Oral heroin in opioid-dependent patients: pharmacokinetic comparison of immediate and extended release tablets

In diacetylmorphine prescription programs for heavily dependent addicts, diacetylmorphine is usually administered intravenously, but this may not be possible due to venosclerosis or when heroin abuse had occurred via non-intravenous routes. Since up to 25% of patients administer diacetylmorphine orally, we characterised morphine absorption after single oral doses of immediate and extended release diacetylmorphine in 8 opioid addicts. Plasma concentrations were determined by liquid chromatography-mass spectrometry. Non-compartmental methods and deconvolution were applied for data analysis. Mean (+/-S.D.) immediate and extended release doses were 719+/-297 and 956+/-404 mg, with high absolute morphine bioavailabilities of 56-61%, respectively. Immediate release diacetylmorphine caused rapid morphine absorption, peaking at 10-15 min. Morphine absorption was considerably slower and more sustained for extended release diacetylmorphine, with only approximately 30% of maximal immediate release absorption being reached after 10 min and maintained for 3-4h, with no relevant food interaction. The relative extended to immediate release bioavailability was calculated to be 86% by non-compartmental analysis and 93% by deconvolution analysis. Thus, immediate and extended release diacetylmorphine produce the intended morphine exposures. Both are suitable for substitution treatments. Similar doses can be applied if used in combination or sequentially.

Changing Europe and The Relevance of Care and The Caring Professions

The aim of the paper is to introduce the challenges of the international care debate of the last ten years in order to grasp basic social needs, to analyse their treatment in the public and private sphere and to look at the orientation of professional answers by the care-professions. The concept of care enhances the societal dealing with - or ignoring of - different forms of dependency on informal and formal personal and social services throughout the life-cycle (child-care, nursing sick or handicapped persons, supporting the elderly) and in special life situations (from help to lone mothers and their children, via help to drug-addicts to help for homeless people). All societies have different approaches to deal with these life-situations, they do so by employ-ing various mixtures of: familial support, mostly provided by women, social politics, organized by the state, public and/or private social services. This welfare-mix shows different combinations of private and public obligations, paid and und unpaid work, professional and laymen's tasks based on a specific understanding of mo-rality and justice embedded in the gender structure and intergenerational relationships. The importance of social work as a profession in this context differs according to the historical developments and cultural traditions. Characteristic for the profile of social work is the rele-vance of a care ethics and the existence of social rights, the tension of mothering and profes-sional methods, the relationship between help, denial and punishment and the ways of institu-tionalisation. The actuality of this debate is closely intertwined with the restructuring of societal bonds in the face of globalisation, the political reorganisation of states, the changes in the living to-gether of different generations and both sexes and the consequences for the organisation and contents of welfare. Looking at Germany and Eastern Europe two new phenomena of social relevance for the dis-cussion of care work and care needs can be taken as an example: the extent of cheap illegal women laborers travelling between east and west, especially Polish women working intermit-tendly in private care for old people and the highly organized traffiking of women from Russia to Germany to work in the sex business. The care debate entails a reframing of welfare issues in the light of social justice between classes, ethnicities and gender groups.

Perfil clínico y social del paciente adicto hospitalizado

Objetivos: Determinar las características clínicas y morbilidad de los pacientes (pac.) adictos ingresados a un Servicio de Clínica Médica. Material y métodos: Estudio protocolizado, observacional, descriptivo y transversal. Criterio de inclusión: pac. adicto con consumo de sustancias ilícitas. Informe preliminar: Periodo: 24 meses. Datos analizados en Epi info 6.4 Resultados: Se incluyeron 40 pac. Prevalencia: 0.2/1000 egresos. El 82.5% eran hombres. Edad media: 31.5 años (DS±9.65). Permanencia media: 11 días (DS±13.98) vs 7.12 (DS±10.1) del Servicio (p=0.016). Consumían cocaína el 82.5% (IC95%67.22-92.66) marihuana el 77.5% (IC95% 61.65- 89.16), tolueno el 10% (IC95%2.79-23.66), floripondio y hachis el 2.5% (IC95% 0.06-13.16) cada uno. En el 2.5% la vía de administración era endovenosa y el 60% eran poliadictos. Solo el 10% recibió tratamiento para abandonar la adicción (100% tratamiento psicológico y 5.13% farmacológico). De clase social pobre el 75%. El 62.5% de los pac. estaban desocupados, tenían antecedentes judiciales el 10% y el 7.5% había estado en prisión. El 92.5% (IC95% 76.34-97.21) era heterosexual, 2.5% hombres que tenían sexo con hombres y bisexuales 5% (IC95% 0.61-16.92). Solo el 10% tenían secundaria completa. El 80% ingreso por Emergencias y por causa infecciosa el 45%. El 12.5% ingreso por complicaciones de la adicción. Las manifestaciones relacionadas con la adicción fueron: manifestaciones del sistema nervioso central: 12.5% (IC95%4.19-26.80); síndrome de abstinencia y temblor 7.5% cada uno y excitación psicomotriz, delirium, signo de foco neurológico y rigidez 5% cada uno. El 100% presentaba alguna comórbida; tabaquismo 80%, depresión 12.8% Y alcoholismo 57.5%, entre otras. Presentaban enfermedades de transmisión sexual 5 pac. (4 HIV, 2 VHC y 1 pediculus pubis). No hubo mortalidad hospitalaria. Conclusión: El paciente adicto internado se caracteriza por ser joven, pertenecer a un grupo social desprotegido, sin trabajo y sin educación, tener poliadicción, con alta carga de comórbidas y de internación, principalmente por complicaciones infecciosas.

