Heroin Addiction and Related Clinical Problems 2008; 10(1):7-14
Sexual Behaviour of Heroin Addicts In Treatment
Brajevic-Gizdic I., Pletikosa M.
Correspondence: Brajevic-Gizdic Igna, MD, Boticevo setaliste 1, 21 000 Split, Croatia. Telephone: 00358 21 217 979, E-mail: igna.brajevic-gizdic@st.htnet.hr
Summary: Addicts are a high risk group for diseases transmissible sexually or through the blood. Their pathological behaviour caused by addiction makes it a priority to collect information about the sexual conduct of addicts, especially those who are trying to cure themselves. It is important to get results about how they assess the risks related to certain kinds of behaviour and how they see the need to be educated about the issue. The aim of this study is to determine the sexual behaviour patterns of heroin addicts who have already begun treatment, while getting insights into how they assess the risks associated with being sexually active, and whether they need to be informed about the whole issue. According to the survey, heroin addicts displayed an uncritical attitude towards the risk assessment of their sexual behaviour and failed to understand that they need to be informed about protection.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):15-20
First Experience of Opioid Therapy with Buprenorphine in Ukraine
Dvoryak S., Grishayeva I.
Correspondence: Sergey Dvoryak, MD, Ukrainian Institute on Public Health Policy, Kiev, Ukraine 53/30 Bozhenko Str., Apt 15 Kiev, 03150 Ukraine. Tel.: +38 044 537 6415. E-mail: dvoryak@uiphp.org.ua
Summary: Ukraine is the country that has the highest rate of HIV/AIDS among IDUs in Europe. The development of opioid maintenance treatment for opioid users is an important public health issue.The earliest utilization of buprenorphine for OMT was made in 2004-5, within the framework of the UNDP Applied Human Rights Project. It was accompanied by research which was a part of the WHO Collaborative Study on Opioid Treatment of Opioid Dependence and HIV/AIDS. There were 67 opioid drug users under observation. This was a prospective observational study with assessments at baseline, and at 3- and 6-month follow-ups. All assessments refer to the period of one month prior to interview. The main aims of outcome evaluation were to explore changes in the following domains: health status and well-being of individuals in opioid treatment; community/social benefits and also programme performance. Improvements in the main indicators were documented after 6 months of treatment. The retention level was 66% and the mean buprenorphine dose was about 8 mg/day. The main conclusion is that buprenorphine treatment is effective in the context of Ukrainian social conditions.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):21-26
Administration of Nalbuphine to Heroin Addicts. Feasibility and Short-Term Effects
Voronkov M., Ocheret D., Bondarenko S., Yu Y. I., Koren S.
Correspondence: Sergey Koren, MD, AIDS Foundation East-West, 15/5 Chayanova St., Moscow 125047 Russia. E-mail: psycab@rambler.ru
Summary: Kappa opioid agonists attenuate some of the neurochemical and behavioural effects of opiates and are under consideration as potential treatments for opiate dependence. We have shown that mixed kappa-agonist mu-antagonist nalbuphine (0.25 mpk im b.i.d.) was effective in reducing opiate consumption in 29 patients with a broad range of ages (29.4±6.4 years) and with a long history of substance abuse (9.3 ±3.6 years). Administration of nalbuphine for at least 14 days, up to at most 6 months, on an outpatient basis, led to a dramatic fall in the consumption of heroin and other totally illicit substances, along with a decline in criminal behaviour, as well as a higher level of retention of patients in the study, but also to improvements in patients’ quality of life. Nalbuphine was safe, effective and highly compatible with the traditional therapy used to combat opiate addiction in Russia. Nalbuphine can also be used to stabilize HIV-positive patients. The study showed that both the current Russian medical infrastructure and medical professionals themselves could successfully contribute to the long-term agonist-antagonist treatment of patients with opiate addiction. We believe that our study warrants the further investigation of nalbuphine in treating opiate addiction.
