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