1
|
Zamboni L, Franceschini A, Portoghese I, Morbioli L, Lugoboni F. Sexual Functioning and Opioid Maintenance Treatment in Women. Results From a Large Multicentre Study. Front Behav Neurosci 2019; 13:97. [PMID: 31156404 PMCID: PMC6528617 DOI: 10.3389/fnbeh.2019.00097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
Opioid maintenance treatment (OMT) is the most widespread therapy for both females and males opioid addicts. While many studies have evaluated the OMT impact on men's sexuality, the data collected about the change in women's sexual functioning is still limited despite the fact that it is now well-known that opioids - both endogenous and exogenous - affect the endocrine system and play an important role in sexual functioning. The present study aims to determine how OMT with buprenorphine (BUP) or methadone (MTD) affects sexual health in women; examining also any possible emerging correlation between sexual dysfunction (SD), type of opioid and patients' mental health. This multi-center study case recruited 258 female volunteers attending Italian public Addiction Outpatients Centers that were stabilized with OMT for at least 3 months. SD was assessed with the Arizona Sexual Experience Scale. The twelve-item General Health Questionnaire was used to assess participants' mental health conditions. The results show that 56.6% of women receiving OMT for at least 3 months presented SD without significant differences between MTD e BUP groups. The majority of the subjects with SD have a poorer quality of intimate relationships and worse mental health than the average. To the best of our knowledge, the present study is the largest report on the presence of SDs in women as a side effects of MTD and BUP used in OMT. Since SDs cause difficulties in intimate relationships, lower patients' quality of life and interfere with OMT beneficial outcomes, we recommend that women undertaking an opioid therapy have routine screening for SD and we highlight the importance to better examine opioid-endocrine interactions in future studies in order to provide alternative potential treatments such as the choice of opioid, opioid dose reduction and hormone supplementation.
Collapse
Affiliation(s)
- Lorenzo Zamboni
- Department of Medicine, Verona University Hospital, Verona, Italy
| | - Anna Franceschini
- Addictive Behaviors Department, Local Health Authority, Treviso, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Morbioli
- Department of Medicine, Verona University Hospital, Verona, Italy
| | - Fabio Lugoboni
- Department of Medicine, Verona University Hospital, Verona, Italy
| | | |
Collapse
|
2
|
Fiumana V, Zamboni L, Mazza M, Janiri L, Cibin M, GICS , Lugoboni F. Quality of Life in Heroin Users Attending Substitution Treatment: A Multicenter Study in Italy. Health (London) 2016. [DOI: 10.4236/health.2016.812123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
3
|
Let It "B"? The role of Hepatitis B universal vaccination among italian problematic drug users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3979-92. [PMID: 25872013 PMCID: PMC4410228 DOI: 10.3390/ijerph120403979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 02/07/2023]
Abstract
Hepatitis B virus (HBV) hepatitis is extremely common among problematic drug users (DUs). As of 2012, 47 of the 53 European countries had implemented a universal hepatitis B vaccination programme, a scenario that could radically change its spread. Even so, drug users are still one of the main groups at risk of being infected by HBV, exposing the fact that universal vaccination still has not managed to reach an optimal level of contagion protection. In order to evaluate the role of universal HBV vaccination in protecting against risk behaviour related to the use of illicit drugs, a group of 748 DUs, 511 male and 237 female, was tested for HBV markers, at their first access to public addiction clinics in the metropolitan area of Bologna, Italy. 487 were born after 1981, so they were eligible to have received HBV vaccination in adolescence or at birth; in these subjects antibodies against HBV core antigen had the significant prevalence of 6.2%. Universal HBV vaccination has shown evidence of protecting against infection in the general population. These results, amongst the first to evaluate actual protection in DUs vaccinated at birth or during adolescence, show that compulsory universal vaccination does not solve the problem of HBV transmission in the most at risk groups and that additional strategies must be studied and implemented to address this issue.
