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