Heroin
Addiction and Related Clinical Problems 2009; 11(1):5-14
Treatment of Opioid Dependence
and ADHD/ADD with Opioid Maintenance and Central Stimulants
Blix
O., Dalteg A., Nilsson P.
Correspondence:
Olof Blix, MD, Dr. Med. Sc., Addiction Medicine Unit, Department of Psychiatry,
Ryhov County Hospital, SE-551 85 Jönköping, Sweden, EU. Phone ++46 36323404 ;
Fax +46 36323061 ; E-Mail: olof.blix@lj.se
Summary:
Since January
2005 Medically Assisted Rehabilitation of opiate addicts (MAR) is a regular
treatment supported by the National Board of Health and Welfare in Sweden.
Treatment facilities are now open in most parts of Sweden. At the addiction
medicine unit in Jönköping, high dose buprenorphine has been used since 1999,
and methadone was added in 2005, when the previously separate regulations for
the use of those two substances were merged in the present regulations. ADHD
and ADD, together with OCD, are relatively common disorders among drug addicts.
Since 2004 we have diagnosed over 150 patients with these disorders at the
addiction medicine unit. By November 2007, treatment with long-acting
methylphenidate or modafinil had been initiated in 85 subjects. Of those 85, 12
had also met the criteria for opioid substitution. This paper will discuss our
experiences with the combined treatment with opioids and central stimulants, as
administered to those drug addicts. In this naturalistic study, all 12 subjects
(1 female), mean age 38 (range 20 to 51) were evaluated before starting Central
Stimulant (CS) treatment with clinical interviews, self-assessments and formal
computerized tests (EuroCog). The ambition is to follow each patient’s
development through the use of drug tests, interviews (subjects and
relatives/significant others), and a retest to evaluate the outcome of the
combined treatment.
publication
Type: Preliminary Communication
Heroin
Addiction and Related Clinical Problems 2009; 11(1):15-22
Dihydrocodeine for the
Treatment of Alcohol Dependence
Ulmer
A., Müller M., Frietsch B.
Correspondence:
Albrecht Ulmer, MD, Schwabstr. 26, D - 70197 Stuttgart, Germany, EU, E-mail:
albrecht.ulmer@gmx.de
Summary:
Objective: In
most cases, alcohol dependence shows a profile similar to that of many chronic
diseases, but no effective basic treatment comparable to that adopted with the
other illnesses has been established up to now. In particular, patients with
repeated relapses, despite a broad range of therapeutic approaches, and
patients who are unable to attain what is essentially a state of abstinence
from alcohol, continued to need a basic medication. Methods: Convinced by a few
specialized colleagues who reported successful treatments of alcohol addicts
with Dihydrocodeine (DHC) and by a first own patient of ours who showed a
complete reduction of his severe alcohol craving when given Codeine-based pain
medication, we went on to treat as many as 77 (M/F: 55/22) heavily
alcohol-addicted patients with DHC, beginning in 1997. Right from the start,
the data were documented meticulously. We present a retrospective analysis of
this documentation here. Results: The patients had a history of a total of 1060
medically assisted detoxifications and specialized therapies. The 4
year-retention rate was 26.1%, including 6.5% of treatments that had a
successful outcome. In our 12-step scale on clinical impressions, we noticed a
significant improvement from a mean of 3.5 to 6.7. The demand for medically
assisted detoxifications in patients who had at most 2 years left was reduced
by 63%. Mean GGT improved from 201.1 U/l at baseline to 57 U/l after 4 years.
