Heroin Addiction and Related Clinical Problems 2002; 4(1):5-12
Bargagli A. M., Sperati A., Davoli M., Perucci C., Vicente J., Hartnoll R., Barry J., Brugal T., Buster M., Ferraz De Oliveira F., Haastrup L., Heinemann A., Kouklinos A., Risser D., Svensonn D., Vuori E.
Agency for Public Health, Latium (Lazio) - Via di S. Costanza, 53 - 00198 Rome - Italy
Summary: The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is currently co-ordinating a project which aims to enrol and follow up prospective cohorts of problem drug users (PDUs) in several countries, so as to compare overall and cause-specific mortality. Within the project a literature overview of drug user mortality and a comparative analysis of data from already followed-up cohorts were performed. Although the joint analysis provided new knowledge on mortality trends among PDUs in several European countries, care should be taken in comparing data from retrospective cohorts due to the heterogeneity of study populations and their settings and follow-up procedures. The formation of prospective cohorts, in line with a standard methodology, should improve the comparability of results both for overall and cause-specific mortality
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2002; 4(1):13-24
Buprenorphine: Evidence for effectiveness
Pacini M., Maremmani I.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies - University of Pisa, Via Roma 67 - 56100 Pisa - Italy
Summary: In all cases, opiate addiction is best treated by the use of opiate agonist agents. A maintenance regimen based on an opiate agonist leads to a gradual dwindling of the subjective effects due to street opiates, thanks to the blockade achieved by these agents on the receptors that are reached by heroin.
Publication Type: Review article
Heroin Addiction and Related Clinical Problems 2002; 4(1):25-28
Pisec A.
A-Center for Treatment of Addicts to Prohibited Drugs, Zdravstveni dom dr. A Drolca, Ul.talcev 9, 2000 Maribor, Slovenia
Summary: A study covering six years of treatment at our centre was dedicated to 570 patients addicted to prohibited (because illegal) drugs; those patients were enrolled in the period April 1995 - April 2001. Group A results are those for 284 addicts treated with methadone, while those for group B refer to the comprehensive treatment outcomes for all 570 addicts enrolled there in that period. Patients in group A had an average age of 26 years, and an average daily methadone dose of 80 mg of methadone, the following infections were recorded: (i) 21 patients (7.4%) had the hepatitis B virus, (ii) 105 (36.9%) had the hepatitis C virus, and (iii) no patients ( 0%) had the HIV virus . For 16 patients (5.6%) the results are unknown.
Publication Type: Clinical Report
Heroin Addiction and Related Clinical Problems 2002; 4(1):29-36
Does therapeutic threshold of methadone concentration in plasma exist
Okruhlica L., Devinsk F., Valentova D., Klempova D.
Institute for Drug Dependencies, Centre for Treatment of Drug Dependencies, Hranicna 2, P.O. Box 51, 82799 Bratislava, Slovak Republic
Summary: This study was conducted among the group of 69 patients in the methadone maintenance programme in Bratislava. There were 56 males and 13 females, with an average age of 26.9 years (SD ± 5.4). Daily methadone doses (mean: 134 mg, SD ± 56.1, from 10 to 270 mg) were compared with methadone concentrations in plasma (mean: 376.6 ng/ml, SD ± 226.1, from 44 to 1103 ng/ml); of these, 17.4% of the patients had levels below the threshold of 200 ng/ml of plasmatic concentration of methadone, whereas 15.9% had levels above the level of 600 ng/ml. All of them had previously been stabilized clinically, with negative urinalysis for morphine
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2002; 4(1):37-46
Gunne L., Gronbladh L., Ohlund L.
Medical Product Agency, 751 03, Uppsala, Sweden
Summary: From 1967 to 1990, the Swedish methadone maintenance programme treated 345 heroin addicts, using a two-phase treatment model described in this paper. The retention rates remained remarkably stable throughout these 23 years, when measured as 1-year and as 3-year retention of newly admitted patients (mean 1-year retention was 86%, mean 3-year retention 73%) and 1-year retention of all patients in treatment (mean 89%). It is hypothesized that these high and stable retention rates might be associated with the high rates of social and vocational rehabilitation (between 71% and 81%) achieved during these years in the Swedish programme
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2002; 4(2):5-9
Maxwell S., Shinderman M. S., Miner A., Bennet A.
