Heroin Addiction and Related Clinical Problems 2003; 5(1):5-16
Ghodse H., Clancy C., Oyefeso A., Rosinger C., Finkbeiner T., Schifano F., Forza G., Sommer B., Nielson K. R., Schodt J., Wieviorka S., Gionnet C., O'connor J., Tidone L., Riglietta M., Lopes I., Torrens M., San L., Montes M., Copez C. R.
Department of Addictive Behaviour and Psychological Medicine, 6th Floor Hunter Wing, CRanmer Terrace, St George's Hospital Medical School, London SW17OORE, United Kingdom, EU
Summary: commonly used treatments for opiate dependence, legitimate questions continue to be raised about its effectiveness. Objective: To evaluate the impact of MST on illicit drug use and drug abuse-related quality of life (QoL). Design: Multicentre, cross-sectional case control study. Setting: Eleven MST programmes in eight European countries. Participants: Heroin dependent patients in MST programmes. Main outcome measures: Data on illicit drug use in the last month and injecting behaviour was extracted from the patient's substance use profile derived from EuroSUD as part of intake and ongoing assessment. The Brief Addiction Recovery Status Scale (EuroSAAQ-BARSS). Results: In Treatment (IT) groups reported a significantly lower number of illicit drugs used in the last month than controls (IT1: t = -6.81, p <.00001; IT2: t = -7.61, p <.00001; IT3: t = -6.32, p <.00001; IT4: t = -10.14, p <.00001). IT patients reported significantly lower rates of injecting than controls IT1 (OR = 0.48, 95%CI = 0.24, 0.95), IT2 (OR = 0.21, 95%CI = 0.12, 0.37), IT3 (OR = 0.43, 95%CI = 0.22, 0.87) and IT4 (OR = 0.27, 95%CI = 0.13, 0.57). They also expressed better drug-abuse related QoL for those patients who had been in treatment for at least 7 months (IT2: t = 4.43, p <.00001; IT3: t = 4.52, p <.00001; IT4: t = 6.22, p <.00001). Furthermore, there was a consistently positive relationship between duration in treatment and QoL scores. Conclusions: MST impacts positively on illicit drug use, injecting and drug abuse-related QoL. MST has been demonstrated as a culture-free and
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2003; 5(1):17-32
Maremmani I., Pacini M., Lubrano S., Lovrecic M.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Via Roma 67, 56100 Pisa, Italy, EU
Summary: In the longstanding diatribe about methadone maintenance, Dole & Nyswander were the first to support the practice of standard methadone treatment with dosages above 100 mg/day. However, several clinicians persisted in their view that lower dosages could provide most patients with significant improvement. Data from the literature strongly support the evidence that 100 mg-maintenance is more effective than that with 50 mg- in treating opiate abuse during the first 5-10 months of treatment. High dosages can be useful, bringing special benefits to patients whose opiate use has proved to be particularly resistant to treatment. Higher dosages may be used where there is a concurrent psychopathology, persistent opiate use or symptoms of incomplete coverage by methadone. Dosages above 100 mg/die, seem to give the best results. Therefore there is no scientific justification for boycotting the use of dosages between 80 and 120 mg/day .
Publication Type: Review Article
Heroin Addiction and Related Clinical Problems 2003; 5(1):33-38
The impact of continuing terror and stress on the use of psychoactive drugs in Israel
Arieli M., Greenspoon A., Glaser J., Blackman S., Kahan N.
Ministry of Health, Pharmacy, Ramla Govt Complex, Hertzel 91, Ramla 72430, Israel
Summary: An unprecedented wave of terrorism has plagued the Israeli population over the last two years. Between September 29, 2000 and October 1, 2002, Magen David Adom recorded a total of 4,535 casualties. Of these, 539 people were killed, 406 severely injured and 554 moderately injured. Among the additional 3,036 people lightly injured were 11 MDA staff members. 3 Fears of random shootings and of human bombs exploding in schools, restaurants, and buses have caused extreme stress in the general population. Because the country is so small, everyone knows a terror victim personally - or knows someone else who does. At the same time, the economic situation, with its rising unemployment, reflects both the reality of war and the international recession. Stress and uncertainty are widespread. This ongoing study explores the assumption that terror, stress and uncertainty influences the prescribing practices of community physicians. Initially, we were interested only in psychoactive drugs, namely anxiolytics, hypnotics and anti-depressants. However, as this pilot study was planned to become part of a larger study done by the Mental Health Services, we then decided to include analgesics, asthma medications and H1 antagonists for hyperacidity and anti-hypertensives We believed that by measuring changes in prescribing patterns and actually measuring the dispensing of these medications, we would also receive a certain picture regarding the coping mechanisms of Israeli society.
