Heroin Addiction and Related Clinical Problems 2006; 8(1):5-10
Parrino M.
Address for reprints: Mark W. Parrino, President of American Association for the Treatment of Opioid Dependence. 217 Broadway, Suite 304, New York, NY 10007 USA. Phone: 212 56-5555, Fax 212 349-2944, e-mail: AmerMeth@aol.com
Summary: Not available
Publication Type: Editorial
Heroin Addiction and Related Clinical Problems 2006; 8(1):11-24
Heroin dependence in the Russian Federation: the current situation
Kozlov A. A., Perelygin V. V., Rohlina M. L., Vyshinsky K. V.
Address for reprints: Alexander A. Kozlov, MD - Federal Center on Medical and Social Expertise (FCMSE) -Ivana Susanina St. 3, Moscow, Russian Federation
E mail aakozlov@inbox.ru
Summary: This article reviews the current situation surrounding heroin addiction in the Russian Federation; it describes the epidemic patterns associated with that addiction, including their negative impact and complications (HIV, hepatitis, asocial behaviour, mortality). The need to search further for effective integrated approaches to prevention, treatment and rehabilitation is demonstrated with reference to the attitudes of progressive scientists, to the historical experience of Russian addictive psychiatry and to the recommendations of the WHO. The proposal is made that there should be an ongoing search for a differentiated approach and for appropriate criteria to be adopted in integrated treatments of HIV infection and other socially significant consequences of drug addiction; these will call for discussions on substitution therapy.
Publication Type: Research report
Heroin Addiction and Related Clinical Problems 2006; 8(1):25-30
Klempova D., Okruhlica L.
Address for reprints: Danica Klempova, Institut drogovych zavislosti Centra pre liecbu drogovych zavislosti, P.O. BOX 51, 827 99, Bratislava, Slovak Republic. Telephone: +421 2 5341 74 75. E-mail: klempova@pobox.sk, okruhlica@cpldz.sk
Summary: The aim of the present study is to explore the maturity of neonates of women who had conceived while being stabilized on methadone and who remained stabilized throughout their pregnancies. The sample comprised ten women and their neonates. All the neonates were eutrophic and nine of them were full-term. Mean birth weight of the neonates was 3,193 g. None of the measures of maturity differed from the data for the general population. The results obtained do not indicate any negative effect of methadone alone on neonatal maturity.
Publication Type: Research Article
Heroin Addiction and Related Clinical Problems 2006; 8(1):31-48
Effectiveness of buprenorphine in double diagnosed patients. Buprenorphine as psychothropic drug
Maremmani I., Pacini M., Pani P. P.
Address for reprints: Icro Maremmani, MD - Department of Psychiatry NPB, University of Pisa, Via Roma 67- 56100 PISA, Italy - E-mail: maremman@med.unipi.it
Summary: Opiate drugs were first proposed for the treatment of dysphoric syndromes, depression and psychoses many years ago. Even so, the usefulness of these compounds in psychiatry is supported by only a small corpus of data. The reasons given for the restrictions placed on opiate use are based on prejudice rather than scientific evidence. Buprenorphine, with its unique pharmacological profile, has proved to possess antidepressant, anti-dysphoric and antipsychotic properties in small groups of psychiatric patients. Moreover, it may turn out to be the opiate of choice in subjects affected by lower severity addiction coupled with dysthymic disorders, anxiety disorders and personality disorders. The best dosages appear to be those that ensure a combination of k-antagonism with high levels of µ-mediated stimulation.
Publication Type: Review Article
Heroin Addiction and Related Clinical Problems 2006; 8(2):5-22
Say “Yes” to Methadone and Buprenorphine in Russian Federation
Maremmani I., Pacini M., Pani P. P., Parrino M.
This paper is a comeback to the pubblication in Russian Federation of a paper titled "Say No to Methadone in Russia (see appendix A). For further informations, please, contact AATOD\EUROPAD e-mail <Mark.Parrino@aatod.org><aucns@libero.it>
Summary: The medical community has determined that narcotic addiction is a chronic and relapsing medical disorder, which is effectively treated with medications. The success rate of patients, who are treated with medications, such as methadone and buprenorphine, when combined with other needed treatment services, improves the health of the patient.
