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