Publication Type: Preliminary Communication
Heroin Addiction and Related Clinical Problems 2008; 10(1):27-40
González-Saiz F., Rojas O. L., Gómez R. B., Acedos I. B., Martínez J. G., Collantes M. A. G., Fernández A. L., Serum Methadone Levels Study Group
Correspondence: Francisco González-Saiz, Fundación Andaluza para la Atención e Incorporación Social (FADAIS), Avda Hytasa, edificio Toledo II. Plt. 3ª. 41006. Sevilla, Spain, EU. E-mail: pacogonzalez@comcadiz.com
Summary: Introduction: The testing and adjusting of methadone dosing is a clinical procedure that must be individualized to meet the needs of each patient. So far no evidence has been published of a tool capable of providing a global measurement of dose adequacy. For this reason, we have devised the Opiate Dosage Adequacy Scale (ODAS), which is intended as a means of implementing a theoretical construct called ‘dose adequacy’. Aim: To provide evidence of the reliability and validity of the ODAS. Methods: The study was carried out on a total of 300 patients on MMT, randomly selected from 10 public out-patient drug abuse treatment centres. We used ODAS, Addiction Severity Index (ASI), Outcomes Clinical Impression Form (OCIF) and laboratory tests (serum methadone levels, serum EDDP levels, serum a-1 acid glycoproteins levels [AAG] and urinanalysis). Results: Internal consistency for the ODAS was acceptable (a Cronbach = 0.70). Very high inter-rater reliability was found across items (kappa values between 0.95 and 1). The factor analysis yielded a four factor structure exactly coinciding with the dimensions of the ‘dose adequacy’ construct proposed a priori (‘opiate withdrawal syndrome’ ‘craving’ ‘overmedication’ and ‘drug use’. As far as construct validity is concerned, methadone dose adequacy as measured by the ODAS was correlated with clinical stabilization variables (heroin use, OCIF, ASI), while neither the methadone dose nor SML values correlated significantly with these variables. Conclusions: This study provides sufficient evidence for the reliability and validity of the ODAS as a tool for measuring methadone dose adequacy. The results of the construct validity test support the hypothesis put forward by several authors that an individualized clinical assessment of methadone dose adequacy is better able to account for a patient’s condition than either the methadone dose or the patient’s serum level.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):41-48
Maremmani I., Pani P. P., Popovic D., Pacini M., Deltito J., Perugi G.
Correspondence: Icro Maremmani, MD; Vincent P. Dole, Dual Diagnosis Unit, Santa Chiara University Hospital,
Department of Psychiatry, University of Pisa, Via Roma,67 56100 PISA, Italy, EU. Phone +39 0584 790073 Fax +39 0584 72081, E-Mail: maremman@med.unipi.it
Summary: The main goals of opioid treatment in heroin addiction is to eliminate or reduce the use of heroin and other substances of abuse, to promote patients’ social rehabilitation and to improve their quality of life. The purpose of this study is to evaluate the efficacy of buprenorphine and methadone on the quality of life of patients. These subjects were sampled on the basis of the same severity of illness and the same impairment of quality of life at the start of treatment. 50 patients (41 male and 9 female) in buprenorphine treatment and 83 patients (63 males and 20 females) in methadone treatment, were evaluated regarding their retention in treatment, the use of substances, their clinical improvement and their quality of life over a one year period. In markedly ill patients buprenorphine and methadone both successfully and similarly reduce substance abuse and the severity of illness. Patients treated with buprenorphine show a better improvement of quality of life especially regarding improvements in jobs, leisure activities, income and self-acceptance. We conclude that Buprenorphine is a good choice for markedly ill patients with severe impairment in their quality of life parameters.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):49-56
Methadone: A Fast and Powerful Anti-anxiety, Anti-depressant and Anti-psychotic Treatment
Deglon J. J., Wark E.
Correspondence: Jean-Jacques Deglon, MD, Fondation Phénix, Route Chene 100, case postale 215 - 1224 Chene-Bourgeries, Geneve, Switzerland - E-mail: jjdeglon@gmail.com
Summary: Not Available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2008; 10(1):55-56
Explaining Agonist Treatment Through Movie Language: The Interesting Allegory of ‘Videodrome’
Pacini M.
Correspondence: Matteo Pacini, MD, "G. De Lisio" Institute of Behavioural Sciences, Via di Pratale, 3 - 56127-Pisa, Italy, EU. E-mail: paciland@virgilio.it
Summary: Not Available
Publication Type: Letter to the Editor
Heroin Addiction and Related
Clinical Problems 2008; 10(2):5-10
Uchtenhagen
A., Stevens A., Berto D., Frick U., Hunt N., Kerschl V., Mcsweeney T., Puppo
I., Santamaria A., Schaaf S., Steffan E., Gegenhuber B., Turnbull P., Werdenich
W.