Methadone and buprenorphine are the most exhaustively studied medications for the treatment of any disease. More than 40 years of research and clinical practice have repeatedly demonstrated its efficacy in millions of patients throughout the world. An objective observer might argue that it is irresponsible not to use such medications to treat narcotic addiction in an age of HIV infection, hepatitis-C and other developing co-morbidities
Publication Type: Positional paper
Heroin Addiction and Related Clinical Problems 2006; 8(2):23-35
Dolzhanskaya1 N. A., Bouzina T. S., Kozlov A. A., Sarang A.
Central and Eastern European Harm Reduction Network, Coordinator. anya@ceehrn.org, Tel: +7 1851703, Mobile: +7 916 1689062
Summary: Illicit drug use and HIV has spread rapidly in Russia, with 75% of HIV cases attributed to heroin and opiate IDU. The integration of drug treatment and HIV services would ensure access to HIV prevention and treatment for IDUs, but so far this has not happened. A series of interviews and focus groups reveals the attitudes of drug treatment specialists to the risks run by their patients, together with those specialists’ knowledge of the issues involved; these data make clear the opportunities that exist to integrate HIV services. We recommend better training in HIV issues such as principles of HIV counselling, harm reduction and substitution treatment. Measures to ensure access to HIV information and care within drug treatment settings and better research on these issues are an important priority.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2006; 8(2):37-46
Lawental E., Eshkol D.
Dr. Eli Lawental (D.S.W.) – Director, Haifa Drug Abuse Treatment Centre, Rambam Medical Center and Senior Lecturer, Haifa University Faculty of Health and Welfare Studies. Address: 26 Hageffen Street, Haifa, Israel.
Phone: 04-8523382. Fax: 04-8517471. E-mail: Lawental@netvision.net.il
Summary: Purpose: This study evaluated, for the first time, the effectiveness of a voucher-based contingency management programme (CMP) with a population of methadone-maintained patients outside the U.S.A. The study reported was carried out at the Haifa Drug Abuse Treatment Centre in Israel. The population studied differed culturally from previously studied groups in the U.S.A. Vouchers were given to patients upon providing a urine test that was negative for illicit drug use. With the accumulation of three consecutive vouchers subjects could redeem one for one take home dose. After the accumulation of five or more consecutive vouchers subjects were able to redeem two for two consecutive take-home doses. Method: Two groups of subjects were evaluated in this study. In the first group, subjects (n = 35) treated prior to the initiation of the CMP were included. These subjects provided 455 urine samples in the three months prior to the CMP. In the second group, subjects (n = 41) treated after initiation of the CMP were included. A three-month period was allowed for the Centre to adjust to the new CMP. Subjects in the “post” group provided 554 urine samples in the three months following this period. No statistically significant differences were noted between the groups with reference to their pre-treatment characteristics and the length of time subjects stayed in treatment. Results: The post CMP group showed an improvement in providing samples free of illicit substance abuse. An improvement of 36.3% was noted. The post group also had 47.1% more stable-on-methadone subjects. Conclusions: This study supports the claim that such a CMP may be effective in reducing illicit drug abuse in the Israeli methadone-maintained patient population. As the sample of this study is relatively small and no attempt was made to identify a specific group of Israeli patients that may benefit even more from this type or other types of CMP, additional studies are needed.
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2006; 8(2):47-49
Remy A. J., Serraf L., Galinier A., Hedouin V., Gosset D., Wagner P.
andre.remy@ch-perpignan.fr
Summary: Background: A French survey of 85 jailhouses in 2000 yielded disappointing results on the diagnosis and treatment of hepatitis C (HCV) in inmates: serology was available for 2/3 of the patients, but only 36% had undergone liver biopsies (LB) and only 4% had been treated. LB access was identified as an obstacle to therapy. This prospective study (POPHEC) was designed to increase treatment access in this population. Methods: 37 medical units in French jailhouses participated. Patients were all to be treated with a combination of pegylated interferon alpha 2b and ribavirin. LBs were optional. Biochemical, virological and clinical data were collected. Therapy and data collection continued for patients who were transferred. In cases where final data were unavailable, patients were classified as non-responders. Results: As of 1st June 2004, 200 patients were analysed: 94% were male, mean age 37 years, contamination route IVDU in 78%, transfusion in 3%. The genotype was 1a, 1b, 3a and 4 in 28%, 11%, 36% and 7%, respectively; 12% were also infected with HIV; 37% were treated with methadone or buprenorphine. The average viral load was 1227689 IU/mL; 33% had LB before treatment, with a mean Metavir score of A1.8 F1.73. The mean treatment duration ranged between 4 months in patients with early termination due to non-medical reasons and 7 months for patients who completed therapy; 95 patients (47.5%) experienced a complete sustained response). Conclusion: treatment for HCV in jailhouses is feasible and sucessful; the limitations placed on indications for LBs, as recommended by the 2002 French consensus conference, apply specifically to the inmate population and facilitate access to HCV therapy, besides helping initiatives such as POPHEC
Publication Type: Research Report
Heroin Addiction and Related Clinical Problems 2006; 8(2):51-54
Martin-Soelch C.