Center for Addictive Problems - 609 N Wells, Chicago, IL 60610
Summary: Hepatitis C infection is epidemic in intravenous drug users worldwide. This has great impact on opiate-addicted patients. Prevention of infection must depend on treatment of opiate addiction. This report discusses findings from 1,163 methadone-maintained patients tested for hepatitis C infection. The prevalence of HCV seropositivity in IVDU patients was 68%. Seropositive patients required significantly higher doses of methadone (169 mg/d vs. 100 mg/d, p<.05). This difference in dose was independent of duration of addiction and time in treatment. It is suggested that Hepatitis C infection may be associated with metabolic changes that lead to increased methadone requirement.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2002; 4(2):11-17
Is craving for heroin and alcohol related to low methadone dosages in methadone maintened patients
Lubrano S., Pacini M., Giuntoli G., Maremmani I.
Department of Psychiatry NPB, University of Pisa, Via Roma 67, 56100 Pisa, Italy, EU
Summary: The craving for heroin, alcohol and cocaine of 84 heroin-addicted patients under Methadone Maintenance Treatment have been evaluated to highlight possible craving clusters, and to underline contingent correlations with clinical characteristics such as addiction history, positive symptom distress and methadone dosages. The results show a correlation between methadone dosage and a craving for heroin and alcohol. Patients treated with low dosages of methadone show more psychopathological symptoms and a stronger craving for heroin and alcohol. On this basis, the search for an appropriate methadone dosage should be viewed as crucial to the success of the treatment, because it minimizes alcohol and heroin craving, and reduces the risk of psychopathological symptoms during treatment.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2002; 4(2):19-31
Clinical foundations for the use of methadone. Italian Consensus Panel on Methadone Treatment
Maremmani I., Barra M., Bignamini E., Consoli A., Dell'aera S., Deruvo G., Fantini F., Fasoli M. G., Gatti R., Gessa G. L., Guelfi G. P., Jarre P., Michelazzi A., Mollica R., Nardini R., Pani P. P., Polidori E., Siragusa C., Spazzapan B., Starace F., Tagliamonte A., Tidone L., Vendramin A.
Department of Psychiatry NPB, University of Pisa, Via Roma 67, 56100 Pisa, Italy, EU
Summary: not available
Publication Type: Positional Paper
Heroin Addiction and Related Clinical Problems 2002; 4(2):33-37
Aa.Vv.
PAIMM programme: Collegi Oficial de Metges de Barcelona (COMB), Passeig de la Bonanova, 47 - 08017 Barcelona, Spain
Summary: not available
Publication Type: Positional Paper
Heroin Addiction and Related Clinical Problems 2002; 4(2):39-42
Galicia document on problems related to addictive disorders in Europe
Aa.Vv.
Department of Psychiatry NPB, University of Pisa, Via Roma 67, 56100 Pisa, Italy, EU
Summary: not available
Publication Type: Positional Paper
Heroin Addiction and Related Clinical Problems 2002; 4(2):43-46
Www.Europad.Org
Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
Summary: Not available
Publication Type: Notes
Heroin Addiction and Related Clinical Problems 2002; 4(3):5-11
Maremmani I., Pacini M., Lubrano S., Giuntoli G., Lovrecic M.
Department of Psychiatry, Neurobiology, Pharmacology and Biotecnologies, University of Pisa, Via Roma, 67, 56100 Pisa, Italy, EU
Summary: So far, harm-reduction campaigns have focused on the personal and social needs of heroin addicts, with the aim of preventing the consequences of addictive behaviours. An unduly sharp dichotomy usually seems to come to mind when harm-reduction interventions are compared with specific treatments for heroin addiction. In reality, some of the specific targets in the treatment of heroin addiction, as well as features of mentally ill subpopulations, may be reasonable targets for harm reduction, too. Convergence on overlapping targets may be hypothesized as long as harm reduction and specific treatment come to share the same therapeutic instruments. Opioid agonists, the primary option for the specific treatment of heroin addiction, are also valuable as harm reduction instruments, as long as harm reduction is conceived of as a means for acting on that disease, but only at a low-threshold level. The personal and social impact of possible agonist-mediated harm-reduction seems to carry special weight in higher-risk populations, such as mentally ill heroin users, who have turned out to be sensitive to therapeutic opioid agonism. Harm reduction can best be regarded as a low-level approach to more severely disabled subjects, bridging the gap between the street and clinical settings by a sub-therapeutic but specific pharmacotherapy. Stepping up from harm reduction to a higher level of intervention should, in fact, be the ultimate goal of harm reduction . Transition to specific treatment is particularly important for dually diagnosed addicts, who can be expected to receive a relatively greater benefit; without that transition, they are likely to quickly lose the opportunity to attain a positive outcome.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2002; 4(3):13-19
Methadone treatment in Croatia
Ivancic A.