The MCV value also showed a significant improvement. Mean GGT of patients with
additional chronic hepatitis C improved from 198.3 U/l at baseline to 86.4 U/l
after 1 year. Conclusions: Our data are preliminary, and these are
practice-generated results, which are far from reflecting the whole potential
of this new approach. Between 10 and 20% of these patients recorded no good
effects from DHC. In around half of the patients the treatment was abandoned
for several reasons, in some cases because of the anxiety caused by the
pioneering nature of this non-established therapy: a treatment with partly
overcautious dosages. But in about 25% of the patients, DHC was an almost
perfect medication, sometimes even crucially better than all previous
approaches, even in absolutely desperate cases. A lot of regular studies are
needed, comparing different substances, settings, dosages and clarifying the
cause and pathomechanism of the effects. This should be done because it seems
that we are standing at a gateway leading into immense new opportunities. In
the long run the breakthrough will be a question of the right mixture of
scientific investigation, well-structured implementation with sufficient
control, but also, and this may be most important factor, enough trust in our
patients and the prescribing doctors. On a long-term basis there will be no
success without a structure that supports and reassures, but also represents,
this trust.
publication
Type: Regular Article
Heroin
Addiction and Related Clinical Problems 2009; 11(1):23-30
Use and Abuse of High-Dose
Buprenorphine (HDB) Obtained Without a Prescription: a French Survey
Courty
P.
Correspondence:
Pascal Courty MD., PhD. CSST SATIS CHU G. MONTPIED F-63003 CLERMONT-FERRAND
CEDEX 1 FRANCE, EU - Phone: + 33 (0) 473 752 134; Email:
p_courty@chu-clermontferrand.fr
Summary:
Objectives: To
gain information on the profile of patients using High-Dose Buprenorphine in
France without a medical prescription. Methods: This was a naturalistic survey
on 27 survey sites (n=298) comprising three different groups: people who had
always obtained their HDB without a prescription, people who had obtained HDB
both with and without a prescription over the previous month and an
intermediary group who had previously obtained it on prescription, but not over
the course of the previous month. Results: In terms of treatment and
supervision objectives, significant differences were found between the group of
patients who were under the supervision of a doctor and those who continued to
obtain HDB without any prescription. Discussion: Medical supervision is a
central factor in treatment. Conclusion: Treatment education for patients,
medical training for prescribers, and pharmaceutical form appear to be means
that need to be developed simultaneously to optimize the treatment.
publication
Type: Brief Communication
Heroin
Addiction and Related Clinical Problems 2009; 11(1):31-34
A 10-Year Evaluation of
Chronic Pain Patients Treated with Opioids
Tennant
F.
Correspondence:
Forest Tennant M.D., Dr. P.H.; Veract Intractable Pain Center, 338 S. Glendora
Ave. West Covina, CA 91790. Phone 888-919-7476; Fax , E-Mail: veractinc@msn.com
Summary:
Over the past
15 years laws and guidelines have been widely promulgated to allow physicians
to prescribe opioids for severe, chronic pain patients who have non-malignant
conditions. To date little is known about the outcomes of long-term opioid pain
therapy. Reported here is an evaluation of 24 patients with non-malignant
conditions who have been in continual opioid treatment for at least 10 years.
Data collected indicates that some chronic pain patients greatly benefit from
long-term opioid therapy. Almost all (22 of 24: 91.7%) patients report that
their pain has permanently decreased over time, and the great majority (20 of
24: 83.3%) believe that opioids continue to relieve their pain as well as when
treatment was initiated. All patients report they can now do a variety of
activities and physical functions they could not do prior to opioid therapy.
The major complications of opioid therapy detected to date are hormonal
abnormalities which can be easily managed with replacement therapy.
publication
Type: Brief Communication
Heroin
Addiction and Related Clinical Problems 2009; 11(1):35-40
Todorov
O.