Dr. Chantal Martin-Soelch, Department of Psychology, University of Basel, Missionsstr. 62 A CH-4055 Basel Switzerland Tel: +41 (0)61 267 35 23 FAX: +41 (0)61 267 35 26 E-Mail: chantal.martin@unibas.ch
Summary: The functioning of reward in drug addicts is a major issue both in terms of pathophysiology and in a rehabilitative view. We used a PET imaging device to assess the hedonic functioning of methadone maintained heroin addicts, compared to control subjects, by two modalities: 1) the elicitation of interest by anticipated monetary reward; 2) the neuroimaging correlates of visually elicited pleasure. In heroin addicts fewer brain regions showed activated during tasks implying known monetary reward in comparison to tasks without any reward. On the other hand, the processing of subjectively pleasant videoclips resorted to different brain pathways in heroin addicts. Heroin addicts seem to show a lower level of anticipatory sensitivity to monetary reward, whereas the topography of pleasure-feeling seems to be different from normal subjects’. Such results show a different reward-seeking and reward-feeling status of methadone maintained heroin addicts, although it is to be clarified whether such a status was also forerunning heroin use, or developed as a correlate of addiction.
Publication Type: Review article
Heroin Addiction and Related Clinical Problems 2006; 8(3):5-10
Forty years of Methadone Maintenance Treatment around the world: past, present and future
Maremmani I.
Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
E-mail: maremman@med.unipi.it
Summary: Not available
Publication Type: Editorial
Heroin Addiction and Related Clinical Problems 2006; 8(3):13-36
Methadone and Treatment Quality. The EFQM Excellence Model
Flego A.
Dipartimento per le Dipendenze, Via Interna, 5 Pordenone, Italy. Phone +39 0434 208027 e-mail: andrea.flego@ass6.sanita.fvg.it
Summary: In the technologically advanced world, providers of products and services have
been dealing with the problem of quality, of how to assess its level, and of how
to improve it continuously and systematically for many years. Therefore, this
aspect cannot be eluded when scientifically planning and practically organizing
a methadone treatment program. The treatment with methadone, although it is
safe and relatively easier than others, is still at the centre of a great controversy.
This is mainly due to the fact that the controversy lies in the basic reasons of
the treatment with methadone rather than in the effectiveness of this treatment.
The search for quality is a never-ending, dynamic process, and excellence itself
is not definitive. It is a circular process that has to progressively improve the
performances but also to defend itself from the natural entropy of not-managed
situations (it has to continually introduce “negative entropy”). This process
has to continually take into consideration innovations and new knowledges or
‘scientific evidence'
Publication Type: Review article
Heroin Addiction and Related Clinical Problems 2006; 8(3):37-48
Treatment of chronic hepatitis C virus infection in intravenous drug addicts: State-of-the-Art
Guadagnino V., Trotta M. P., For the Nocchiero Study Group
Prof. Vincenzo Guadagnino, Chair of Infectious Diseases. University “Magna Graecia” of Catanzaro, Viale Europa (Localitŕ Germaneto), 88100 Catanzaro, Italy. E-mail: vguadagnino@unicz.it
Summary: Injection drug users (IDUs) are the largest group of people infected with the hepatitis C virus, and the group among whom most new infections occur. Treatingchronic hepatitis C in IDUs is important at an individual level and from a public health perspective. Treatment with a combination of pegylated interferon and ribavirin eradicates the virus in a high percentage of patients depending on the HCV genotype. Unfortunately, HCV-positive IDUs are rarely offered this treatment because of their assumed lower compliance with treatment, psychiatriccomorbidities, social discomfort and the risk of reinfection. However, there is increasing evidence that IDUs treated for HCV infection can achieve a sustained virological response comparable to that of non-IDUs. It has also been shown that drug addicts with HCV infection can benefit from anti-HCV treatment if it is given within the framework of a multidisciplinary standardized model of care. In this scenario, prospective clinical trials are warranted to establish new guidelines for the treatment of HCV infection in patients with drug dependence.
