Methadone maintenance therapy for opioid dependence - A guide to appropriate use

Opioid dependence is a chronic, relapsing condition that is associated with significant morbidity and mortality. Methadone maintenance therapy involves the provision of a controlled supply of an orally administered opioid, thereby stabilising the opioid-dependent patient. Research studies have shown that methadone maintenance reduces illicit opioid use, opioid-related crime, premature mortality and the risk of HIV infection. It is most effective when prescribed at an adequate dosage (usually 60 to 100 mg/day) and when long term maintenance on methadone is the goal of treatment rather than detoxification from all drugs including methadone. Successful long term methadone maintenance is more likely when it takes place within the context of a well established therapeutic relationship and when the medical, social and psychological needs of patients are met either through direct assistance or referral.

The distribution of naloxone to heroin users

Overdose deaths are a manor contributor to excess mortality among heroin users. It has been proposed that opioid overdose morbidity and mortality could be reduced substantially by distributing the opioid antagonist naloxone to heroin users. The ethical issues raised by this proposal are evaluated from a utilitarian perspective. The potential advantages of naloxone distribution include the increased chance of comatose opioid users being quickly resuscitated by others present at the time of an overdose, naloxone's safety and its lack of abuse potential. The main problems raised by the proposal are: the medico-legal complications of medical practitioners prescribing a drug that is most likely to be administered to and by people other than the one for whom it is prescribed; the economic costs of distributing naloxone sufficiently widely to have an impact on overdose morbidity and mortality; and the potentially greater cost-effectiveness of simpler educational interventions. Given the possible benefits of naloxone distribution, it may be worthwhile considering a controlled trial of naloxone distribution to high-risk heroin users.

Loss of the Ca2+/calmodulin-dependent protein kinase type IV in dopaminoceptive neurons enhances behavioral effects of cocaine

The persistent nature of addiction has been associated with activity-induced plasticity of neurons within the striatum and nucleus accumbens (NAc). To identify the molecular processes leading to these adaptations, we performed Cre/loxP-mediated genetic ablations of two key regulators of gene expression in response to activity, the Ca2+/calmodulin-dependent protein kinase IV (CaMKIV) and its postulated main target, the cAMP-responsive element binding protein (CREB). We found that acute cocaine-induced gene expression in the striatum was largely unaffected by the loss of CaMKIV. On the behavioral level, mice lacking CaMKIV in dopaminoceptive neurons displayed increased sensitivity to cocaine as evidenced by augmented expression of locomotor sensitization and enhanced conditioned place preference and reinstatement after extinction. However, the loss of CREB in the forebrain had no effect on either of these behaviors, even though it robustly blunted acute cocaine-induced transcription. To test the relevance of these observations for addiction in humans, we performed an association study of CAMK4 and CREB promoter polymorphisms with cocaine addiction in a large sample of addicts. We found that a single nucleotide polymorphism in the CAMK4 promoter was significantly associated with cocaine addiction, whereas variations in the CREB promoter regions did not correlate with drug abuse. These findings reveal a critical role for CaMKIV in the development and persistence of cocaine-induced behaviors, through mechanisms dissociated from acute effects on gene expression and CREB-dependent transcription.

Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil

This study reports on the views of Primary Health Care (PHC) providers in Southeast Brazil on the use of alcohol and other drugs which reflect stigma, moralization, or negative judgment. Six hundred nine PHC professionals from the Brazilian states of Sao Paulo and Minas Gerais took part in the study. The majority (86.5%) of these professionals were female. Attitudes toward the use of alcohol and other drugs were evaluated in comparison to Hansen`s disease, obesity, depression, schizophrenia. HIV/AIDS, and tobacco use. The use of tobacco, marijuana/cocaine, and alcohol were the most negatively judged behaviors (p < 0.05). Nursing assistants and community health care workers demonstrated the severest judgment of alcohol use. In addition, marijuana/cocaine addicts and alcoholics suffered the highest rate of rejection by professionals. The hypothesis that the use of alcohol and other drugs is a behavior stigmatized by health professionals being confirmed, it is important to develop strategies for changing provider attitudes in order to provide a higher quality of service to these patients. This study is important as a first study among PHC professionals about social stigma of alcohol and other drugs users. (C) 2009 Elsevier Ltd. All rights reserved.