Collapse
|
4
|
Des Jarlais DC, Feelemyer JP, Modi SN, Arasteh K, Hagan H. Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas. Drug Alcohol Depend 2012; 124:95-107. [PMID: 22257753 PMCID: PMC3353009 DOI: 10.1016/j.drugalcdep.2011.12.020] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are multiple reasons why females who inject drugs may be more likely to become infected with HIV than males who inject drugs. Where this is the case, special HIV prevention programs for females would be needed. DESIGN International systematic review and meta-analysis of studies across 14 countries. METHODS Countries with high seroprevalence (>20%) HIV epidemics among persons who inject drugs (PWID) were identified from the Reference Group to the UN on HIV and Injecting Drug Use. Systematic literature reviews collected data on HIV prevalence by gender for these countries. Non-parametric and parametric tests along with meta-analytic techniques examined heterogeneity and differences in odds ratios (OR) across studies. RESULTS Data were abstracted from 117 studies in 14 countries; total sample size N = 128,745. The mean weighted OR for HIV prevalence among females to males was 1.18 [95% CI 1.10-1.26], with high heterogeneity among studies (I(2)= 70.7%). There was a Gaussian distribution of the log ORs across studies in the sample. CONCLUSION There was a significantly higher HIV prevalence among females compared to males who inject drugs in high seroprevalence settings, but the effect size is extremely modest. The high level of heterogeneity and the Gaussian distribution suggest multiple causes of differences in HIV prevalence between females and males, with a specific difference determined by local factors. Greater understanding of factors that may protect females from HIV infection may provide insights into more effective HIV prevention for both females and males who inject drugs.
Collapse
Affiliation(s)
- Don C Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York City 10038, USA.
| | | | | | | | | |
Collapse
|
5
|
Roux P, Carrieri PM, Cohen J, Ravaux I, Spire B, Gossop M, Comer SD. Non-medical use of opioids among HIV-infected opioid dependent individuals on opioid maintenance treatment: the need for a more comprehensive approach. Harm Reduct J 2011; 8:31. [PMID: 22123176 PMCID: PMC3286372 DOI: 10.1186/1477-7517-8-31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/28/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Opioid maintenance treatment (OMT) has a positive impact on substance use and health outcomes among HIV-infected opioid dependent patients. The present study investigates non-medical use of opioids by HIV-infected opioid-dependent individuals treated with buprenorphine or methadone. METHODS The MANIF 2000 study is a longitudinal study that enrolled a cohort of 476 HIV-infected opioid-dependent individuals. Data were collected in outpatient hospital services delivering HIV care in France. The sample comprised all patients receiving OMT (either methadone or buprenorphine) who attended at least one follow-up visit with data on adherence to OMT (N = 235 patients, 1056 visits). Non-medical use of opioids during OMT was defined as having reported use of opioids in a non-medical context, and/or the misuse of the prescribed oral OMT by an inappropriate route of administration (injection or sniffing). After adjusting for the non-random assignment of OMT type, a model based on GEE was then used to identify predictors of non-medical use of opioids. RESULTS Among the 235 patients, 144 (61.3%) and 91 (38.9%) patients were receiving buprenorphine and methadone, respectively, at baseline. Non-medical use of opioids was found in 41.6% of visits for 83% of individual patients. In the multivariate analysis, predictors of non-medical use of opioids were: cocaine, daily cannabis, and benzodiazepine use, experience of opioid withdrawal symptoms, and less time since OMT initiation. CONCLUSIONS Non-medical use of opioids was found to be comparable in OMT patients receiving methadone or buprenorphine. The presence of opioid withdrawal symptoms was a determinant of non-medical use of opioids and may serve as a clinical indicator of inadequate dosage, medication, or type of follow-up. Sustainability and continuity of care with adequate monitoring of withdrawal symptoms and polydrug use may contribute to reduced harms from ongoing non-medical use of opioids.