Publication Type: Reasearch report
Heroin Addiction and Related Clinical Problems 2003; 5(1):39-46
Okruhlica L., Devinsky F., Klempova D., Valentova J.
CPLDZ Hranicna 2, 82105 Bratislava, Slovak Republic
Summary: ICD-10 criteria have been used for the assessment of opioid dependence and the Fagerstrom Tolerance Questionnaire (FTQ) to assess tobacco smoking. The mean methadone dose was 106 mg (SD=45) in the studied group, after twelve months in the methadone maintenance treatment programme (MMTP). The mean FTQ score was 6.5 (SD+1.8) before entering, 5.6 (SD+2.1) after stabilization in the MMTP (p<0.001) and 3 were non-smokers at the time of the second FTQ testing. No smoking cessation programme has been implemented. The findings do show a tendency for nicotine dependence among patients to fall in their period of stabilization in the MMTP.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2003; 5(1):47-48
Liver cytochrome overexpression in human HCV infection
De Bernardis E., Busŕ L.
SerT di Augusta, Ospedale Muscatello, Contrada Granatiello, 96011 Augusta (SR), Italy, EU
Summary: Publication Type: Letter to editor
Heroin Addiction and Related Clinical Problems 2003; 5(2):7-98
Dual diagnosis heroin addicts. The clinical and therapeutic aspects
Maremmani I., Pacini M., Lubrano S., Lovrecic M., Perugi G.
PISA-SIA (Study and Intervention on Addictions) Group. 'Santa Chiara' University Hospital, Department of Psychiatry, University of Pisa, Italy, EU
Summary: Addiction and other mental disorders interact in various ways. Substance abuse tends to exacerbate psychiatric symptoms, and to induce a more chronic course with fewer and shorter disease-free intervals. It also often prevents the effectiveness of psychoactive therapies. At the same time coexisting mental disorders worsen the course of addiction itself. Mentally ill abusers tend to have a turbulent lifestyle and be prone to risky behaviours. Lastly, the risk of relapse is often heightened to the point of discouraging any therapeutic intervention. In this paper we focus on particularly important aspects of maintenance treatment and delineate guidelines for clinical practice. The authors have taken part in a collaborative effort to develop the field of comorbidity and this paper is built on literature surveys and clinical experiences in their own treatment centre. We suggest that dually diagnosed addicts should first be treated for their addictive disease by using adequate methadone dosages, which can be expected to be higher than those required for the treatment of uncomplicated addicts; stabilization should be considered a medium-term goal. Some dually diagnosed patients may benefit from treatment that targets their addictive problem while taking into account their mental disorder. Apart from their anticraving activity, opioid agonists should be reconsidered as psychotropic instruments for the treatment of mental illness, especially mood, anxiety and psychotic syndromes. Lastly, dually diagnosed addicts are expected to benefit from facilities offered within integrated programmes to the same extent as uncomplicated addicts, once programmes are based on adequate dosages for a sufficient length of treatment.
Publication Type: Overview article
Heroin Addiction and Related Clinical Problems 2003; 5(3):5-12
Maremmani I., Pacini M.
Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy, EU
Summary: Meaningful therapeutic interventions for addictive diseases should be designed with a hierarchy of targets from the very beginning. The ability to target the core symptoms and the underlying dynamics imply a deep knowledge of the clinical picture, the links between observed behaviours and their psychopathological roots. First of all, a distinction should be drawn between habit and addiction, as the former cannot be considered a target for medical intervention. The identification of craving, loss of control over appetitive behaviour, and relapse proneness are crucial to the singling out ot drug addicts within a wider population of drug users. Secondly, addiction should be approached as a relationship between the addict and the substance he is hooked on, as most environmental variables are consequential, and, in any case, aspecific. Effective treatments target the relationship between the individual and the substance from within the addicted patient’s brain. Different strategies may be indicated for the disease process, at its different stages, but all available options do share a common psychopathological target. Moreover, treatments should be planned so as to fit the spontaneous chronic course of addiction, that is, as maintenance programmes.
Publication Type: Point of view
Heroin Addiction and Related Clinical Problems 2003; 5(3):13-22
Structured motivational interventions in methadone maintenance treatment
Kantchelov A., Vassilev G.