The use of different doses of metamizol for post-operative analgesia in dogs

Objective To evaluate the post-operative analgesic effect of metamizol (dipyrone) administered intravenously at three different doses (15 mg kg(-1), 25 mg kg(-1) and 35 mg kg(-1)) compared to placebo in dogs undergoing ovariohysterectomy. Study design Prospective, comparative, randomized. blinded trial. Animals Forty healthy bitches, aged 1-6 years, weighing 10-35 kg Methods The animals were randomly divided into four groups and received their respective treatments immediately after surgery: placebo group (0.9% saline solution), D15 group (metamizol 15 mg kg(-1) IV), D25 group (metamizol 25 mg kg(-1) IV), D35 group (metamizol 35 mg kg(-1) IV). The following variables were measured: sedation, pulse rate (PR). respiratory rate (f(R)). arterial blood pressure (ABP), plasma catecholamines. serum cortisol, blood urea nitrogen (BUN) and creatinine metabolites. albumin, alanine aminotransferase (ALT), alkaline phosphatase (ALP). hemogram. platelet counts and level of analgesia which was assessed by visual analog (VAS). descriptive and behavioral scales. Patients were monitored for 48 hours after the administration of the analgesic agent. Rescue analgesia (tramadol, 2 mg kg(-1), intramuscularly) was provided for animals with pain scores >= 4, as determined by the VAS or descriptive scale. Results The D25 and D35 groups showed equivalent post-operative analgesia, as shown by decreased pain scores, according to the three different pain scales, and fewer animals that required rescue analgesia. Significantly lower serum cortisol concentrations were observed in the D25 and D35 groups when compared to the placebo and D15 groups. No hematologic, renal, hepatic or clinical adverse effects were observed during the treatment. Conclusions and clinical relevance Metamizol administered intravenously at 25 or 35 mg kg(-1) can provide adequate post-operative analgesia in bitches undergoing ovariohysterectomy.

Peripheral withdrawal recruits distinct central nuclei in morphine-dependent rats

This study examined if brain pathways in morphine-dependent rats are activated by opioid withdrawal precipitated outside the central nervous system. Withdrawal precipitated with a peripherally acting quaternary opioid antagonist (naloxone methiodide) increased Fos expression but caused a more restricted pattern of neuronal activation than systemic withdrawal (precipitated with naloxone which enters the brain). There was no effect on locus coeruleus and significantly smaller increases in Fos neurons were produced in most other areas. However in the ventrolateral medulla (A1/C1 catecholamine neurons), nucleus of the solitary tract (A2/C2 catecholamine neurons), lateral parabrachial nucleus, supramamillary nucleus, bed nucleus of the stria terminalis. accumbens core and medial prefrontal cortex no differences in the withdrawal treatments were detected. We have shown that peripheral opioid withdrawal can affect central nervous system pathways. Crown Copyright (C) 2001 Published by Elsevier Science Ltd. All rights reserved.

Improving pain management by nurses: A pilot peer intervention program

Significant pain continues to be reported by many hospitalized patients despite the numerous and varied educational programs developed and implemented to improve pain management. A theoretically based Peer Intervention Program was designed from a predictive model to address nurses' beliefs, attitudes, subjective norms, self-efficacy, perceived control and intentions in the management of pain with p.r.n. (as required) narcotic analgesia. The pilot study of this program utilized a quasi-experimental pre-post test design with a patient intervention, nurse and patient intervention and control conditions consisting of 24, 18 and 19 nurses, respectively. One week after the intervention, significant differences were found between the nurse and patient condition and the two other conditions in beliefs, self-efficacy, perceived control, positive trend in attitudes, subjective norms and intentions. The most positive aspects of the program were supportive interactive discussions with peers and an awareness and understanding of beliefs and attitudes and their roles in behavior.

Breaking the deadlock over an Australian trial of injectable opioid maintenance

INJECTABLE HEROIN MAINTENANCE has been advocated as a form of treatment for opioid dependence that would attract, and retain in treatment, addicts who have either not sought treatment or who have failed at other forms of treatment, including methadone maintenance. Advocates of heroin maintenance argue that it would increase the proportion of addicts in treatment and reduce heroin use, drug related crime, and deaths due to overdose.

