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Leyton M, Nikolic M. Learning from opioid withdrawal: Effects on striatal dopamine (Commentary on Ahn et al., 2023). Eur J Neurosci 2024; 59:1063-1066. [PMID: 38129315 DOI: 10.1111/ejn.16235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Marco Leyton
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, Quebec, Canada
- Research Unit on Children's Psychosocial Maladjustment, Université de Montréal, Montreal, Quebec, Canada
| | - Maja Nikolic
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
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Qin Y, Sun Q, Wang L, Hu F, Zhang Q, Wang W, Li W, Wang Y. DRD2 TaqIA polymorphism-related functional connectivity between anterior insula and dorsolateral prefrontal cortex predicts the retention time in heroin-dependent individuals under methadone maintenance treatment. Eur Arch Psychiatry Clin Neurosci 2024; 274:433-443. [PMID: 37400684 DOI: 10.1007/s00406-023-01626-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/22/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Dopamine receptor D2 (DRD2) TaqIA polymorphism has an influence on addiction treatment response and prognosis by mediating brain dopaminergic system efficacy. Insula is crucial for conscious urges to take drugs and maintain drug use. However, it remains unclear about the contribution of DRD2 TaqIA polymorphism to the regulation of insular on addiction behavioral and its relation with the therapeutic effect of methadone maintenance treatment (MMT). METHODS 57 male former heroin dependents receiving stable MMT and 49 matched male healthy controls (HC) were enrolled. Salivary genotyping for DRD2 TaqA1 and A2 alleles, brain resting-state functional MRI scan and a 24-month follow-up for collecting illegal-drug-use information was conducted and followed by clustering of functional connectivity (FC) patterns of HC insula, insula subregion parcellation of MMT patients, comparing the whole brain FC maps between the A1 carriers and non-carriers and analyzing the correlation between the genotype-related FC of insula sub-regions with the retention time in MMT patients by Cox regression. RESULTS Two insula subregions were identified: the anterior insula (AI) and the posterior insula (PI) subregion. The A1 carriers had a reduced FC between the left AI and the right dorsolateral prefrontal cortex (dlPFC) relative to no carriers. And this reduced FC was a poor prognostic factor for the retention time in MMT patients. CONCLUSION DRD2 TaqIA polymorphism affects the retention time in heroin-dependent individuals under MMT by mediating the functional connectivity strength between left AI and right dlPFC, and the two brain regions are promising therapeutic targets for individualized treatment.
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Affiliation(s)
- Yue Qin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
- Department of Radiology, Xi'an Daxing Hospital, Xi'an, People's Republic of China
| | - Qinli Sun
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
| | - Lei Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
- Department of Radiology, Xi'an Daxing Hospital, Xi'an, People's Republic of China
| | - Feng Hu
- Department of Radiology, Hospital of Shaannxi Provincial Geology and Mineral Resources Bureau, Xi'an, People's Republic of China
| | - Qiuli Zhang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, 710038, People's Republic of China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, 710038, People's Republic of China.
| | - Yarong Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, People's Republic of China.
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de Jong LAA, Kloost T, Olyslager EJH, Böttcher M, Wieferink JA, Vossenberg P, Belgers M, Beurmanjer H, de Haan HA. Towards adherence monitoring using breath or oral fluid as a matrix in a methadone maintenance treatment program for patients with a chronic heroin use disorder: Issues and interpretation of the results. J Anal Toxicol 2023; 47:842-849. [PMID: 37639616 DOI: 10.1093/jat/bkad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 08/28/2023] [Indexed: 08/31/2023] Open
Abstract
Urine has been the preferred matrix for monitoring heroin and methadone adherence due to its large detection window. Drawbacks such as privacy concerns and adulteration however require other matrices. The study aims to determine if oral fluid and exhaled breath are suitable alternatives for heroin and methadone monitoring and to assess the detection time in exhaled breath. Forty-three participants, all on methadone and heroin-assisted treatment, were studied. Participants were monitored after the first and right before the second dosage of heroin. At both time points, oral fluid and exhaled breath samples were collected with urine at the second time point. All samples were screened for opiates, methadone and other drugs using immunoassay and LC-MS-MS. At the second time point, 98% of oral fluid samples and all exhaled breath samples tested positive for 6-monoacetylmorphine (6-MAM). Regarding morphine detection, the findings were reversed (100% in oral fluid, 98% in exhaled breath). Methadone-related results were 100% positive across all matrices, as expected. Notable is the detection of the heroin marker acetylcodeine in oral fluid and exhaled breath samples, which resulted in relatively low negative predictive value (average 54.6%). Oral fluid and exhaled breath are suitable alternatives for heroin and methadone maintenance monitoring. Clinicians should consider ease of collection, adulteration risk, costs, turn-around time and the substance of interest while choosing a matrix. In addition, even in cases when medicinal heroin is used, medical professionals should be aware of the presence of acetylcodeine in these alternate matrices.