Collapse
Affiliation(s)
- Perrine Roux
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Patrizia M Carrieri
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Julien Cohen
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Isabelle Ravaux
- Hôpital La Conception, Service des Maladies Infectieuses, 147 boulevard Baille, 13005 Marseille, France
| | - Bruno Spire
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Michael Gossop
- King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Sandra D Comer
- Division on Substance Abuse, New York State Psychiatric Institute and Columbia University, NY, USA
| |
Collapse
|
6
|
Lugoboni F, Pajusco B, Albiero A, Quaglio G. Hepatitis A Virus among Drug Users and the Role of Vaccination: A Review. Front Psychiatry 2011; 2:79. [PMID: 22347865 PMCID: PMC3276338 DOI: 10.3389/fpsyt.2011.00079] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 12/26/2011] [Indexed: 12/11/2022] Open
Abstract
In countries with advanced economies better health and hygiene conditions, along with the introduction, in some cases, of global vaccination, have relegated most viral hepatitis to marginal social groups and, in particular, drug users (DUs). The availability of safe and effective vaccines for hepatitis A virus (HAV) and B (HBV) may play a major role in combating this phenomenon. Despite the availability of a safe and effective vaccine for over a decade and the recommendations of international health organizations, vaccinations against HAV among DUs are not as widely known and available as are HBV vaccinations. The purpose of this review article is to present the most significant data in the literature on the prevalence of HAV among DUs and the role of targeted vaccination. To our knowledge, the present article is the first to solely deal with vaccination against HAV in DUs. Immunization after the administration of anti-HAV vaccine has been demonstrated in DUs even if they have responded significantly less than either the general population or carriers of chronic liver disease. All the vaccines were well tolerated and adherence to the vaccine schedule was good. Further studies are needed to optimize the timing and doses of vaccine to be administered to DUs, especially to assess adherence and antibody persistence. Vaccination campaigns are feasible among DUs and have proven to be highly cost-effective.
Collapse
Affiliation(s)
- Fabio Lugoboni
- Addiction Unit, Department of Internal Medicine, Verona University Hospital Verona, Italy
| | | | | | | |
Collapse
|
7
|
Quaglio G, Pattaro C, Gerra G, Mezzelani P, Montanari L, Jarlais DCD, Lugoboni F. Buprenorphine in maintenance treatment: experience among Italian physicians in drug addiction centers. Am J Addict 2010; 19:222-30. [PMID: 20525028 DOI: 10.1111/j.1521-0391.2010.00040.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to assess the attitudes of Italian physicians regarding buprenorphine and its clinical use approximately 6 years after the medication was introduced into clinical practice. The sample consisted of 305 randomly selected physicians, working in public centers of drug addiction. In Italy buprenorphine seems a valid tool in the field of drug addiction treatment, although it is far from replacing methadone even though it seems to guarantee better compliance. Interviewees follow clinical experience more than international guidelines, with pharmaceutical company representatives as the most cited source for information about the medication. The data also suggests a need for the development of formal guidelines for treatment with buprenorphine in Italy.
Collapse
Affiliation(s)
- Gianluca Quaglio
- Medical Service for Addictive Disorders, Department of Internal Medicine, University of Verona, Verona, Italy.