A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system

Objectives: The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. Methods: All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report; drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. Results: Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n = 191) or control (n = 191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. Conclusions: Consideration should be given to the introduction of prison methadone programs particular where community based programs exist. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

A trajetória de um serviço público em álcool e outras drogas no município de Vitória : o caso do CPTT

Comunicação oral apresentada na 18th World Conference of Social Work realizada em 2006 em Munique, Alemanha.

Programa de competências pessoais e sociais para adultos em exclusão social

Trabalho apresentado em XIII Congreso Internacional Galego-Portugués de Psicopedagoxía, Área 8 Interculturalidad, inclusión social y educación. Universidad da Coruña, 3 de Setembro de 2015.

Prevalência do consumo de drogas ilícitas nas Forças Armadas estudo epidemiológico num dos ramos

RESUMO: Desde 1976 que as Forças Armadas desenvolvem acções de prevenção do consumo de drogas e álcool. Na década de 80 foi criada capacidade laboratorial e deu-se início a um programa de rastreios toxicológicos. No quinquénio 2001 a 2005, as proporções de resultados positivos, associando todos os tipos de rastreio, variaram entre 3,7% e 1,5%. De Outubro de 2006 a Julho de 2007 realizou-se um estudo analítico transversal, para estimar a prevalência do consumo de drogas (canabinóides, opiáceos, cocaína e anfetaminas) num dos Ramos das Forças Armadas, com base nos despistes realizados pelo seu laboratório. Foi utilizada uma amostra aleatória simples de 1039 militares, profissionais (QP) e contratados (RC), no activo e de ambos os sexos. Desde a nomeação dos militares a rastrear, passando pela cadeia de custódia das amostras até à obtenção do resultado foi utilizado apoio informático específico. O processo de pesquisa utilizou duas técnicas de triagem por imunoensaio e tecnologia de confirmação por GC/MS, de acordo com as recomendações europeias, permitindo estabelecer uma metodologia standard para organizações e empresas. A prevalência estimada, de consumidores de droga, foi de 3,8/1.000, para um erro de 0,37%. O número de casos registado (4) não permitiu a utilização de testes estatísticos que conduzissem à identificação de características determinantes da positividade, mas não deixou de revelar aspectos inesperados. A observação de séries de casos e a realização regular de estudos epidemiológicos, que ajudem a redefinir grupos alvo e a perceber a dimensão, as determinantes e as consequências do consumo de drogas é sugerida, em conclusão.--------------------------------------- RÉSUMÉ: Depuis 1976, les Forces Armées mettent au point des mesures visant à prévenir la consommation de drogues et d'alcool. En 1980, fut créé capacité laboratoriel et ont ensuite commencé un programme de dépistage toxicologique. Au cours des cinq années allant de 2001 à 2005, les proportions de consommateurs, impliquant tous les types de dépistage, allaient de 3,7% à 1,5 %. D'octobre 2006 à juillet 2007, une étude analytique transversale a été organisée pour évaluer la prévalence de l’usage de drogues (cannabis, opiacés, cocaïne et amphétamines) dans une branche de les Forces Armées, basée sur les dépistages faites par un laboratoire militaire, à l'aide d'un échantillon aléatoire de 1039 militaires, professionnels (QP) et sous contract (RC), à l’actif et des deux sexes. Tout au long du procès, de la nomination des donneurs, en passant par la chaine de garde des échantillons, jusqu’à obtention du résultat, il fut employé un appui informatique sécurisé. Le processus de recherche employa deux techniques de tri par imunoessay et la technologie de confirmation GC/MS, selon les recommandations européennes, permettant d'établir une méthodologie standard pour les organisations et les entreprises. La prévalence estimée fut de 3,8/1.000 pour une marge d’erreur de 0,37%. Le nombre de cas enregistrés (4) n'autorise pas l'utilisation de testes statistiques de menant à l'identification de caractéristiques déterminant de la positivité, mais il permet à révéler des aspects inattendus. L'observation de séries de cas et la tenue régulière d’études épidémiologiques, qui contribuent à redéfinir les groupes cibles et de comprendre l'ampleur, les déterminants et les conséquences de l'usage de drogues, est suggéré, en fin de compte.--------------------------------------- ABSTRACT: Since 1976, the Armed Forces, have been developing measures to prevent the use of drugs and alcohol. In 1980, was created laboratory facility which then started a program of toxicological screenings. In the five years running from 2001 to 2005, the proportions of consumers, involving all types of screening, ranged from 3,7% to 1,5%. From October 2006 to July 2007, a cross-sectional study was held to estimate the prevalence of drug use (cannabinoids, opiates, cocaine and amphetamines) in one branch of the Portuguese Armed Forces, based on laboratory screenings, using a random sample of 1039 military, professional (QP) and enlisted (RC), active-duty and of both sexes. Specific computer support was used all the way, from the appointment, including the chain of custody of samples, to the obtaining of the result. The process of search used two techniques for sorting by immunoassay and confirmation technology GC/MS, according to European recommendations, allowing to establish a standard methodology for organizations and companies. The estimated prevalence of drug users was 3.8/1.000 for a 0.37% error (95% confidence interval). The number of cases registered (4) does not permit use of statistical testing leading to the identification of characteristics weighing in the establishing to extrapolate for the population, but it allows revealing unexpected aspects. The observation of series of cases and the regular holding of epidemiological studies, which help redefine target groups and to understand the extent, the determinants and consequences of drug use, is suggested, in conclusion.