Correspondence:
Orlin Todorov, MD - The Kantchelov Clinic, 102-B Hadjikocev Str. Office n.6,
1421 Sofia, Bulgaria, EU; E-mail: idomeneus@hotmail.com
Summary:
This
communication presents a number of theoretical and clinical formulations that
belong to a psychodynamic framework specifically constructed to foster the
understanding and treatment of drug addiction. I find this framework useful not
merely for the purpose of conceptualizing drug addiction as a clinical
category, but also in explaining the complex experiences involved in the
therapeutic process to people suffering from that condition. Contemporary
psychoanalytic tradition sees drug addiction as an unsuccessful attempt to ward
off the unbearable and unmanageable effects through self-medication, but also,
more importantly, as a massive disorder originating in early interactions with
significant others, resulting in a fragmentation of the self that prompts the
individual to self-injury, constant traumatic experiences and a paradoxical
fear/pain/pleasure relationship with the drug via addictive fantasies. All of
this, enacted in everyday life and in therapeutic sessions, evokes complex
emotional experiences on the part of patients, therapists and whole
institutions. Relieving, bearing, getting to understand and, crucially,
modifying these experiences is seen to be the task at stake in the therapeutic
encounter. The final part of the article reflects on some of the advantages for
the psychotherapeutic work that derive from methadone maintenance treatment and
well-organized team work within a specialized clinic.
publication
Type: Regular article
Heroin
Addiction and Related Clinical Problems 2009; 11(1):41-42
Daulouède
J.-P., Caer Y., Galland P., Villeger P., Brunelle E., Bachellier J., Piquet
J.-M., Harbonnier J., Leglise Y., Courty P.
Correspondence:
Pascal Galland, MD - Unité d'Addictologie, Centre Hospitalier, 2 Rue Valentine
Hany BP740-34500 Beziers, France, EU. E-mail pascal.gallard@ch-beziers.frstudy
Summary:
Not Available
publication
Type: Letter to the editor
Heroin
Addiction and Related Clinical Problems 2009; 11(1):43-46
Coordinating Methadone
Treatment Providers and Policymakers: Lessons Learned Over 30
Years
Parrino
M. W.
Correspondence:
Mark W. Parrino, MPA - AATOD - 225 Varick Street - New York. NY 10014 - USA -
Phone: +1 212 5665555 Fax: +1 212 3664647 E-mail: Mark.Parrino@aatod.org
Summary:
Not Available
publication
Type: Letter to the editor
Heroin
Addiction and Related Clinical Problems 2009; 11(1):47-48
En Route to 90%
Retention. ‘Active Rehabilitation’ in Central Norway
Nordstrand
B.
Correspondence:
Berit Nordstrand, LAR-Midt, Pb 4335 7417-Trondheim, Norway. Phone +47 73874260;
E-Mail: berit.nordstrand@rus-midt.no
Summary:
Not Available
publication
Type: Letter to the editor
Heroin Addiction and Related
Clinical Problems 2009; 11(2):5-8
Swedish Use and Misuse of the
Dole & Nyswander Treatment
Gunne L.
Correspondence: E-Mail:
lars.gunne@gmail.com
Summary: For 23 years (1966-1989) Sweden had a National Methadone
Maintenance treatment of opioid addicts, delivering 70-80 % vocationally rehabilitated
patients, taxpaying citizens, with no drug abuse and a great reduction in
mortality rates. This treatment was changed in 1990 into a short-term methadone
program, resulting in numerous discharges for disciplinary reasons, a high
mortality rate among the newly discharged and poor rehabilitation results.
Politically, the short-term treatment is called “restrictive”, which is
regarded as commendable by the Swedish mass media
Publication Type: Regular article
Heroin Addiction and Related
Clinical Problems 2009; 11(2):9-20
González-Saiz
F., Gómez R. B., Bilbao Acedos I., Lozano Rojas O., Gutiérrez Ortega J.
Correspondence: Francisco González-SaizAvda.
