poor, due to acquired receptor tolerance. 61 heroin addicts on MMP doses agreed on between therapist and patient have been evaluated with Europasi at the beginning and at the end of observational and therapeutic periods ranging between 12 and 57 months. Addicts who showed a positive development revealed haematic levels (non-oral ones) higher than non-responder patients, and some of the former reached haematic levels higher than those reported in current literature. Estimates of the haematic concentration of methadone may be useful, even if availed of “una tantum” during the treatment period.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2001; 3(1):21-25
Therapeutic effects of paroxetine on the cocaine abuse in heroin addicts
Manna V.
Drug Dependance Department, AUSL FG/3, Via Arpi c/o Vecchio Ospedale, Foggia, Italy
Summary: During the last few years, cocaine abuse has been detected in increasing numbers of heroin addicts taking part in a methadone maintenance programme. Paroxetine, a serotoninergic reuptake blocker, was administered, 20 mg p.o. a day, to 12 outpatients, cocaine abusers with heroin addiction, during a methadone maintenance treatment, to evaluate the possible anti-craving and therapeutic effects of the prescribed drug on cocaine use. Four patients discontinued paroxetine treatment after a few days. Eight patients received paroxetine for at least eight weeks. Cocaine abuse was detected by weekly toxicology screening. After eight weeks of treatment, three patients had completely stopped using cocaine, and four had considerably reduced their consumption. One patient reported no change. So, paroxetine, as suggested for other serotonin reuptake inhibitor drugs, may be considered a safe, effective therapeutic agent in treating of cocaine abuse in heroin addicts.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2001; 3(1):27-31
Methadone regulations in USA: Comments, proposal to adopt new regulations and proposed rule
Newman R. G.
Continuum Helth Partners, Inc., 555 West 57th Street, 10019 New York, NY, USA
Summary: The current regulatory process governing methadone treatment of addiction is associated with one problem that overshadows all others: it effectively limits the prescribing of methadone to “programmes” that, collectively, can accommodate no more than 15-20% of all who need and could benefit from this medication. As a consequence, lives are lost (literally as well as figuratively), and there are staggering costs to the general community. The proposed new Rule does nothing about this problem. To the contrary: it exacerbates it, and by implicitly endorsing the status quo reduces the prospects for future change. In addition to raising further the barriers to expanding methadone availability, the Rule would complicate rather than streamline the bureaucratic process that governs treatment, do nothing to enhance quality of care of the lucky few who do gain access to methadone, and raise costs for Government, providers and patients.
Publication Type: Policy Initiatives
Heroin Addiction and Related Clinical Problems 2001; 3(1):33-39
Articulation of codeine treatment and methadone maintenance programs
Okruhlica L., Klempova D., Timulakova K.
Institutte for Drug Dependencies, Centre for Treatment of Drug Dependencies,Hranicna 2, P.O. Box 51, 82799 Bratislava, Slovak Republic
Summary: The Centre for Treatment of Drug Dependencies in Bratislava is implementing a complex integrative model which provides fourteen different programme options for its clients. This paper studies the relashionship and interaction between the treatment process in two maintenance programmes: 1) with codeine phosphate (n=74), and 2) with methadone hydrochloride (n=132). There were no differences in the gender composition or working status of the groups, but a significant difference was found in age composition; differences in retention rates and dosages were focused on, too. Codeine substitution had been introduced into our practice prior to the availability of methadone maintenance. It has still not been eliminated, largely due to the fact that it is requested by the patients, but also because of some other aspects considered by the therapist in managing the treatment process. The different characteristics of these two programmes, their possible determinants, as well as practical considerations and the advantages of keeping the two programmes running side by side on a non-competitive basis are discussed.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2001; 3(1):41-46
Lovrecic M., Dernovsek M. Z., Tavcar R., Maremmani I.
Centre for Prevention and Treatment of Illegal Drug Dependence, Koper, Slovenia
Summary: The aim of the survey was to compare clinical and sociodemographic differences between patients with substance abuse or dependence and mental illness who, over a three-month period, sought psychiatric help in a hospital (UPH) or a methadone clinic (CPTIDD).
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2001; 3(2):7-20
The problem of drug dependence
Tagliamonte A., Maremmani I.
Department of Neurosciences - University of Siena, Via Aldo Moro, 4 - 53100 Siena, Italy
Summary: Knowledge about psychoactive substances has always had to challenge sociocultural dogmas and expectations, which usually prevail over scientific evidence. Along with that, addictive disorders have mostly been thought to arise from a choice of inappropriate sources of stimulation and blame addressed at addicts who lack judgement. The definition and assessment of the differences between use, abuse and dependence have therefore been a controversial matter. Stimuli differ in nature and different dynamics are there for behaviours to be elicited and structured. Some objects are pursued along with the need for them, as soon as they become unavailable, whereas others are craved for most strongly when they are available. Behavioural dynamics are crucial in discriminating between what we struggle not to run out of, and what we strive to win, i.e. between loss avoidance and self-empowerment. Need-satisfying behaviours tend to dwindle through satisfaction, and develop through the experience of frustration, whereas pleasure-seeking is reinforced by success and is structured upon subjective reward. Both forms of behaviour are displayed as habits, and stay functional as long as control over behavioural production is maintained. The neurobiological bases for these conceptualizations are discussed, and clinical models are described to draw a line between physiological habits and addictive diseases, and between benign transient behavioural conditioning and the proneness to malignant relapse which underlies true addiction. The debate on addictive diseases, setting aside the question of resorting to irrational methods, should be referred to strictly medical models, so as to let meaningful interventions follow scientific knowledge.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2001; 3(2):21-28
Coppel A., Bloch-Laine J. F., Charpak Y., Spira R.