Correspondence: Prof. Ambros
Uchtenhagen, MD, PhD - Kirchgasse 30 - CH-8001 Zurich, Switzerland. Tel.
+41-44-252 71 02, E-mail: uchtenhagen@isgf.uzh.ch
Summary: A multi-country, multi-site comparative research study has
documented the feasibility of recruiting drug-dependent individuals receiving
treatment as an alternative to imprisonment (‘quasi-compulsory’ treatment, in
the setting of an experimental group), while comparing them with those receiving
treatment in the same therapeutic institutions, on a voluntary basis (control
group). The study combined qualitative and quantitative methods in describing
the evolution and outcome of each case after 6, 12 and 18 months in treatment.
845 probands were recruited from 9 sites in 5 countries (Austria, Germany,
Italy, UK, Switzerland), 429 in the experimental and 416 in the comparison
group. Data were collected using a standardized instrument set and following a
joint protocol that allowed for the testing of a number of pre-established
hypotheses. Significant reductions in drug use and delinquent behaviour,
together with improvements in social integration and health, were found in both
groups. Higher rates of perceived external pressure to stay in treatment in the
experimental group did not affect motivation of these patients as regards
improvement and retention in the study. It can be concluded that the
availability of treatment alternatives to imprisonment for drug dependence are
a valuable policy option, under various different conditions, but that this
option is open to further improvement.
Publication Type: Regular Article
Heroin Addiction and Related
Clinical Problems 2008; 10(2):11-20
Motivational
interventions for Methadone-Treated patients
Kantchelov
A.
Correspondence: Alexander
Kantchelov, MD, The Kantchelov Clinic, 102 - B, D.Hadjikocev Str., Office N.6,
1421 Sofia Bulgaria, EU- E-mail: al.kantchelov@gmail.com
Summary: Implementing a motivational approach in MMT acts as a powerful
resource in influencing in a positive way the dominant programme atmosphere,
staff-client interactions, quality of services and programme functioning as a
whole. There are various ways in which motivational interventions can be
successfully applied in MMT. The evidence to date is very encouraging in
suggesting that even brief interventions can enhance client motivation and
trigger significant improvement and change. The use of these promising methods
in the future will depend on the creativity of clinicians and researchers in
adopting, adapting and evaluating motivational interventions to make them more
widely and effectively implemented in MMT clinical practice for the good of our
clients.
Publication Type: Review
Heroin Addiction and Related
Clinical Problems 2008; 10(2):21-26
Health care utilization and
morbidity associated with Methadone and Buprenorphine
Treatment
Bell J.,
Butler B.
Correspondence: Dr. James Bell,
The Langton Centre, 591 South Dowling St., Surry Hills NSW 2010, Australia -
E-mail: James.bell@sesiahs.health.nsw.gov.au
Summary: Background: Methadone and buprenorphine treatment reduce the high
mortality associated with heroin addiction, but even in-treatment, Standardised
Mortality Rates are high. Aim: This study investigates the nature of morbidity
associated with methadone and buprenorphine treatment, and investigates
predictors of health care utilization among people in a variety of treatment
settings. Methods: Collation of data from earlier studies, and from published
reports. Findings: In a recent study of an entry cohort, the SMR was 5.52
[4.62, 5.65]; suicide and overdose accounted for 2/3 of the mortality, but
allowing for this, mortality rates remain elevated. Cancer, heart disease and
respiratory disease were the three major contributors to mortality. Taken in
conjunction with a recent study of medical co-morbidity, this suggests that
alcohol, tobacco and other drug use represent the major factors contributing to
serious illness in treated opioid addicts. In addition, side-effects of
treatment may themselves contribute to some morbidity. Lack of access to health
care does not appear to be a contributing factor, as opioid users consult
doctors (other than their methadone doctors) at rates far higher than the
general population. Predictors of doctor attendance “outside” doctors were
psychological distress, and benzodiazepine use. Adjusting for these factors, we
found evidence that quality of methadone treatment was a significant predictor
of doctor attendance, with better clinical care being associated with less
outside doctor attendance. Conclusion: There is a paradox; heroin users have
significant physical illness, but their attendance for health care tends to be
driven by psychological distress, and can be improved by good care within
treatment programs. The priority in addressing health problems of stabilised
heroin users is dealing with alcohol and tobacco problems.