Libertad 48. Pinar Hondo. Puerto de Santa María. Cádiz. Spain, EU. E. mail:
pacogonzalez@comcadiz.com
Summary: Background: evaluating the addiction-related quality of life of a
sample of opiate-dependent patients in treatment with buprenorphine in
therapeutic communities after a switch from methadone. Design and participants:
observational (descriptive), open longitudinal prospective study
(‘before-after’ design); a non-probabilistic consecutive sampling procedure was
used. After their admission to five therapeutic communities, a sample of
patients in treatment with methadone switched to buprenorphine induction
(SubutexR). When considered appropriate, a gradual reduction in buprenorphine
dose was begun, so as to bring it down to 0 mg within 16 weeks. The patients
met DSM-IV-TR criteria for Opiate Dependence, were adults and had signed an
informed consent release. All the patients were evaluated at three times;
baseline assessment (Mo), after one month of treatment (M1) and after three
months (M2). The study protocol was approved by the Andalusian Regional
Committee for Clinical Trials, and was conducted in accordance with the
Declaration of Helsinki. Measurements: The Objective Opiate Withdrawal Scale
(OOWS), the Subjective Opiate Withdrawal Scale (SOWS), the Health Related
Quality of Life for Drug Abusers Test (HRQoLDA Test), the General Health
Questionnaire (GHQ-28), the Opiate Treatment Index (OTI) and the Schedules for
Clinical Assessment in Neuropsychiatry (SCAN). Results: A total of 119 patients
met the selection criteria. Of these, 46 subjects transferred from methadone to
buprenorphine, while the remaining 73 decided to stay on their methadone
maintenance treatment. A statistically significant increase was observed in
scores on the quality of life scale after one month of treatment with
buprenorphine (from 0.62 to 0.99; p<0.05) and at three months (from 0.43 to
0.77; p<0.05). One month after the start of treatment, statistically
significant improvements were observed in “general state of health” (from 10.7
to 4.3; p<0.05), in “severity of dependence” (11.7 to 4.1; p<0.05) and in
“psychological adjustment” (from 7.5 to 3.7; p<0.05). At the three-month
assessment, statistically significant differences were again observed in the
same variables, except for “psychological adjustment”. Conclusions: the
patients who were in treatment with methadone after their admission to a
therapeutic community and switched to buprenorphine were able to experience
ongoing improvement in their quality of life.
Publication Type: Regular article
Heroin Addiction and Related
Clinical Problems 2009; 11(2):21-30
Vázquez
M. L., Castillo I. I., Jiménez-Lerma J. M., Beldarrain J. A. H., Gutiérrez-Fraile
M.
Correspondence: Miguel
Landabaso Vázquez. Centro de Tratamiento de Toxicomanias de Barakaldo. C/
Berriotxoa 2. 48903 - Barakaldo-Bizkaia. Spain, EU. E-mail: miguelangel.landabasovazquez@osakidetza.net
Summary: The consumption of cocaine among people included in Methadone
Maintenance Therapy (MMT) is a widely identified phenomenon, but clinical
experience and the literature have highlighted the difficulty of finding an effective
pharmacological alternative for cocaine abusers. The aim of this study was to
assess the use of olanzapine as a therapy for reducing the use of cocaine in
MMT while implementing a more controlled design. A randomized clinical trial
has been applied to 60 subjects assigned to three MMT programmes. The
independent variable was treatment with olanzapine at three dose levels (0, 5
and 10 mg/day), with three treatment groups being formed; they comprised 20, 21
and 19 subjects, respectively. The outcome variable was the percentage of
positive urine tests for cocaine consumption, as estimated by means of urine
monitoring using immunoassay, during the first three months after the start of
treatment. For the data analysis, MANOVA and the hierarchical regression model
were used. The mean proportion of previous cocaine consumption was 25.8%
(S.D.= 26.4; range 0-100), with no differences between the treatment groups
(F(2,57) = 0.167; p= 0.845). Hierarchical regression analysis
showed a significant model in final step (F(5,54)= 8.61; p = 0.001),
with an explained variance of 44.3% (R2= 0.443). The semi-partial
correlation coefficients (rs-m) indicated significant effects on the variables:
methadone dose (rs-m= -0.229), previous cocaine consumption (rs-m= 0.345) and
treatment with 5 mg/day (rs-m= -0.469) and 10 mg/day (rs-m= -0.514) of olanzapine. The mean proportion of positive control
results in the untreated subjects was 21%, whereas, in the patients receiving
olanzapine therapy, it was 8.8% in those taking a dose of 5 mg/day and
9.5% in those on a dose of 10 mg/day. The prior consumption of cocaine is
shown to be a risk predictor for subsequent consumption, whereas an increase in
the dose of methadone or treatment with olanzapine both show a protective
effect. Specifically, the 10 mg dose of olanzapine, when followed by the
5 mg dose shows the highest degree of explained variance in post-treatment
cocaine consumption, after checking the effects induced by the remaining
variables.
