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Huang CL, Chiang YC, Chang WC, Su YT, Yang JC, Cheng WC, Lane HY, Ho IK, Ma WL. Add-On Selective Estrogen Receptor Modulators for Methadone Maintenance Treatment. Front Endocrinol (Lausanne) 2021; 12:638884. [PMID: 34434167 PMCID: PMC8381776 DOI: 10.3389/fendo.2021.638884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
Methadone maintenance treatment (MMT) remains the cornerstone for the management of opiate abuse. However, MMT can be associated with complex factors, including complications during the tolerance phase, the inability of some patients to maintain treatment effects during the tapering or abstinence phases, and the development of methadone dependence. Previous studies have revealed a sex disparity in MMT efficacy, showing that women undergoing MMT experiencing an increase in psychological symptoms compared with men and suggesting a link between disparate responses and the effects of estrogen signaling on methadone metabolism. More specifically, estradiol levels are positively associated with MMT dosing, and the expression of a single-nucleotide polymorphism (SNP) associated with estrogen receptor (ER) regulation is also associated with MMT dosing. In addition to performing mechanistic dissections of estrogen signaling in the presence of methadone, past studies have also proposed the targeting of estrogen signaling during MMT. The present report provides an overview of the relevant literature regarding sex effects, including differences in sex hormones and their potential impacts on MMT regimens. Moreover, this article provides a pharmacological perspective on the targeting of estrogen signals through the use of selective ER modulators (SERMs) during MMT. Preliminary preclinical experiments were also performed to evaluate the potential effects of targeting estrogen signaling with tamoxifen on methadone metabolism.
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Affiliation(s)
- Chieh-Liang Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Taichung, Taiwan
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
| | - Yao-Chang Chiang
- Department of Nursing, Division of Basic Medical Sciences, Chang Gung University of Science and Technology, Chiayi County, Taiwan
| | - Wei-Chun Chang
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Ting Su
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
| | - Juan-Cheng Yang
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chung Cheng
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
| | - Ing-Kang Ho
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Lung Ma
- Sex Hormone Research Center, Center for Drug Abuse and Addiction, Chinese Medicine Research and Development Center, Department of Psychiatry, Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, Asia University, Taichung, Taiwan
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Horyniak D, Agius PA, Degenhardt L, Reddel S, Higgs P, Aitken C, Stoové M, Dietze P. Patterns of, and Factors Associated With, Illicit Pharmaceutical Opioid Analgesic Use in a Prospective Cohort of People Who Inject Drugs in Melbourne, Australia. Subst Use Misuse 2015; 50:1650-9. [PMID: 26576630 DOI: 10.3109/10826084.2015.1027928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are a key population engaging in pharmaceutical opioid analgesic (PO) use, yet little is known about patterns of illicit PO use among this group. OBJECTIVES The aims of this research were to measure the prevalence and frequency of lifetime and past-month illicit PO use and injection in a sample of regular PWID, to examine patterns of past-month illicit PO use within individuals over time, and to identify factors independently associated with past-month illicit PO use. METHODS Data were drawn from a prospective cohort study of regular PWID (N = 666) in Melbourne, Australia. Data from five waves of annual data collection (including baseline) were analyzed descriptively and using generalized estimating equations (GEE). RESULTS At baseline, 59% of participants reported lifetime illicit PO use and 20% reported past-month use, predominantly through injecting. Most illicit PO users at baseline transitioned to nonuse of illicit POs across the study period. In multivariable GEE analysis, factors associated with past-month illicit PO use included past-year arrest [adjusted odds ratio (AOR): 1.39], opioids other than heroin as drug of choice (AOR: 5.14), experiencing poorer physical health (AOR: 0.98) and a range of other drug use variables. CONCLUSIONS We found little evidence of ongoing illicit PO use among those followed up, with illicit PO use linked to polydrug use more broadly. Nonetheless, trends in illicit PO use among PWID should continue to be monitored and harm reduction interventions implemented to reduce the associated public health risks.