Publication Type: Review
Heroin Addiction and Related
Clinical Problems 2008; 10(2):27-38
Michelazzi
A., Vecchiet F., Leprini R., Popovic D., Deltito J., Maremmani I.
Correspondence: Icro Maremmani,
MD, “Vincent P. Dole” Dual Diagnosis Unit. “Santa Chiara” University Hospital,
Department of Psychiatry, University of Pisa, Via Roma, 67 56100 PISA. Phone:
+39 0584 790073; Fax: +39 0584 72081; E-Mail: maremman@med.unipi.it
Summary: Objective: To evaluate the effectiveness of methadone treatment
carried out by General Practitioners (GPs) and to identify response treatment
factors. Methods: 33 subjects with heroin addiction according to the DSM-IV-R
criteria , 25 males and 8 females with an average age of 26 ± 6 years, were
placed in an observational protocol with average duration of 429 ± 273 days.
Retention rate, substance use, overall clinical improvement, social adaptation,
quality of life and psychopathologic symptoms were used as outcome measures. In
order to assess predictors of treatment response dropout and non-dropout
subjects were compared at baseline. Results: At the end of the observational
period, 6 patients (18.2%) had a positive outcome, 8 (24.2%) negative outcome,
while 19 (57.6%) were still in treatment with a cumulative retention of 60% at
the end of the third year of observation. In 25 non-dropout patients
baseline-endpoint improvement results were statistically significant for
substance use, global clinical evaluation, psychological, social and
occupational functioning, and craving. They also showed improvement in all of
investigated psychopathological and quality of life dimensions. There were no
significant side effects associated with their treatment. Patients with higher
severity of illness, with problematic relationships with spouse/partner, difficulty
with socialization and organization of leisure, with an altered mental state at
beginning of treatment, subjects with dual diagnosis (especially bipolar
disorder), with greater severity of obsessive-compulsive symptoms,
interpersonal sensitivity, depression, violence, with greater severity of
psychopathological symptoms, with the largest number of problematic areas as
regarding the quality of life, patients with a low dose of methadone given for
treatment were considered most at risk for abandoning treatment. Conclusions:
Methadone treatment carried out by General Practitioners appears safe and
effective, especially in less severe patients treated with adequate doses,
without severe psychopathology, without dual diagnoses (particularly bipolar
disorder) and with quality of life impairment only in limited areas.
Publication Type: Regular article
Heroin Addiction and Related
Clinical Problems 2008; 10(2):39-40
Use of Sertraline in
depressed methadone maintenance patients
Trajanovska
A. S., Popovska O. S.
Summary: Not Available
Publication Type: Letter to the Editor
Heroin Addiction and Related
Clinical Problems 2008; 10(3):5-12
When a New Drug Promotes
the Integration of Treatment Modalities: Suboxone and Harm
Reduction
Maremmani
I.
Correspondence: Icro Maremmani,
MD, “Vincent P. Dole” Dual Diagnosis Unit, “Santa Chiara" University
Hospital, Department of Psychiatry, University of Pisa, Italy, Via Roma, 67,
56100 - Pisa, Italy, EU.
E-mail: maremman@med.unipi.it,
Telephone: +39 0584 790073, Fax: +39 0584 72081.
Summary: In medicine, the introduction
of a new drug is often associated with an overall enhanced understanding of the
clinical issues that originally stimulated its own development. Sometimes newer
drugs must be introduced to counter the improper use of existing drugs. In this
paper, we discuss some concepts regarding the pharmacotherapy of heroin
addiction (regarding blocking dosages and stabilization dosages), the
advantages and disadvantages of opioid agonists in the pharmacotherapy of
heroin addiction, the role of motivation for harm reduction strategies, the
difficulties of methadone, buprenorphine, naltrexone and naloxone use in harm
reduction strategies, and the possible use of buprenorphine-naloxone
combination in harm reduction strategies. A buprenorphine-naloxone combination
is not only a clinical improvement over pre-existing treatments, but it also
represents a good example of a drug designed to limit the misuse of another
resulting in the integration of different modalities of intervention,
previously believed to be in opposition.
Publication Type: Regular article
Heroin Addiction and Related
Clinical Problems 2008; 10(3):13-24
Pseudo-Addiction: The
Illustrative Case of Howard Hughes
Tennant
F.