Publication Type: Regular Article
Heroin Addiction and Related
Clinical Problems 2009; 11(2):31-40
Orgel M.,
Wilson A., Leavey R., Sell L., Zador D.
Correspondence: Dr Michael
Orgel: Edinburgh Community Drug Problem Service Edinburgh Harm Reduction Team,
22-24 Spittal Street, Edinburgh EH3 9DU - tel: +44 131 537 8315 - fax: +44 131
537 8350; E-mail: michael.orgel@nhslothian.scot.nhs.uk
Summary: Aims and Methods: To describe the views and experiences of drug
users receiving unsupervised injectable opiate treatment (IOT) for opiate
addiction, the most common current form of injectable treatment in the UK.
Semi-structured interviews were completed by 29 IOT recipients from two
Community Drug Teams in northwest England.
Findings: Attitudes of most
respondents were positive with personal and social benefits: reduction or
cessation of illicit drug use; health gains; more “normal” lifestyle; reduced
criminal activity. IOT recipients were not a homogeneous group and had
different needs and goals. Conclusions: Individuals valued the stability IOT
had brought to their lives. The treatment challenge is how to maintain
stability without allowing drift into inertia. Much of the IOT debate has been
led by service providers and academics. IOT recipient views have been neglected
and this study adds a new voice.
Publication Type: Regular Article
Heroin Addiction and Related
Clinical Problems 2009; 11(2):41-46
Substitution Therapy. A
New Problem of Biomedical Ethics and Medical Law
Mendelevich
V. D.
Correspondence: Vladimir D.
Mendelevich, MD - Mental Health Research Institute, Kazan Medical State
University, Kazan, Russian Federation. E-mail: mend@tbit.ru
Summary: Substitution maintenance therapy can be judged from different
perspectives focused on its medical, legal, social, economic and ethical
aspects. A subject that attracts special attention is the ethical side of
substitution therapy. In the opinion of the opponents of substitution
maintenance therapy, there are several key ethical problems that make this
therapy immoral. From our point of view, it is unethical to refuse a patient
this kind of help (substitution therapy). Substitution therapy for opioid dependence
should be seen as the most ethical and humane of all methods. The absence of
substitution therapy in the Russian Federation puts Russian patients in an
awkward position.
Publication Type: Regular Article
Heroin Addiction and Related
Clinical Problems 2009; 11(2):47-58
New Approaches in the
Treatment of Opioid Dependency During the Pregnancy
Finnegan
L., Winklbaur B., Fischer G., May O., Welle-Strand G.
Correspondence: Loretta
Finnegan, MD. Finnegan Consulting, Inc. Winward Harbor Unit E -1700 Ocean
Drive, Avalon, NJ 08202, USA. E-mail: finnegal337@aol.com
Summary: Not Available
Publication Type: Symposium Proceedings
Heroin Addiction and Related
Clinical Problems 2009; 11(2):59-62
Parrino
M., Aatod Board of Directors
Correspondence: Mark Parrino,
MS. American Association for the Treatment of Opioid Dependence (AATOD) - 225
Varick Street, 4th Floor; New York, NY 10014, USA - Phone 212 566 5555 Fax 212
366 4647 - Email: info@aatod.org
Summary: Not Available
Publication Type: Letter to the editor
Heroin Addiction and Related
Clinical Problems 2009; 11(3):5-10
Methadone
Treatment in Italy in the Third Millennium: Continuing Fear of
Treatment
Maremmani
I.