Publication Type: Review article
Heroin Addiction and Related Clinical Problems 2006; 8(4):5-8
Maremmani I., Pacini M.
Address for reprints: Icro Maremmani, MD; Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy. Phone: +390584790073 Fax: +39058472081 E-mail: maremman@med.unipi.it
Summary: Not available
Publication Type: Editorial
Heroin Addiction and Related Clinical Problems 2006; 8(4):9-28
In the Service of Patients: The Legacy of Dr. Dole
Joseph H., Woods J. S.
Address for reprints: Herman Joseph, Board of Directors, National Alliance of Methadone Advocates (NAMA), 435 2nd Ave. New York, NY 10010, USA
Summary: The underlying theme in Dr, Vincent P. Dole’s work is the effect of metabolism on behavior. This led to ground breaking investigations at The Rockefeller University in electrophoresis, lipids, obesity, addiction, and the development of methadone maintenance in 1964 with his late wife, Dr. Marie E. Nyswander. Dr. Mary Jeanne Kreek, a research resident in his laboratory in 1964, is now continuing addiction research as a professor at Rockefeller. Dole developed methadone detoxification in the New York City jail system and office based methadone medical maintenance with Nyswander. His major concern was to resolve the stigma that methadone patients encounter.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2006; 8(4):29-40
Injecting Buprenorphine Tablets: A Manageable Risk
Reisinger M.
Address for reprints: Marc Reisinger, European Opiate Addiction Treatment Association, 193 Avenue Louise, 1050 Brussels, Belgium, EU. Phone\Fax: +322 640 46 28 Mobile +32 475 57 15 44 E-mail: reisinge@tiscali.be\m.reisinger@worldonline.be
Summary: Buprenorphine for the treatment of heroin addicts was launched on the French market in February 1996. Ten years on, more than 85,000 patients are undergoing this treatment and most reports are positive. However, it has been observed that a certain proportion of patients are using buprenorphine inappropriately. Instead of taking buprenorphine sublingually, as prescribed, these users crush tablets to inject them3. This practice of injection also involves individuals not undergoing this treatment. The same problem of buprenorphine diversion and injection has been observed in several other countries, like England, Scotland, Ireland, New Zealand, Australia, Finland and the Czech Republic. Given the reported substantial benefits of buprenorphine for individuals and for public health generally, it is important to analyse the problem of buprenorphine injection to get a better understanding of the origins of this problem, its incidence, consequences, causes and remedies.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2006; 8(4):41-52
QTc Prolongation in Methadone Maintenance: Fact and Fiction
Schmittner J., Krantz M. J.
Address for reprints: Mori J. Krantz, MD FACC, Denver Health Medical Center, Cardiology Division, Mail Code 0960, 777 Bannock Street, Denver CO 80204-4507. Phone: 303-436-7818 Fax: 303-436-7739 E-mail: Mkrantz@dhha.org
Summary: Methadone is an effective treatment for opioid dependence- and, until recently, was viewed as a medication without cardiac properties. High-dose therapy has been linked to prolongation of the rate-corrected QT interval (QTc) and torsade de pointes (TdP), a form of ventricular tachycardia requiring QTc prolongation. To date, only one prospective study has demonstrated a modest increase in QTc with methadone. Arrhythmia risk is related to the magnitude of the QTc change from baseline. Clinicians should be aware of methadone’s potential cardiovascular effects and weigh the benefit-to-risk ratio for each patient, based upon individual risk for arrhythmia.
Publication Type: Review
Heroin Addiction and Related Clinical Problems 2006; 8(4):53-64
Gossop M.
Address for reprints: Professor Michael Gossop, Head of Research, National Addiction Centre. Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London, SE5 8AF. E-mail: m.gossop@iop.kcl.ac.uk
Summary: This paper looks at the applications of methadone in day-to-day clinical practice. It reviews the evidence of effectiveness, including those areas in which the outcomes of methadone treatment are less satisfactory. Although the majority of patients respond well to methadone maintenance, about one in four tends not to respond well to treatment. An important question is how to achieve a better understanding of the reasons why patients respond or fail to respond to methadone treatment. The paper considers some ways in which methadone treatments could be strengthened.
Publication Type: Review