Correspondence: Forest Tennant
M.D., Dr. P.H. Veract Intractable Pain Centre 338 S. Covina, CA 91790, USA,
Phone: 888-919-7476; E-mail: veractinc@msn.com
Summary: While the need for chronic pain
treatment is evident by epidemiologic surveys from many countries, countless
persons continue needless suffering due to lack of pain treatment. One is a
bias against opioid drugs, and the false belief that persons who take opioids
are “addicts”. Modern definitions essentially relegate the term “addict” to
persons who take opioids for non-pain purposes. The term “pseudo-addiction” is
now the term properly used for those persons who seek pain relief by
patronizing a variety of sources to obtain opioids because they lack a regular,
medical source of treatment with opioids. Perhaps the most famous
“pseudo-addict” was Howard Hughes. He was involved in a plane crash in 1946 and
suffered severe chronic pain as a result of facial and neck fractures and third
degree burns of the upper torso. His subsequent post-trauma neuropathies are
now commonly referred to as Reflex Sympathetic Dystrophy. They were so severe
that he often could not brush his teeth, comb his hair, shave, or wear clothes
or shoes. He survived 30 years taking about 200 mg equivalent of morphine a day
for pain control. At this time the author is treating a cohort of severe,
chronic pain patients who have taken high, daily opioid dosages for 20 to 30
years. As did Howard Hughes, these patients lead high quality, productive lives
despite high dose opioid treatment. Severe, chronic pain, per se, and unrelated
to its underlying cause, has life shortening and debilitating complications
that are caused by uncontrolled electrical conduction, excess sympathetic
discharge in the autonomic nervous systems, and excess pituitary-adrenal
hormone secretions. Pseudo-addicts are easy to clinically differentiate from
bonafide opioid addicts and treatment facilities should differentiate between the
two. We need a world wide humane movement to provide life-time, opioid, medical
management for persons afflicted with severe, chronic pain that can only be
controlled by opioid drugs.
Publication Type: Regular article
Heroin Addiction and Related
Clinical Problems 2008; 10(3):25-32
The Under-Treatment of
Pain: A Global Problem. An Educational Approach
Buttfield
I.
Correspondence: Ian Buttfield,
MB BS: MD: FRACP: FRACMA. Chairman, International Association for Pain and
Chemical Dependence - 90 Unley Rd, Unley, South Australia 5091, Australia.
Phone 61-8-8267-3618, E-mail:buttfield@ozemail.com.au
Summary: In order to undertake
comprehensive pain treatment, acute and chronic, all prescribers are required
to understand opioid medication, and to appreciate the phenomenon of addiction.
Throughout the world there is a major concern with under treatment of pain.
This paper aims to assist health professionals in their efforts to treat
patients’ pain effectively. It also outlines medications available for use, typical
patient situations and strategies for intervention to relieve pain. Barriers to
pain treatment are reviewed, in both developed and developing nations.
Publication Type: Regular article
Heroin Addiction and Related
Clinical Problems 2008; 10(3):33-36
Simojoki
K., Alho A.
Correspondence: Hannu Alho, MD,
National Public Health Institute, Helsinki, Finland POB 33, 00251 Helsinki, Finland, EU. Phone: +358-9-47448123; E-mail:
hannu.alho@ktl.fi
Summary: Finland, with a population of
around 5.5 million, has four years of prescribing a buprenorphine-naloxone
combination product (bup/nx) under its belt, and it already has the most bup/nx
experience within Europe. Our data show that the decision to transfer patients
from buprenorphine to bup/nx more than halved the street value of an 8 mg
tablet, in a country where buprenorphine had previously been the most widely
intravenously-abused drug. Patients are now maintained on an average daily dose
of 16 mg bup/nx and, reassuringly, buprenorphine misuse is decreasing. Most
importantly, the pre-buprenorphine heroin mortality figures have all but
vanished: from 63 deaths in 2000, in the last few years Finland has seen heroin
claim just 0 - 4 lives per annum.
Publication Type: Preliminary Communication
Heroin Addiction and Related
Clinical Problems 2008; 10(3):37-40
Fifteen Years of
Office-Based Prescribing in Croatia. Attitudes, Obstacles and
Outcomes.
Ivancic
A.