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: Not Available
Publication Type: Editorial
Heroin Addiction and Related
Clinical Problems 2009; 11(3):11-28
Pharmacology and
Neurochemistry of Methadone
Vendramin
A., Sciacchitano A. M.
Correspondence: Andrea
Vendramin, MD; Department of Drug Dependence (ULSS 16), Via dei Colli, 4 -
35100 Padova - Italy E-Mail:
<andrea.vendramin@unipd.it>
Summary: Contrary to what might be thought initially, the pharmacology of
methadone is only partly known, and current research continues to investigate
into its distinctive aspects. Clinical evidence provides key guidance to
pharmacological research on the opiate system; on the other hand, evolving
expectations from therapeutic drugs or putative agents for addiction treatment
provide a key incentive to the broadening of pharmacological knowledge. Apart
from the classic description of receptorial opioid agonism, narcotic blockade
and tolerance/withdrawal dynamics, some crucial issues need to be clarified in
a comprehensive way. For instance, studies have proved the importance of
metabolic polymorphism in treatment planning and offered interpretations of
apparent resistance to normal dosages, so authorizing the employment of high
dosages on a sound pharmacological basis. Also, dosages should not be regarded
as stable through time, especially in the first few months, and clinicians may
schedule dose variations that take into account such expected variations while pursuing
stabilization. Methadone’s action profile in the central nervous system is not
exclusively based on opioid receptors, and a thorough knowledge of its
'collateral' effects may explain its beneficial action against specific
psychopathological abnormalities. The role of the inactive enantiomer in the
context of racemous methadone’s tolerability and action profile has also been
outlined. Lastly, some of the therapeutic effects of methadone endure without
being neutralized by the emergence of tolerance; one of these is its crucial
anticraving property. In order to clarify this issue, the mechanisms of cell
membrane endocytosis and signal transduction have been illustrated and compared
between different opiates.
Publication Type: Regular Article
Heroin Addiction and Related
Clinical Problems 2009; 11(3):29-34
Cannabis and Premonitory
Symptoms of Schizophrenia: What Is the Time Sequence?
Vernex
N., Dagher G., Touzeau D.
Correspondence: Nadia Vernex,
M.D. 12, Avenue Condorcet 91200
Athis-Mons, France. E-Mail: <nadiavernex@yahoo.fr>
Summary: Nowadays, cannabis is the most widely used illegal drug in
France. Epidemiological studies have shown that in schizophrenic patients the
risk of developing cannabis dependence is six times what it is in the general
population. However, debates on the real chronology of the appearance of
psychiatric disorders and addictive cannabis behaviour are ongoing. The aim of
this article is to try to find out how best to interpret the association of
cannabis and premonitory symptoms through a review of the literature. Some
recent longitudinal studies suggest a potential role for pre-existing troubles,
taking the view that cannabis would only aggravate them and turn them into
schizophrenic symptoms. By contrast, other studies propose a causal linkage as
well as a dose-effect relationship between cannabis consumption and the
appearance of schizophrenia. Conclusion: The methodology of these studies
limits the possibility of a reverse causality. In addition, it must be noted
that some research teams excluded from their cohort subjects who presented
psychiatric disorders at entrance. Cannabis appears to be a risk factor for
psychotic disorders, because it interacts with a pre-existing vulnerability.
Neuroimagery research will make it possible to clarify the common cerebral
mechanisms of cannabis and schizophrenia.
Publication Type: Brief review
Heroin Addiction and Related
Clinical Problems 2009; 11(3):35-38
Alcoholics With a History
of Heroin Consumption: Clinical Features and Chronology of Substance
Abuse
Ceccanti
M., Vitali M.