Centre Emergence Espace-Tolbiac, Institut Mutualist Monstouris, 60 rue de Tolbiac, 75013 Paris, France
Summary: Emergence Espace-Tolbiac is a methadone treatment clinic. Over the last 5 years, EET has initiated methadone treatment with 738 patients, including 548 who have been referred to a network of 220 GPs The way of service functions is defined by the French regulations for methadone treatment. Such treatment must be initiated by specialized clinics, but once patients have stabilized, can be referred to GPs. Our service initiates the treatment, and patients stay at the clinic, where methadone is administered every day by a specialized team. During the first few weeks, the patient’s needs are evaluated and he or she is referred to various professionals, such as social workers, doctors and psychiatrists, according to whatever is appropriate in each case. Patients are referred to GPs when the evaluation is made that they no longer abuse drugs such as heroin or cocaine, or other substances such as alcohol or benzodiazepine. They must have social resources and available accommodation. Patients suffering from a psychiatric disorder do not receive referrals until their condition has been stabilized by any kind of treatment. So far 40% of our patients have received a referral after an average of 2 months at the clinic, and 30% after an average of 9 months, while 18% have stayed at the clinic for over 2 years. A follow-up has been conducted on 296 patients referred to GPs (32 GPs failed to answer) After an average of a year and a half on treatment, 5% were no longer available for follow-up, and 85% are still being advised by their GP. Of these, 95% are still being treated with methadone. Most of the others (9/13), are being treated with high-dosage buprenorphine (Subutex). The mean dosage is 60mg/day, 15 mg less than at the end of the stay at the centre. Relationships with other professionals are frequent (67% of patients). 20% are still in contact with the centre
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2001; 3(2):29-32
Treatments of substance users detainees in 'La Santé' prison
Yakoub S.
Centre Spécialisé de Soins aux Toxicomanes/SMPR - Maison d'arret de La Santé, 42 rue de la Santé - 75014 Paris, France
Summary: In France, care for addict detainees is provided under Ministry of Health responsibility. The psychiatric, psychological and social aspects depend on the Treatment Centre for Addicts in jail (created in 1987). In this report, on the basis of the characteristics of our patients in 1999, we describe the treatments given to substance-user detainees in our Centre at La Santé prison.
Publication Type: Clinical Practice
Heroin Addiction and Related Clinical Problems 2001; 3(2):33-38
Intensive sport and risk of heroin addiction
Deglon J. J.
Fondation Phénix, Route Chêne 100, case postale 215 - 1224 Chêne-Bougeries, Geneve, Switzerland
Summary: Results from Loewenstein’s study on heroin addicts in his methadone programme have led us to verify a correlation between intensive sports and addiction. In our four methadone programmes based on a medical-psychosocial treatment model, 378 patients answered a 200-item questionnaire distributed last year. 25% said they had played a sport on an intensive basis, several hours a day for several months. 32% said they had practised a highly competitive sport. It therefore seems that most of our patients have been intensive sports-players — certainly more so than the majority of the population in a similar age range. Significant statistical correlations to be noted among the athletic group are: higher frequency of parents with psychological problems, higher methadone dosage, a greater use of cigarettes before beginning methadone, a higher score on the Beck Depressive Scale, a lower score on a quality of life test and a need for more psychotropic drug prescriptions. These results allow us to formulate the hypothesis that intensive sports for certain young people can be a means to escape from an underlying depression. The stimulation of endorphins and the ensuing activation of dopamine tracts incite temporary psychological improvement. It would thus appear that the association of narcotics, especially heroin, which gives a pleasure that is incomparably stronger than that obtained through intensive sports, with neurobiological/psychological fragility, can lead to a high risk of addiction in this population.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2001; 3(2):39-44
The differences between heroin addicts with and without comorbidity
Lovrecic M., Dernovcek M. Z., Tavcar R., Maremmani I.
Centre for Precvention and Treatment of Illegal Drug Dependence, Koper, Slovenia
Summary: The aim of this study was to discover what clinical and sociodemographic differences separate heroin addicts without (AWC) and those with comorbidity (substance abuse and mental illness-SAMI) among those seeking help in an outpatient methadone clinic. The RSDA instrument and ICD-10 were used.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2001; 3(2):39-44
Methadone Treatment: Italy vs. USA - Methadone Treatment in Europe [Letter]
Tidone L., Riglietta M., Campana M.
Dipartimento delle Dipendenze - Via Paleocapa, 20 - 24122 Bergamo - Italy
Summary: not available
Publication Type: Letter to the editor