Correspondence: Dr. Ante
Ivancic, Centre for Addiction Treatment, M.Gioseffi 2, 52 440 Porec, Croatia,
E-mail: ante.ivancic@pu.htnet.hr
Summary: Not available
Publication Type: Letter to the Editor
Heroin
Addiction and Related Clinical Problems 2008; 10(4):5-18
Kamien
J. B., Branstetter S. A., Amass L.
Correspondence:
Jonathan B. Kamien, PhD. BioPsych Consulting 95 Fairmount Rd. East Califon, NJ
07830, USA E-mail: jkamien@biopsych.com
Summary:
This is the
first randomised study comparing buprenorphine-naloxone with methadone for
maintenance treatment of opioid dependence. A 17-week, double-blind,
double-dummy trial of daily dosing compared buprenorphine-naloxone (8/2 mg and
16/4 mg) with methadone (45 mg and 90 mg) in 268 participants. The percentage
of opioid-free urine samples over time did not differ by drug or dosage. The
percentage of patients with =12 consecutive opioid-negative urine samples
did not differ by drug and was significantly greater for patients receiving
higher doses of either agent. Induction success, compliance, nonopioid drug
use, retention and Addiction Severity Index scores did not differ among groups.
Buprenorphine-naloxone is a viable alternative to methadone in clinical
practice.
Publication
Type: Regular article
Heroin
Addiction and Related Clinical Problems 2008; 10(4):19-28
Predictors
for Non-Relapsing Status in Methadone-Maintained Heroin Addicts. A Long-Term Perspective
Study
Maremmani I., Pacini M., Lamanna F., Pani P. P.,
Trogu M., Perugi G., Deltito J., Gerra G.
Correspondence:
Icro Maremmani, MD; "Vincent P. Dole", Dual Diagnosis Group,
"Santa Chiara" University Hospital, Department of Psychiatry,
University of Pisa, Via Roma,67 56100 PISA, Italy, EU. Phone +39 0584 790073
Fax +39 0584 72081, E-Mail: maremman@med.unipi.it
Summary:
Despite the
established effectiveness of Methadone Maintenance Therapy (MMT), specific
evidence regarding factors influencing the prognosis of enrolled patients is
quite limited. This study aims to ascertain which patient- or treatment-related
features, assessed in a standardized way at the beginning of the program, do
have an influence on whom is retained for long-term compliance with retention
in treatment. 129 patients (94 male and 35 female) were treated in a methadone
maintenance treatment program for 6 years on average. Retention in treatment
was compared (survival analysis and Leu-Desu statistics) among groups of
patients selected on the basis of socio-demographic and clinical variables. The
variables that showed statistically significant differences (p<0.05) for an
association regarding retention rate were included in separate logistic
backward regression analyses comprising outcomes as dependent variables.
Results show that dual diagnosis, defined by concurrent psychiatric disorders
in evidence before the onset of heroin use, is the strongest negative predictor
of relapse throughout a six year’s average observation period, regardless of
other clinical and socio demographic variables. Such a finding should be read
in the context of a high-threshold setting, and accounts only for those
patients, who had been retained in treatment over the first year
Publication
Type: Regular article
Heroin
Addiction and Related Clinical Problems 2008; 10(4):29-32
Unintentional and Intentional Injuries Due to Opiate
Abuse
Stenbacka
M.
Correspondence:
Marlene Stenbacka Ph.D,, Karolinska Institute,
Department of Public Health Sciences, Magnus Huss, M4:04, 171 76
Stockholm, Sweden, EU. E-mail: marlene.stenbacka@sll.se
Summary:
Alcohol and
drug abuse runs a generally higher risk of fatal and non-fatal injury risk. But
the overall injury pattern in relation to opiate abuse is not well known. Aim. The aim of the study is to analyse
intentional and unintentional injuries –in the forms of accidents and suicides,
as reported in the case histories of opiate abusers compared to the general population in Stockholm.
Method: The analyses are based on a cohort
of 1700 drug abusers identified in 1967 and followed until 2003 and 2005 with
respect to causes of death, and inpatient care stays. Results: The results show that 817 (48%)
subjects took opiate as their primary drug and nearly one third of these had died
due to an intentional or an unintentional injury. Nearly 60 percent of the
opiate abusers had been treated, at least once, in hospital for an injury. On
average, the total cohort had been treated in hospital for an injury 1.6 times
(range, 0-40 times), while the opiate abusers who had been treated in hospital
for a drug-related diagnosis at least once had, on average, also been treated
for an injury diagnosis 2.8 times (0-20 times) during the follow-up period.