In vitro selection of RNA molecules that displace cocaine from the membrane-bound nicotinic acetylcholine receptor

The nicotinic acetylcholine receptor (AChR) controls signal transmission between cells in the nervous system. Abused drugs such as cocaine inhibit this receptor. Transient kinetic investigations indicate that inhibitors decrease the channel-opening equilibrium constant [Hess, G. P. & Grewer, C. (1998) Methods Enzymol. 291, 443–473]. Can compounds be found that compete with inhibitors for their binding site but do not change the channel-opening equilibrium? The systematic evolution of RNA ligands by exponential enrichment methodology and the AChR in Torpedo californica electroplax membranes were used to find RNAs that can displace inhibitors from the receptor. The selection of RNA ligands was carried out in two consecutive steps: (i) a gel-shift selection of high-affinity ligands bound to the AChR in the electroplax membrane, and (ii) subsequent use of nitrocellulose filters to which both the membrane-bound receptor and RNAs bind strongly, but from which the desired RNA can be displaced from the receptor by a high-affinity AChR inhibitor, phencyclidine. After nine selection rounds, two classes of RNA molecules that bind to the AChR with nanomolar affinities were isolated and sequenced. Both classes of RNA molecules are displaced by phencyclidine and cocaine from their binding site on the AChR. Class I molecules are potent inhibitors of AChR activity in BC3H1 muscle cells, as determined by using the whole-cell current-recording technique. Class II molecules, although competing with AChR inhibitors, do not affect receptor activity in this assay; such compounds or derivatives may be useful for alleviating the toxicity experienced by millions of addicts.

Sociología y drogodependencia: la mirada ténica en la intervención social. Fundamentos para la constitución de una sociología de las drogodependencias

Almost thirty years have passed since the City Council of Madrid approved the first Municipal Plan against Drugs, thus laying the foundations of the current commitment to offer assistance to drug addicts. A Service that has been continuously growing (in funding), maturing (in organizations) and diversifying (in actions) during these decades, in the same manner as the scenario in which these actions are deployed has been evolving. But, what can be said today about the status of drugaddiction intervention? This study adopts a sociological approach that starts with and is focused on what has been defined as the hegemonic vision on drug addiction, with the aim of studying (precisely and progressively) the different and most widely accepted theoretical-practical developments and to understand how certain conceptions or positions determine the form of this social fact. Therefore, the main objective of this study is to understand and evaluate the performative effects of certain practices, techniques and professionals on defining and addressing a reality that is in question and/or in conflict, as a social problem. In addition, this study is focused on identifying a series of fundamental elements to address what is understood as the state of the issue of drug addiction in depth (discourse of drugs Vs. discourse on drugs) in order to offer a series of sociological questions and insights to focus attention onto this reality. For this purpose, once its intentions have been defined and due to the social nature of the object under study, the present research deploys qualitative methodology as a tool for approximation, delimiting the scope that professional technicians assume regarding the issue in question as well as their own professional practices within their organizations. Thus, we have contacted certain public as well as non-governmental organizations with long-term experience in drug addiction, so as to find out first hand, in addition to their writings, the different meanings they find in the performance of their specific practice (micro) as well as the framework within which their practice is defined and materialised (macro) on a population defined or characterised by (drug) addiction...

The Impact of a Substance Abuse Treatment for Offenders in Relation to the Time Spent in Treatment

The objective of this research is to evaluate the outcomes of a treatment for addicts. 123 subjects were tested before treatment and at 5, 8 and 11 months follow-up periods with a French version of the Addiction Severity Index (ASI). Exposure to treatment was based on the number of clients’ contact-hours with a therapist. The sample was divided into three groups according to the number of hours spent in treatment. The data was analysed using MANOVA on the seven scales of the ASI for the three groups and the four time periods. Results showed that all groups improved significantly but that this improvement was not related to the number of hours spent in treatment.

The Impact of a Substance Abuse Treatment for Offenders in Relation to the Time Spent in Treatment

The objective of this research is to evaluate the outcomes of a treatment for addicts. 123 subjects were tested before treatment and at 5, 8 and 11 months follow-up periods with a French version of the Addiction Severity Index (ASI). Exposure to treatment was based on the number of clients’ contact-hours with a therapist. The sample was divided into three groups according to the number of hours spent in treatment. The data was analysed using MANOVA on the seven scales of the ASI for the three groups and the four time periods. Results showed that all groups improved significantly but that this improvement was not related to the number of hours spent in treatment.

Grief and grief training in the substance abuse treatment field.

Mode of access: Internet.

Annual report of the physician in charge of the Oxford Retreat, for the year ending ...

Latest issue consulted: 13th (1895).

Global Research Network Meeting on HIV Prevention in Drug-Using Populations : inaugural meeting report, June 25-26, 1998, Geneva, Switzerland /

Shipping list no.: 99-0352-P.

Mortality data from the Drug Abuse Warning Network, 2001.

"January 2003."

Outreach risk reduction strategies for changing HIV-related risk behaviors among injection drug users : the National AIDS Demonstration Research (NADR) Project.

S/N 017-024-01531-8 (GPO)

National Institute on Drug Abuse statistical series.

Discontinued

Basic management skills : resource manual /

Operated pursuant to contract no. 271-75-4018.

Financing drug treatment through state programs /

Shipping list no.: 94-0200-P.