Suporte social em cuidadores informais de dependentes de substâncias.

Os cuidadores informais têm de lidar com situações potencialmente causadoras de stress e Sobrecarga. Uma amostra com 120 cuidadores de Dependentes de Substâncias, residentes em Portugal, completou uma bateria de questionários que incluía o BDI (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; McIntyre & Araújo-Soares, 1999), BSI (Canavarro, 1999; Derogatis, 1975, 1993), CRA (Given, et al., 1992), WHOQOL – Bref (Fleck, 2000; Vaz Serra, et al., 2006) e o IESSS (Ensel & Woelfel, 1986; Faria, 1999). De seguida, os participantes foram distribuídos por três grupos (G1, G2 e G3), dependendo do tempo de abstinência do familiar a quem prestavam cuidados. O estudo explorou a relação entre diversas variáveis clínicas e psicológicas e o suporte social nesses cuidadores. Os resultados revelaram que a coabitação com o paciente, o distress psicológico, a qualidade de vida (relações sociais e psicológica) e a sobrecarga são preditores, do suporte social explicando 48% da variância observada. O modelo de mediação demonstrou que o suporte social é um mediador parcial da relação entre o distress e a sobrecarga, explicando 60% da variância observada. Deste modo, verifica-se a importância de intervir no suporte social no sentido de diminuir o impacto do distress e sobrecarga nos cuidadores.

Salvia divinorum: an hallucinogenic mint which might become a new recreational drug in Switzerland.

Salvia divinorum Epling & Jativa is an hallucinogenic mint traditionally used for curing and divination by the Mazatec Indians of Oaxaca, Mexico. Young people from Mexican cities were reported to smoke dried leaves of S. divinorum as a marijuana substitute. Recently, two S. divinorum specimens were seized in a large-scale illicit in-door and out-door hemp plantation. Salvinorin A also called divinorin A, a trans-neoclerodane diterpene, was identified in several organic solvent extracts by gas chromatography-mass spectrometry. The botanical identity of the plant was confirmed by comparing it to an authentic herbarium specimen. More plants were then discovered in Swiss horticulturists greenhouses. All these data taken together suggest that many attempts exist in Switzerland to use S. divinorum as a recreational drug. This phenomenon may be enhanced because neither the magic mint, nor its active compound are banned substances listed in the Swiss narcotic law.

Prévenir la prise de poids à l'arrêt du tabac: pas de solution miracle: revue Cochrane pour le praticien. [Preventing weight gain in smoking cessation: there is no miracle solution]

http://resfranco.cochrane.org/sites/resfranco.cochrane.org/files/uploads/Arrettabac2009.pdf