Correspondence: Mauro Ceccanti,
MD; Chief of Alcohol Unit, Clinical
Medicine Dept., “La Sapienza” University, Rome, Italy, EU. Phone +39 06
49972093/6/7 Fax +39 06 49972096, E-Mail: mauro.ceccanti@uniroma1.it
Summary: In our clinical experience, when alcohol is used as a surrogate
for heroin, social adjustment improves, although the metabolic destiny does not
change, and the medical outcome is worsened to some extent by alcoholism
itself. Alcohol abusers with a history of heroin use engage in alcohol use in a
more intensive way. Alcohol consumption is higher right from the start, and
reaches higher maximum levels, whereas heroin use dwindles, in some cases to
extinction. The results of our studies support the hypothesis that alcohol
replaces opiate craving in former heroin consumers who break away from heroin,
and often become alcohol abusers or at least increase their use of alcohol.
Publication Type: Brief Communication
Heroin Addiction and Related
Clinical Problems 2009; 11(3):39-40
Opioid Dependence
and Quality of Life: Changes in the Heroin Epidemic
Domingo-Salvany
A.
Correspondence: A.
Domingo-Salvany. Grup de Recerca en Epidemiologia de les Drogues d’Abús.
Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar). Dr. Aiguader,
88. 08003 Barcelona. España. E.mail: adomingo@imim.es
Summary: Not Available
Publication Type: Letter to the editor
Heroin Addiction and Related
Clinical Problems 2009; 11(3):41-44
Maremmani
I., Pacini M., Lamanna F., Maremmani A. G. I., Pani P. P., Perugi G., 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: Not Available
Publication Type: Letter to the editor
Heroin Addiction and Related
Clinical Problems 2009; 11(3):45-48
Echoing the Patient’s Lack of
Insight: A Role We Must Avoid Playing
Pacini M.
Correspondence: Matteo Pacini,
MD; "G. De Lisio", Institute of Behavioural Sciences, Via di Pratale,
3 - 56100 PISA, Italy, EU. E-Mail: paciland@virgilio.it
Summary: Not Available
Publication Type: Letter to the editor
Heroin Addiction and Related
Clinical Problems 2009; 11(4):5-10
Caldarola
P., Cuonzo M.
Correspondence: Pasquale
Caldarola, MD, Cardiologic Unit, "M. Sarcone" Hospital, Via P. Fiore,
153 - 70038 Terlizzi, Bari, Italy E-mail:bari4@cardionet.it
Summary: The electrocardiogram records the electrical activity of the
heart, the depolarization and repolarization of the atria and ventricles.
Deflections are all shown by the single features of the electrocardiogram: the
P wave, the QRS complex, the T wave, the U wave, the PR interval and the QT.
The QT interval represents the entire electrical activity of the left
ventricle: it begins with the onset of ventricular depolarization (start of the
Q wave) and is completed when ventricular repolarization ends (at the end of
the T wave). Measurement of the QT interval is important because of the useful
information it provides on the electrical activity of the heart; the length of
the interval depends on various pathophysiological conditions, changes in
electrolyte concentration, and the pharmacological action of toxic substances.
Publication Type: Seminar
Heroin Addiction and Related
Clinical Problems 2009; 11(4):11-20
Psychoactive Drugs and
Prolongation of the QT Interval
Deruvo
G., Vendramin A., Di Sciascio G.
Correspondence: Gaetano Deruvo,
MD - SerT AUSL BA/4 - Via Giovanna da Durazzo, 53 - 70032 Bitonto (BA),
Italy E-mail:
<deruvogaetano@libero.it>
Summary: The links between psychiatry and cardiology that are pertinent to
potential cardiovascular risks associated with the use of psychotropic drugs,
especially antipsychotics, cannot be viewed as entirely new. In Italy, however,
an important innovation was made when, on 28 February 2007, the Italian
Medicines Agency (AIFA), issued a directive laying down provisions for the
amendment of the printed papers that accompany various medicines, including
haloperidol; that initiative has revived the relevance of the whole question.