Centre for outpatient treatment of drug addicts, M. Gioseffi, 2 -52440 Porec, Croatia
Summary: The war between 1991 and 1995, brought destruction, migrations and victims to Croatia, but it also brought a heron addiction epidemic. The supply of methadone was undermined by war-related crimes and demand was paralysed by confusion about the options that were available. Croatia did have a number of experienced specialists in the field of addiction, and, fortunately, their ideas were accepted and promoted. Methadone was introduced through a “slightly open door”, but no official announcements were made. The first patients were admitted to MT in 1991. Of an estimated 15,000 heroin addicts, about 7,000 were given some kind of treatment, including 3,000 in MT, and about 2,000 in MMT. Methadone policy specifics are: 1. Health insurance coverage that includes MT for virtually all addicts. 2. Centres for outpatient treatment in all major cities. 3. Completely decentralized prescription and dispensing of methadone through GP offices. Despite the lack of strict rules, or maybe just because of that, MT in Croatia is well established and is generally viewed favourably. The obstacles encountered so far have never reached a level that might jeopardize the fundamentals of the programme.
Publication Type: Policy initiative
Heroin Addiction and Related Clinical Problems 2002; 4(3):21-25
The renaissance of methadone treatment in America
Parrino M. W.
American Association for the Treatment of Opioid Dependence, New York, NY, USA
Summary: The renaissance, or revitalization, of methadone treatment services in America is driven by new accreditation standards, as promulgated by the Centre for Substance Abuse treatment, the primary oversight federal agency for methadone treatment services in the United States. This project will take years to develop and a reasonable starting point is the accreditation oversight system. While accreditation is not expected to be the answer to all critical problems in methadone treatment, it will provide the ability to enhance quality of care as patients get access to a more consistent level of services.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2002; 4(3):27-32
Gioè P., Rosa B., Papa M., Troia M., Triolo F.
SerT, Health Local Unit N° 6, P.O. 'Casa del Sole', Via Roccazzo,83 -90100 Palermo, Italy, EU
Summary: Research developments in methadone research point to the need to give adequate doses in maintenance programmes for the treatment of opiate dependence. This suggestion often clashes with the long-standing prejudices of users, who are not fully compliant with long-term substitution programmes; this makes it difficult to fully implement the correct treatment. Our service has therefore tested a different intervention methodology, in order to: 1) favour treatment retention; 2) improve the quality of the treatment itself. Small groups of users under substitution treatment were formed: they met for counselling in a group setting. This form of open discussion allowed: 1) health workers to provide correct information about methadone; 2) patients to learn more about drug addiction and its possible treatments, by following a new route to self-knowledge and taking part in interactive confrontation; 3) both groups (health workers and users) the opportunity to have a more genuine and confidential relationship. In order to make available to those outside the experimental group the subject of this experience, a comic strip directed to all the other users of the service was prepared. One year after the conclusion of this experimental technique, all the users who had been involved in it were still compliant with treatment, in line with the initial therapeutical project, and some of them have entered the detoxification phase.
Publication Type: Research report
Heroin Addiction and Related Clinical Problems 2002; 4(3):33-44
Methadone maintenance and HIV infection
Pacini M., Maremmani I.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies - University of Pisa, Via Roma 67 - 56100 Pisa - Italy
Summary: Methadone therapy is widely ascertained to be the most effective treatment for opioid addiction. Its spreading was promptly followed by a dwindling spreading rates of HIV among heroin addicts. Non only among directly treated patients a clear benefit emerged, but also among non addicts sharing the same environment. The positive impact of methadone upon additive behaviours is to be read mainly as the reduction of the likelihood of seroconversion. Retention in treatment is the most reliable predictor for the lowered likelihood of seroconversion to be maintained through time. The administration of methadone, even in those cases for which stabilization has not been achieved, or for those subjects who do not comply to methadone maintenance programmes, is still an effective in a harm reduction perspective, as far as it keeps infective risk lower than expected.
Publication Type: Review article
Heroin Addiction and Related Clinical Problems 2002; 4(3):45-46
Breast-feeding for a methadone-maintened mother: a case report [Letter]
Lamanna F., Scuotto S., Tedici M.
Department of Addictions, ASL 11, Piazza XXIV Luglio, 1 - 50053 Empoli (FI), Italy, EU
Summary: Not available
Publication Type: Letter to the editor
Heroin Addiction and Related Clinical Problems 2002; 4(3):47-48
Methadone maintenance treatments in European extracommunity target [Letter]
Siconolfi M., Verde L., Auriemma F., Esempio C., Marguccio E., Moccia E., Stimolo R., Guardiana A.
Department for Druf Addiction, Health Local Unit, Via Vincenzo Janfolla, 446 - 80145 Napoli, Italy, EU
Summary: Not available
Publication Type: Letter to the editor