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Affiliation(s)
- Danielle Horyniak
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Paul A Agius
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia
| | - Louisa Degenhardt
- c National Drug and Alcohol Research Centre , University of New South Wales , Sydney , New South Wales , Australia.,d School of Population and Global Health , University of Melbourne , Melbourne , Victoria , Australia
| | - Siobhan Reddel
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia
| | - Peter Higgs
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia.,e National Drug Research Institute , Curtin University , Melbourne , Victoria , Australia
| | - Campbell Aitken
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Mark Stoové
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Paul Dietze
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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Sex differences in outcomes of methadone maintenance treatment for opioid addiction: a systematic review protocol. Syst Rev 2014; 3:45. [PMID: 24887111 PMCID: PMC4031161 DOI: 10.1186/2046-4053-3-45] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of methadone for the treatment of opioid addiction is an effective harm-reduction approach, although variability in treatment outcomes among individuals has been reported. Men and women with opioid addiction have been known to differ in factors such as opioid use patterns and characteristics at treatment entry; however, little has been reported about differences in methadone treatment outcomes between men and women. Therefore, we present a protocol for a systematic review which aims to provide a summary of existing literature on sex differences in outcomes of methadone treatment for opioid addiction. METHODS/DESIGN Electronic search of PubMed/MEDLINE, EMBASE, PsycINFO, and CINAHL databases will be conducted using a priori defined search strategy. Two authors (MB and BBD) will independently screen potential articles for eligibility using pre-determined inclusion and exclusion criteria and extract key information using a data extraction form designed for this study. Discrepancies will be resolved using a third party (ZS). The primary outcome will be sex differences in response to treatment defined as abstinence from illicit opioid use. We will also assess sex differences in treatment outcomes including treatment retention, remission status post-treatment, polysubstance abuse, methadone dose, drug-related adverse events, health status, psychological status, mortality, criminal activity, high risk sexual behavior, social support/relations, and employment. A meta-analysis will be conducted if possible; risk of bias and overall quality of evidence will be assessed to determine confidence in the estimates. DISCUSSION We anticipate that this review will highlight how men and women differ in methadone treatment outcomes and allow us to generate conclusions that can be applied to treatment in a clinical setting. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006549.
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McGowan C, Harris M, Rhodes T. Hepatitis C avoidance in injection drug users: a typology of possible protective practices. PLoS One 2013; 8:e77038. [PMID: 24194855 PMCID: PMC3806740 DOI: 10.1371/journal.pone.0077038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/06/2013] [Indexed: 12/11/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) represents a serious public health concern. People who inject drugs (PWID) are at particular risk and nearly half (45%) of PWID in England may be infected. HCV prevention interventions have only had moderate impact on the prevalence of HCV in this population. Using qualitative methods, we sought to detail the protective practices potentially linked to HCV avoidance among PWID, and explore the motivations for these. Methods The study used a life history approach allowing participants to detail their lived experience both before and during the course of their injecting careers. Thirty-seven participants were recruited from drug services in London, and from referrals within local injecting networks. A baseline and follow-up in-depth qualitative interview was carried out with each participant, and for half, a third interview was also undertaken. All underwent testing for HCV antibody. Analyses focused on developing a descriptive typology of protective practices potentially linked to HCV avoidance. Results Practices were deemed to be protective against HCV if they could be expected a priori to reduce the number of overall injections and/or the number of injections using shared injecting equipment. Participants reported engaging in various protective practices which fell into three categories identified through thematic analysis: principles about injecting, preparedness, and flexibility. Conclusions All participants engaged in protective practices irrespective of serostatus. It is important to consider the relative importance of different motivations framing protective practices in order to formulate harm reduction interventions which appeal to the situated concerns of PWID, especially given that these protective practices may also help protect against HIV and other blood borne infections.
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Affiliation(s)
- Catherine McGowan
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Magdalena Harris
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Tim Rhodes
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Bruneau J, Roy E, Arruda N, Zang G, Jutras-Aswad D. The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users. Addiction 2012; 107:1318-27. [PMID: 22248184 DOI: 10.1111/j.1360-0443.2012.03803.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS To examine trends in prescription opioid (PO) injection and to assess its association with hepatitis C virus (HCV) seroconversion among injection drug users (IDUs). DESIGN Prospective cohort study. SETTING Montreal, Canada. PARTICIPANTS HCV-negative IDUs at baseline, reporting injection in the past month. MEASUREMENTS Semi-annual visits included HCV antibody testing and an interview-administered questionnaire assessing risk behaviours. HCV incidence rate was calculated using the person-time method. Time-updated Cox regression models were conducted to examine predictors of HCV incidence. FINDINGS The proportion of IDUs reporting PO injection increased from 21% to 75% between 2004 and 2009 (P < 0.001). Of the 246 participants (81.6% male; mean age 34.5 years; mean follow-up time 23 months), 83 seroconverted to HCV [incidence rate: 17.9 per 100 person-years; 95% confidence interval (CI) 14.3, 22.1]. Compared to non-PO injectors, PO injectors were more likely to become infected [adjusted hazard ratio (AHR): 1.87; 95%CI:1.16, 3.03]. An effect modification was also found: PO injectors who did not inject heroin were more likely to become infected (AHR: 2.88; 95%CI: 1.52, 5.45) whereas no association was found for participants using both drugs (AHR: 1.19; 95% CI: 0.61, 2.30). Other independent predictors of HCV incidence were: cocaine injection, recent incarceration and >30 injections per month. CONCLUSIONS Prescription opioid injectors who do not inject heroin are at greater risk for HCV seroconversion than are those injecting both heroin and prescription opioids. Important differences in age, behaviour and social context suggest a need for targeted outreach strategies to this population.
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Affiliation(s)
- Julie Bruneau
- Research Center, Centre hospitalier de l'Université de Montréal, 264 René-Lévesque est, Montréal, Québec, Canada.