In particular, contraindications to the use of these drugs have been redefined.
The primary ones are now listed as acute myocardial infarction, decompensated
heart failure, arrhythmias treated with antiarrhythmic drugs belonging to
special classes, the prolongation of the QT interval corrected for heart rate
(QTc), the family history for arrhythmia or torsades de pointes, hypokalaemia
and the concomitant use of drugs that prolong the QTc.
Publication Type: Seminar
Heroin Addiction and Related
Clinical Problems 2009; 11(4):21-28
Opioid Treatment and
“Long-QT Syndrome (LQTS)”: a Critical Review of the Literature
Pacini
M., Maremmani A. G. I., Dell'Osso L., Maremmani I.
Correspondence: Matteo Pacini,
MD, "G, De Lisio" Institute of Behavioural Sciences, Via di Pratale,
3 - 56127 Pisa, Italy E-mail: paciland@virgilio.it
Summary: The present review aims at perusing the available literature
about QT-related cardiac safety during methadone treatment. On the whole, case
reports, either single or multiple, do not seem a reasonable bases to draw
conclusions about the weight of any putative risk factor for QT prolongation.
On the other hand, systematic studies allow making some statements about the extension
and weight of QT prolongation during methadone maintenance treatment for heroin
addiction. No major concern about cardiac safety of methadone itself in the
average addict seems to stand. Conditions at higher risk of multiple and
polydrug treatments deserve some greater surveillance. No rationale for a
dose-ceiling stands in a risk/benefit perspective.
Publication Type: Review
Heroin Addiction and Related
Clinical Problems 2009; 11(4):29-34
Management of Cardiac Risk
during Methadone Treatment: Focus on the QT Interval
Pani P.
P.
Correspondence: Pier Paolo
Pani, MD - Director Social-Health Service, Health District 8 (ASL 8),
Cittadella della Salute, Padiglione C, Via Romagna, 16 - 09100 Cagliari, Italy,
EU. Phone +39 070 47443701; E-mail: pallolo@tin.it
Summary: In recent years, methadone, along with various other drugs, has
been implicated in the lengthening of the QT interval of the electrocardiogram
(ECG) and in the onset of potentially fatal arrhythmias. The risk of prolonged
QT in methadone-maintained subjects is estimated at between 2-4%, while the
risks of torsades de pointes or sudden death are extremely low. Despite the
diversities reported, the guidelines available to date indicate the need to
implement preventive measures based on ECG screening.
The impact of these
recommendations is, however, limited by the lack of a comparative risk/benefit
assessment of specific procedures.
Publication Type: Seminar
Heroin Addiction and Related
Clinical Problems 2009; 11(4):35-40
Cardiovascular
Complications of Cocaine Use
Gambarana
C.
Correspondence: Carla
Gambarana, MD, Dept. Neuroscience, University of Siena, Via Aldo Moro, 4 -
53100 Siena, Italy E-mail: gambarana@unisi.it
Summary: As cocaine use has become prevalent, an increasing number of
reports of cocaine-associated morbidity and mortality, largely because of
central nervous system and cardiovascular toxicity, appeared. Cardiovascular
toxicity is broad, and it may also lead to neurological, psychiatric and other
organ-specific symptoms. Cocaine may induce myocardial ischemia by increasing
myocardial oxygen demand while simultaneously decreasing myocardial oxygen
supply. Most of the cardiovascular toxic effects elicited by cocaine are likely
related to its ability to selectively bind to the L-type calcium channels and
the potassium channels that modulate the Ikr current. In addition, cocaine may
promote intracoronary thrombosis in the absence of coronary atherosclerosis.
This article briefly reviews the current knowledge regarding the cardiovascular
effects of cocaine, providing insight into some of the underpinning mechanisms.
Key Words: adrenergic
receptors, monoamine uptake, L-type calcium channels, acute coronary events
Publication Type: Seminar