Conclusion: Societal support and injury
prevention need to be improved in this vulnerable group.
Publication
Type: Regular article
Heroin
Addiction and Related Clinical Problems 2008; 10(4):33-38
Jones
H.
Correspondence:
Hendree Jones, PhD. Johns Hopkins University, School of Medicine, Department of
Psychiatry and Behavioral Sciences, Baltimore, MD, USA. E-mail:
hejones@jhmi.edu
Summary:
Opioid
dependence during pregnancy is a complex multi-faceted medical challenge that,
if untreated, places the mother and child at risk for life threatening
consequences. While methadone maintenance is the accepted standard of care for
opioid dependent patients who are pregnant, there are limited circumstances
when this life saving medication may not be an immediate option. Thus, this
paper first highlights the data supporting the current USA clinical guidelines
regarding medication-assisted withdrawal during pregnancy in opioid-dependent
patients. Next, the results of a retrospective study comparing the maternal and
neonatal consequences of methadone-assisted withdrawal to methadone maintenance
in pregnant opioid-dependent patients are summarized. Given the generally
poorer maternal outcomes of the medication-assisted withdrawal patients, these
data provide renewed and current support for methadone-maintenance as the
first-line treatment approach for opioid-dependent pregnant women.
Publication
Type: Preliminary Communication
Heroin
Addiction and Related Clinical Problems 2008; 10(4):39-44
Opioid Therapy and Restoration of the Immune Function
in Heroin-Addicted Patients
Somaini
L., Giaroni C., Gerra G.
Correspondence:
Lorenzo Somaini, MD, PhD - Cossato
Addiction Treatment Centre, Local Health Unit, ASL BI, Via P. Maffi, 59,
13836-Cossato (Biella), Italy, EU
E-Mail: lorenzo.somaini@aslbi.piemonte.it
Summary:
There are
several reports suggesting that opioid compounds may influence the immune
response. Studies carried out in experimental animals and in humans have shown
that both innate and acquired immunity are significantly affected by opioids.
From a molecular viewpoint, opioids behave like cytokines, modulating the
immune response by interacting with their receptors both in the central nervous
system and in the periphery. One of the main features of opioid-mediated
modulation of the immune function is the development of immunosuppression,
which has been documented in injecting heroin abusers. Over the last few years,
however, evidence has been provided to suggest that various opioid drugs may
have distinctive effects on the immune function. Data obtained from animal
studies have demonstrated, for instance, that long-acting opioids, such as
methadone and buprenorphine, are devoid of any intrinsic immunosuppressive
activity. In this connection, the hypothesis, which was first put forward some
years ago, that the normalization of altered cellular immunity can, in
injecting heroin abusers, be achieved through long-term methadone or
buprenorphine treatment, has been positively re-evaluated in recent times. Our
group has recently investigated the immune response in heroin-addicted patients
currently under methadone or buprenorphine maintenance treatment, comparing
them with untreated heroin addicts and healthy controls. In agreement with the
data obtained by other groups, our study has provided evidence confirming the
‘immunoprotective’ effect of long-acting opioid drugs. From a
pathophysiological viewpoint, the ability of opioids to modulate the immune
function may have some bearing on the development of the infectious diseases
that are often associated with drug abuse. The high percentage of infections
among injecting drug users is partly related to injection methods and
life-style practices, but it is now accepted that heroin-induced
immunosuppression may contribute as a co-factor in the contraction of several
microbial and viral infections, such as Hepatitis C virus (HCV) infection.
Conversely, in view of the ‘immunoprotective’ action of some opioids, such as
buprenorphine, it has now been proposed that the administration of these latter
compounds may improve the outcome of chronic HCV virus infections.
Publication
Type: Brief Review
Heroin
Addiction and Related Clinical Problems 2008; 10(4):45-48
Parrino
M. W.
Correspondence:
Mark Parrino, President of the American Association for the Treatment of Opioid
Dependence, 225 Varick Street, 4th Floor, New York, NY, 10014, USA Phone: +1
212 566.5555 Fax: +1 212 366-4647 E-mail: Mark.Parrino@aatod.org
Summary:
Not Available
Publication
Type: Letter to the Editor