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Kucirka LM, Sarathy H, Govindan P, Wolf JH, Ellison TA, Hart LJ, Montgomery RA, Ros RL, Segev DL. Risk of window period hepatitis-C infection in high infectious risk donors: systematic review and meta-analysis. Am J Transplant 2011; 11:1188-200. [PMID: 21401874 PMCID: PMC3110646 DOI: 10.1111/j.1600-6143.2011.03460.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The OPTN classifies high infectious risk donors (HRDs) based on criteria originally intended to identify people at risk for HIV infection. These donors are sometimes referred to as 'CDC high risk donors' in reference to the CDC-published guidelines adopted by the OPTN. However, these guidelines are also being used to identify deceased donors at increased risk of window period (WP) hepatitis C virus (HCV) infection, although not designed for this purpose. The actual risk of WP HCV infection in HRDs is unknown. We performed a systematic review of 3476 abstracts and identified 37 eligible estimates of HCV incidence in HRD populations in the United States/Canada. Pooled HCV incidence was derived and used to estimate the risk of WP infection for each HRD category. Risks ranged from 0.26 to 300.6 per 10,000 donors based on WP for ELISA and 0.027 to 32.4 based on nucleic acid testing (NAT). Injection drug users were at highest risk (32.4 per 10,000 donors by NAT WP), followed by commercial sex workers and donors exhibiting high risk sexual behavior (12.3 per 10,000), men who have sex with men (3.5 per 10,000), incarcerated donors (0.8 per 10,000), donors exposed to HIV infected blood (0.4 per 10,000) and hemophiliacs (0.027 per 10,000). NAT reduced WP risk by approximately 10-fold in each category.
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Affiliation(s)
- Lauren M. Kucirka
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harini Sarathy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Joshua H. Wolf
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trevor A. Ellison
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Robert A. Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R. Lorie Ros
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
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Grebely J, Raffa JD, Lai C, Krajden M, Kerr T, Fischer B, Tyndall MW. Low uptake of treatment for hepatitis C virus infection in a large community-based study of inner city residents. J Viral Hepat 2009; 16:352-8. [PMID: 19226330 DOI: 10.1111/j.1365-2893.2009.01080.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the availability of effective therapy for hepatitis C virus (HCV) infection, there are little data on the uptake of treatment. We evaluated factors associated with HCV infection and the uptake of HCV treatment in a large community-based inner city cohort in Vancouver, Canada. The Community Health and Safety Evaluation is a cohort study of inner city residents recruited from January 2003 to June 2004. HIV and HCV status and information on prescriptions for HCV treatment were determined through linkage with provincial databases. HCV prevalence was calculated and factors associated with HCV infection were identified. HCV treatment uptake and incidence of HCV infection from January 2000 to December 2004 were expressed in terms of person-years of observation. Among 2913 individuals, HCV antibody testing was performed in 2118 and the HCV seroprevalence was 64.2% (1360 of 2118). In total, 1.1% of HCV antibody-positive individuals (15 of 1360) initiated treatment for HCV infection from January 2000 to December 2004 [0.28 cases per 100 person-years (95% CI, 0.15-0.46)]. Three of 15 (20.0%) treated individuals achieved a sustained virological response. During the same period, the incidence of HCV infection was 7.26 cases (95% CI, 5.72-8.80) per 100 person-years. Overall, the rate of new HCV seroconversions in this cohort in the study period was about 25 times the rate of HCV treatment uptake. There are extremely low rates of HCV treatment initiation and very limited effectiveness, despite a high prevalence of HCV infection in this large community-based cohort of inner city residents with access to universal healthcare.
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Affiliation(s)
- J Grebely
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, NSW, Australia.
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Thomson N, Sutcliffe CG, Sirirojn B, Keawvichit R, Wongworapat K, Sintupat K, Aramrattana A, Celentano DD. Correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand. Am J Public Health 2008; 99:1232-8. [PMID: 18923109 DOI: 10.2105/ajph.2008.136648] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand in 2005 to 2006. METHODS We conducted a cross-sectional study among 1189 young methamphetamine users. Participants were surveyed about their recent drug use, sexual behaviors, and incarceration. Biological samples were obtained to test for sexually transmitted and viral infections. RESULTS Twenty-two percent of participants reported ever having been incarcerated. In multivariate analysis, risk behaviors including frequent public drunkenness, starting to use illicit drugs at an early age, involvement in the drug economy, tattooing, injecting drugs, and unprotected sex were correlated with a history of incarceration. HIV, HCV, and herpes simplex virus type 2 (HSV-2) infection were also correlated with incarceration. CONCLUSIONS Incarcerated methamphetamine users are engaging in behaviors and being exposed to environments that put them at increased risk of infection and harmful practices. Alternatives to incarceration need to be explored for youths.
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Affiliation(s)
- Nicholas Thomson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205, USA
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