| | | | | | | | | | | | | |
Collapse
|
8
|
Müller MC, Pichler M, Martin G, Plörer D, Winter C, Pogarell O, Bogner JR. [Burden of disease and level of patient's medical care in substitution treatment for opiates]. ACTA ACUST UNITED AC 2009; 104:913-7. [PMID: 20039157 DOI: 10.1007/s00063-009-1196-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 11/18/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Within the framework of an interdisciplinary cooperation, the authors set up an on-site medical service provider in a specialized methadone substitution center in Germany. Here, they report on the prevalence of infectious and noninfectious diseases, and the vaccination status of substituted heroin-dependent patients. PATIENTS AND METHODS All patients who visited the medical care service provider between February 2008 and December 2008 were included in this study. RESULTS Ten patients (7%) were seropositive for the hepatitis A virus. Two patients (1.3%) suffered from chronic hepatitis B; 40 patients (27%) were cured after a hepatitis B infection. Additionally, 99 patients (68%) were infected with hepatitis C virus (HCV), and 41 patients (28%) had active hepatitis C. Furthermore, 48 hepatitis C patients (33%) were cured. Of those, 25 patients (17%) cleared the virus spontaneously and 23 (16%) after ribavirin/interferon combination therapy. Ten (7%) of 146 patients were infected with the human immunodeficiency virus (HIV). Of those, four patients had active hepatitis C, and five patients were cured after a hepatitis C infection. 18 patients (12%) were vaccinated against hepatitis A and 28 (19%) against hepatitis B. Two of the 41 patients with chronic hepatitis C were vaccinated against hepatitis A. The most frequent noninfectious diagnoses were arterial hypertension (n = 28), bronchial asthma (n = 8), and diffuse liver parenchymal damage (n = 12). CONCLUSION These results emphasize that i.v. drug users on substitution therapy are an underserved collective with a high prevalence of disease. The challenge consists in facilitating this population access to internistic and infectious disease service. The offer of an on-site medical service was well accepted. This is essential for an ongoing reduction of HIV and HCV prevalence in the drug users.
Collapse
Affiliation(s)
- Matthias C Müller
- Infektionsabteilung, Medizinische Poliklinik, Campus Innenstadt, Klinikum der Universität München, München.
| | | | | | | | | | | | | |
Collapse
|
9
|
Camoni L, Regine V, Salfa MC, Nicoletti G, Canuzzi P, Magliocchetti N, Rezza G, Suligoi B, The SerT Study Group, Camoni L, Regine V, Salfa MC, Nicoletti G, Canuzzi P, Magliocchetti N, Rezza G, Suligoi B, The SerT Study Group. Prevalence and correlates of infection with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among drug users in Italy: A cross-sectional study. ACTA ACUST UNITED AC 2009; 41:520-3. [DOI: 10.1080/00365540902946528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Kreek MJ, Talal AH, Piccolo P. Treating chronic hepatitis C in recovering opiate addicts: yes, we can. Dig Liver Dis 2009; 41:308-10. [PMID: 19233749 PMCID: PMC2778039 DOI: 10.1016/j.dld.2009.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 01/10/2009] [Indexed: 12/11/2022]
Affiliation(s)
- M J Kreek
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, USA.
| | | | | |
Collapse
|
11
|
Lugoboni F, Quaglio G, Civitelli P, Mezzelani P. Bloodborne viral hepatitis infections among drug users: the role of vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:400-13. [PMID: 19440291 PMCID: PMC2672321 DOI: 10.3390/ijerph6010400] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 01/20/2009] [Indexed: 12/16/2022]
Abstract
Drug use is a prevalent world-wide phenomenon and hepatitis virus infections are traditionally a major health problem among drug users (DUs). HBV and HCV, and to a lesser extent HAV, are easily transmitted through exposure to infected blood and body fluids. Viral hepatitis is not inevitable for DUs. Licensed vaccines are available for hepatitis A and hepatitis B. The purpose of this overview is to show some epidemiological data about HBV and the other blood-borne viral hepatitis among DUs and to summarize and discuss use of hepatitis vaccinations in this population. Successful vaccination campaigns among DUs are feasible and well described. We try to focus on the most significant results achieved in successful vaccination programs as reported in scientific literature. Vaccination campaigns among DUs represent a highly effective form of health education and they are cost-saving.
Collapse
Affiliation(s)
- Fabio Lugoboni
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
- * Author to whom correspondence should be addressed; E-Mail:
; Tel +39-045-812-8292; Fax +39-045-812-8290
| | - Gianluca Quaglio
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
| | - Paolo Civitelli
- Addiction Treatment Clinic (SerT-Asl 4), Thiene (Vicenza), Italy; E-Mail:
| | - Paolo Mezzelani
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
| |
Collapse
|