National Centre for Addiction, Pirotska 117, 1303-Sofia, Bulgaria
Summary: Improving the quality of services and increasing treatment effectiveness is quite a challenge in addiction treatment, including methadone maintenance. Besides adequate methadone dosing and length of treatment, there is an area that is fundamental but that does not yet seem to have been fully explored. It lies in the nature of the staff-client interaction and style used in meeting with clients. It is these factors that create a programme atmosphere and communicate deeper programme values
Publication Type: Clinical Practice
Heroin Addiction and Related Clinical Problems 2003; 5(3):22-36
Pani P. P., Trogu E., Carboni G., Palla P., Loi A.
SerT AUSL8, Via dei Valenzani, 09131-Cagliari, Italy, EU
Summary: Recent studies have shown that the presence and severity of psychiatric comorbidity in opioid addicts enrolled in methadone maintenance programmes does not interfere with the outcome of treatment evaluated in terms of retention in treatment and heroin use. On this basis we sterted a cohort prospective study, in order to gather information on the impact of psychiatric severity on different outcome indicators of the treatment (retention, craving, use of heroin and cocaine, psychiatric status). The results obtained from the first 78 patients enrolled in the study show no significant differences, in terms of retention in treatment or of heroin amd cocaine use, between patients with high (44% of the cohort) and low (56% of the cohort) psychiatric severity. Regarding psychiatric status, almost all the psychopathological dimensions explored by SCL-90 show a significant reduction in symptoms during the course of the treatment, with a significantly higher improvement in patients with a severe psychopathology. Methadone dose tended to be higher in patients with high psychiatric severity. Moreover these patients had a significantly greater involvement in psychopharmacological treatments. The results of this study are consistent with those of previous ones showing that the severity of psychiatric comorbidity does not substantially alter the efficacy of maintenace methadone treatment
Publication Type: Research Article
Heroin Addiction and Related Clinical Problems 2003; 5(3):37-42
Pisec A.
Centre for Medical Treatment of Addicts to Prohibited Drugs, Zdravstveni Dom Dr. A. Drolca, Ul. Talecev 9 -2000-Maribor, Slovenia
Summary: In the penitentiary institutions of Maribor, over the seven-year period 1995-2002, 154 persons addicted to prohibited drugs were held in preventive custody, or served terms for administrative misconduct, or were being held after a conviction. Work with them was carried out in accordance with: (1) the Penal Law of the Republic of Slovenia - art. 66 on the obligatory medical treatment of alcoholics and drug addicts, (2) the Law on implementing the criminal law sanctions affecting the medical treatment of addicts to prohibited drugs, (3) regulations for the treatment of prisoners addicted to prohibited drugs. Before imprisonment 79 addicts were taking part in the methadone programme; in line with instructions, participation in the programme was ended within a month. All these addicts took part in classic medical detoxification, and in individual and group treatments. For these purposes a social welfare worker, a specialist pedagogist, a psychologist and psychiatrists were included in the team. A statistical review of imprisoned addicts showed that there were many more men (145) than women (9). Only a few prisoners were first-time offenders. Epidemiological results: (1) None of addicts examined were infected with the HIV virus. (2) 31 patients were infected with the hepatitis C virus. (3) In 31 cases no results were available (due to patients’ refusal to be examined). (4) Comorbidity affected 60 patients (10 cases of psychosis, and 50 of personality disturbances). Work with imprisoned addicts is specific and difficult; it requires a great deal of knowledge and experience. We are guided by the idea that our task is to help these patients, while all the other data connected with them are irrelevant to us.
Publication Type: Report to EUROPAD
Heroin Addiction and Related Clinical Problems 2003; 5(3):43-52
Clinical picture and treatment of psycho-organic syndrome in drug addicts
Kozlov A. A., Rokhlina M. L., Tchistyakova L. A., Dvorina L. D.
National Research Center on Addictions (NRCA), Stavropolskaya st 27-7, Moscow, Russia
Summary: Objective: To study the clinical picture and treatment of psycho-organic syndromes in drug addicts. Subjects and methods: 100 patients addicted to various drugs. Cerebrolysin was administered by intramuscular injection in 5 ml doses twice per day to 49 patients on the 14-20th day after the most recent drug use. Results: The clinical picture may be defined as “organic decline of the personality with desocialization”, or as a specific psycho-organic syndrome induced by drug consumption. We therefore considered the administration of the peptidergic substance Cerebrolysin potentially useful. Conclusion: Administration of cerebrolysin improves attention and concentration functions, makes intellectual processes more active, and promotes stable, positive emotions.
Publication Type: Research Article