Search Results (6)

Background: One of the most important issues for opiate maintenance therapy efficacy is the involvement of primary care physicians (PCPs) in opiate use disorder treatment, especially after referral from specialized units. This study aimed to analyze the progress of subjects in a specialized center and after referral to PCPs. Methods: This study was an observational prospective study. Recruitment took place in a specialized addictive disorder center in western France. All patients were evaluated (sociodemographical data, severity of substance use disorders through the TMSP scale, the quality of life through the TEAQV scale) by physicians during the 5-year-follow up of the study. Analysis focused on four main times during follow-up: entry/last visit into specialized care and into primary care. Results: 113 patients were included in this study; 93% were receiving methadone and 7% buprenorphine. Ninety (90) were referred to primary care. In primary care follow-up, the probability of the lowest severity score for substance use disorders remained stable over time. Conclusions: In daily practice, a center specialized in addictive disorders referred OMT management to PCPs for a majority of patients, and benefits regarding substance use disorders severity and quality of life remained stable after referral. Our results need to be confirmed. Full article

When psychiatric illness and substance use disorder coexist, the clinical approach to the patient is, unsurprisingly, awkward. This fact is due to a cultural context and, more directly, to the patient’s psychiatric condition and addiction behaviors—a situation that does not favor a scientific approach. In dual disorder facilities, several types of professionals work together: counselors, social workers, psychologists, and psychiatrists. Treatment approaches vary from one service to another and even within the same service. It is crucial to provide dual disorder patients with multiple treatments, comprising hospitalization, rehabilitative and residential programs, case management, and counselling. Still, when treating dual disorder (DD) heroin use disorder (HUD) patients, it is advisable to follow a hierarchical algorithm. First, we must deal with addiction: by detoxification, whenever possible. This means starting most patients on anti-craving pharmacological maintenance, though aversion therapy may be appropriate for a few of them. Opiate antagonists may be used with heroin-addicted patients as long as those patients are only mildly ill. In contrast, agonist opioid medications, i.e., buprenorphine and methadone suit moderately and severely ill patients, respectively. Achieving control of mood instability or psychotic episodes is the next step, to be followed by a prevention strategy to counteract residual cravings and dominate mood disorders or psychotic episodes through long-term pharmacological maintenance that is focused on a double target. Full article

Methadone is a long-acting synthetic opioid with high affinity for various opioid receptors, especially for μ-opioid receptors. Methadone has been used as a successful pharmacologic intervention for the treatment of heroin dependence and acute and chronic pain. This treatment is effective for opiate addiction, reducing morbidity and mortality associated with heroin use. However, overdosing with methadone has become a growing phenomenon because of the increased availability of this drug. Patients enrolled in a methadone maintenance treatment program may become physically dependent and may experience methadone withdrawal symptoms. In this review article, there are discussed about pharmacokinetic and pharmacodynamic properties of methadone, clinical symptoms of its overdose, dosage problems, detection of methadone in biological samples, treatment, and causes of methadone overdose-related deaths. Full article

Injection drug use (IDU) continues to be a significant public health issue in the U.S. and internationally, and there is evidence to suggest that the burden of injection drug use and associatedmorbidity and mortality falls disproportionately on minority communities. IDU is responsible for a significant portion of new and existing HIV/AIDS cases in many parts of the world. In the U.S., the prevalence of HIV and hepatitis C virus is higher among populations of African-American and Latino injection drug users (IDUs) than among white IDUs. Methadone maintenance therapy (MMT) has been demonstrated to effectively reduce opiate use, HIV risk behaviors and transmission, general mortality and criminal behavior, but opiate-dependent minorities are less likely to access MMT than whites. A better understanding of the obstacles minority IDUs face accessing treatment is needed to engage racial and ethnic disparities in IDU as well as drug-related morbidity and mortality. In this study, we explore knowledge, attitudes and beliefs about methadone among 53 out-of-treatment Latino and African-American IDUs in Providence, RI. Our findings suggest that negative perceptions of methadone persist among racial and ethnic minority IDUs in Providence, including beliefs that methadone is detrimental to health and that people should attempt to discontinue methadone treatment. Additional potential obstacles to entering methadone therapy include cost and the difficulty of regularly attending a methadone clinic as well as the belief that an individual on MMT is not abstinent from drugs. Substance use researchers and treatment professionals should engage minority communities, particularly Latino communities, in order to better understand the treatment needs of a diverse population, develop culturally appropriate MMT programs, and raise awareness of the benefits of MMT. Full article

