Heroin
Addiction and Related Clinical Problems 2010; 12(2):5-8
Addiction:
Challenging the dual diagnosis construct
Pani P. P.
Correspondence:
Pier Paolo Pani, ASL 8 Cagliari, Direzione
dei Servizi Socio-Sanitari, Cittadella della Salute – Padiglione Q, Via
Romagna 16 – 09127 Cagliari, Italy.
Phone
+39 070 6096385/ +39 349 3280112; Fax: +39 070 6096387 E-Mail: pallolo@tin.it
Summary: Not
Available
Publication Type: Editorial
Heroin
Addiction and Related Clinical Problems 2010; 12(2):9-18
Adherence and social antecedents in
relation to outcome in Methadone Maintenance Treatment (MMT)
Gronbladh L., Öhlund L. S.
Correspondence:
Leif Grönbladh, MD, University Hospital, Se-75017
Uppsala, Sweden, EU, E-mail: Leif.Gronbladh@neuro.uu.se,
Leif.Gronblad@akademiska.se
Summary: Numerous
reports of the effectiveness of methadone in reducing opiate use as well as
mortality, criminality, prostitution and the risk for HIV-infection have been
published during the last forty years. However, poor adherence to treatment,
continuing drug use and increasing rate of premature termination may lead to
less than optimal outcome results or in too many cases death. The aim of this
paper is to investigate which of the background variables, collected at the
admission procedure, that can be used to tell which type of patient will adhere
to the treatment regime and succeed or who will fail and who either need
special considerations or ought not to be accepted for a methadone treatment
(MMT). As much as 86 percent of the compliers in this study did benefit from
the treatment and were rated as medium to very much improved according to
CGI-I. The group not improved or worse had significantly more background
problems such as school problems, a history of non-opioid abuse, many non-MMT
treatment episodes, low age at drug debut and opioid debut than the group much
or very much improved. Those moderately improved is usually situated somewhere
in between the others.
Publication Type: Regular article
Heroin
Addiction and Related Clinical Problems 2010; 12(2):19-24
Rupnik J. C.
Correspondence:
Jasna Cuk Rupnik, MD - CPZOPD Logatec, Notranjska 2, 1370 Logatec,
Slovenia, EU
Phone. +386
17508264, +386 17508220, Fax +386 17508222
e-mail:
cukovi@gmail.com, cpzopd@zd-logatec.si
Summary: Objectives:
The objective of the study was to analyse the
practice of giving take-home dosages of opioid medications to patients with
reference to the reasons for and the quantity of the medications given as
additional or extra take-home dosages. Methods: All the patients were checked
regarding the kind of medication, urine samples, reasons for extra take-home
dosages and their quantity. Results: Of the 150 patients selected for the group
in the programme, 27 needed one or more extra take-home dosages in 2007. 10
(11*) of those patients had negative urine samples for all illicit drugs and
never used alcohol at any stage of the year of the study. 7 patients used
marijuana, benzodiazepines or alcohol only once or just occasionally in that
year. 10 patients used other illicit drugs or used alcohol and benzodiazepines
more often. Among the reasons for extra take-home dosages, hard physical work
was listed 7 times, vomiting because of the bad taste of the medication 3
times, difficulties in intiating medical therapy
after entering the programme 3 times, vomiting as a part of illness twice and
lowering the dosage too quickly twice. Other reasons were listed once each.
Altogether, the percentage of the overall quantity of medications received by
patients during the year as extra take-home dosages was: 0.47% for methadone,
0.75% for buprenorphine and 0.10% for SR morphine.
Conclusions: Reviewing the fairly good results of treatment at the centre,
therapeutic decisions to give additional take-home dosages to the patients have
proved to be reasonable and usually correct. Throughout this study a continual
therapeutic wish to achieve a better understanding of opioid addiction as just
one among other chronic diseases has been made evident.
Publication Type: Regular article
Heroin
Addiction and Related Clinical Problems 2010; 12(2):25-28
From methadone to buprenorphine
or back to methadone. The Croatian experience
Ivancic A.
Correspondence:
Ante Ivancic, MD. Centre for Adddiction
Treatment, M.Gioseffi 2 52 440 Porec,
Croatia
E-mail
ante.ivancic@pu.t-com.hr
Summary: In
Croatia maintenance treatment is made widely available through a network of GP
offices that covers the whole of the country. More then 50% of all GPs in
Croatia have at least one patient in MT. Methadone was the only opioid agonist
used for over a decade, but this changed when buprenorphine
was introduced 4 years ago.
There
is little difference in the regimen for the prescription and provision of the
two medications: both are free of charge and are prescribed by GPs; in
addition, there are no restrictions on the dose to be used or on ‘take home’
policy. The decision on which medication will be used is based exclusively on
the clinical assessment and patient-doctor agreement.
The
example of Croatia gives an opportunity to compare the acceptance of this
medication by patients and doctors in situations of equal availability.
Publication Type: Brief Communication
Heroin
Addiction and Related Clinical Problems 2010; 12(2):29-36
Methadone
treatment for pregnant heroin addicted women
Finnegan L., Pacini M., Maremmani I.
Correspondence:
Finnegan Loretta, MD - Perinatal Addiction and
Women's Health, 700 Ocean Drive, Unit E-1, 08202 Avalon New Jersey, USA -
E-mail: finnegal337@aol.com
Summary: A
review of methadone-related issues and the approach to heroin addicted patients
is presented with the aim to clarify what is practiced by the establishment of
anti-craving treatment and what is expected within a history of addiction. A
series of clinical situations occurring throughout pregnancy to early child
development are described, and the etiological hypothesis discussed. Moreover,
some methodological considerations are described in order to better understand
some ambiguity about the effectiveness and harmlessness of methadone treatment,
particularly with regard to neonatal opiate withdrawal. Limitations to the
outcome of pregnancies in heroin addicted women seems to be due to
misconceptions about methadone toxicity and neonatal damage, which may lead to
the mishandling of methadone as a therapeutic modality, especially with regard
to maintenance at effective dosages.
Publication Type: Seminar
Heroin
Addiction and Related Clinical Problems 2010; 12(2):37-40
What is the right
dosage for our patients?
Ulmer A.
Summary: Not
Available
Publication Type: Letter to the editor