Background: The use of cannabis among people suffering from psychosis is common and doubles the risk of relapse, aggravates positive symptoms and decreases the level of social functioning. Access to care remains difficult for these patients. Psychotic symptoms themselves could either be a powerful motivation to change behaviour when patients link traumatic psychotic events with cannabis use, or represent a cognitive and symptomatic obstacle to the treatment. Principles of treatment of dual diagnosis disorders have been described, mainly for cocaine and opiate users. However, cannabis among persons with psychosis is generally perceived as trivial and inoffensive, although particularly harmful for these subjects. Treatment strategies must therefore be adapted to these specificities. Acceptable and effective interventions must be developed on the basis of the following principles: (a) simultaneously treating psychosis and consumption of cannabis, (b) taking account of cognitive deficits associated with schizophrenia and (c) adapting the motivational interviewing to these cognitive deficits. The first four sessions of our intervention include: (1) the creation of an alliance and evaluation consumption, (2) the resolution of the ambivalence about the consumption of motivational techniques and (3) the adaptation of goals according to the stage of change. Objectives: The purpose of this article is to describe and illustrate a clinical scenario, stages of a motivational intervention aimed at consumers of cannabis with psychotic symptoms. Method: The intervention has been developed and performed on 30 subjects as part of a controlled study.The first four sessions are: (1) the establishment of a therapeutic alliance and the evaluation of consumption, (2) resolution of the ambivalence about cannabis use by motivational techniques, (3) adaptation of goals according to the stage of change. The description of the intervention was based on an anonymised clinical vignette. Results: The population covered by the study is predominantly male (87%) with a diagnosis of schizophrenia (60%) and with a dependence on cannabis (87%).The intervention is well accepted by the subjects, who are maintained at 80% in the treatment after one year.The initial assessment of consumption makes it possible to evaluate the extent of the problem and can be accompanied by the user’s awareness about the links between psychotic symptoms and cannabis use.The motivational approach allows the therapist to get an empathetic understanding of the patient’s reasons for cannabis use and to explore possible alternatives. The patient may also share ambivalent aspects without fearing retaliation.The goals of treatment are then set according to the current stage of motivation. Thus, this method is also applicable to persons without perception of the problem and no desire for change. Conclusion: The intervention is well accepted and allows access and maintenance to treatment for psychotic patients with problematic cannabis use. Preliminary data available do not yet permit the analysis of results in terms of reducing cannabis, positive changes in symptoms or use of acute psychiatric services. Full article

Background. The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being.
Objective. Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived health of opioid-dependent persons in Lithuania.
Methods. A total of 102 opioid-dependent patients were recruited in the study. A prospective follow-up study design was used. To assess quality of life, the WHOQOL-BREF 26-item version was used. The impact of methadone maintenance treatment on self-perceived health was assessed by Opiate Treatment Index (OTI).
Results. Following 6 months of methadone maintenance treatment, significant improvements in physical (P=0.004), psychological (P=0.004), and environmental (P=0.048) components of quality of life were observed; no statistically significant improvements were found in social component of quality of life. Study participants reported lower rates of medical morbidity associated with injection (P<0.001), cardiorespiratory (P=0.034), musculoskeletal (P<0.001), neurological (P=0.013), gastrointestinal (P<0.001), and general health (P<0.001).
Conclusions. Methadone maintenance treatment substantially reduces morbidity associated with opioid dependence and improves the quality of life of patients. Full article