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Affiliation(s)
- Lutea A A de Jong
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Tim Kloost
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Erik J H Olyslager
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Michael Böttcher
- Department of Toxicology, MVZ Medizinische Labore Dessau Kassel GmbH, Bauhüttenstr. 6, Dessau-Roßlau 06847, Germany
| | - Jan A Wieferink
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Peter Vossenberg
- Tactus Addiction Treatment Center, P.O. Box 154, Deventer 7400 AD, The Netherlands
| | - Maarten Belgers
- IrisZorg, Institute for Addiction Care and Sheltered Housing, Mr. B.M. Teldersstraat 7, Arnhem 6842 CT, The Netherlands
| | - Harmen Beurmanjer
- Novadic-Kentron Addictioncare, Hogedwarsstraat 3, Vught AE 5261, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen 6500 HE, The Netherlands
| | - Hein A de Haan
- Tactus Addiction Treatment Center, P.O. Box 154, Deventer 7400 AD, The Netherlands
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Lv Q, Zhang M, Jiang H, Liu Y, Zhao S, Xu X, Zhang W, Chen T, Su H, Zhang J, Wang H, Zhang J, Feng Y, Li Y, Li B, Zhao M, Wang Z. Metabolic and functional substrates of impulsive decision-making in individuals with heroin addiction after prolonged methadone maintenance treatment. Neuroimage 2023; 283:120421. [PMID: 37879424 DOI: 10.1016/j.neuroimage.2023.120421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/08/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
Elevated impulsivity has been frequently reported in individuals with opioid addiction receiving methadone maintenance therapy (MMT), but the underlying neural mechanisms and cognitive subprocesses are not fully understood. We acquired functional magnetic resonance imaging (fMRI) data from 37 subjects with heroin addiction receiving long-term MMT and 33 healthy controls who performed a probabilistic reversal learning task, and measured their resting-state brain glucose using fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET). Subjects receiving MMT exhibited significantly elevated self-reported impulsivity, and computational modeling revealed a marked impulsive decision bias manifested as switching more frequently without available evidence. Moreover, this impulsive decision bias was associated with the dose and duration of methadone use, irrelevant to the duration of heroin use. During the task, the switch-related hypoactivation in the left rostral middle frontal gyrus was correlated with the impulsive decision bias while the function of reward sensitivity was intact in subjects receiving MMT. Using prior brain-wide receptor density data, we found that the highest variance of regional metabolic abnormalities was explained by the spatial distribution of μ-opioid receptors among 10 types of neurotransmitter receptors. Heightened impulsivity in individuals receiving prolonged MMT is manifested as atypical choice bias and noise in decision-making processes, which is further driven by deficits in top-down cognitive control, other than reward sensitivity. Our findings uncover multifaceted mechanisms underlying elevated impulsivity in subjects receiving MMT, which might provide insights for developing complementary therapies to improve retention during MMT.
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Affiliation(s)
- Qian Lv
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yilin Liu
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, China
| | - Shaoling Zhao
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, China
| | - Xiaomin Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenlei Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hang Su
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiangtao Zhang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, China
| | - Heqiu Wang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, China
| | - Jianmin Zhang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, China
| | - Yuanjing Feng
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Yongqiang Li
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Zheng Wang
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.
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Chang H, Huang M, Fang S, Lin S. Quality of life and associated factors of heroin-dependent patients receiving methadone and buprenorphine maintenance treatment. Neuropsychopharmacol Rep 2023; 43:607-615. [PMID: 38088122 PMCID: PMC10739136 DOI: 10.1002/npr2.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
AIM Although studies in Western countries have investigated the quality of life (QoL) of heroin users, limited research on this topic has been conducted in Asia. The present study assessed QoL in patients with heroin dependence receiving medications to treat opioid use disorder. METHODS We performed a cross-sectional study of patients with heroin dependence receiving methadone and buprenorphine treatment. The demographic and substance use variables of patients receiving methadone and buprenorphine were compared. The Chinese Health Questionnaire (CHQ-12), Obsessive Compulsive Drug Use Scale (OCDUS), and World Health Organization Quality of Life Short Form Taiwan version (WHOQOL-BREF-T) were administered to measure patient mental health problems, addiction severity, and QoL, respectively. Multivariate regression was used to identify the factors associated with QoL. RESULTS A total of 149 patients receiving methadone and 31 receiving buprenorphine completed the questionnaires. Individuals in the buprenorphine group were more likely to be married (p = 0.024) or employed (p = 0.024), have a higher educational level (p = 0.013), have lower drug craving (OCDUS: p = 0.035), or have higher QoL (WHOQOL-BREF-T: p = 0.004) than those in the methadone group. After adjustment for other variables, employment was positively associated with the physical, psychological, and environmental domains of QoL. Receiving buprenorphine treatment (p = 0.032) and longer treatment duration (p = 0.016) were associated with higher psychological QoL. CONCLUSION Several factors were associated with QoL in patients with heroin dependence. Some measures may improve their QoL, such as reducing employment barriers, improving treatment adherence, or increasing accessibility to buprenorphine treatment.
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Affiliation(s)
- Hu‐Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan
| | - Ming‐Chyi Huang
- Department of Addiction Sciences, Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Su‐Chen Fang
- Department of NursingMackay Medical CollegeTaipeiTaiwan
| | - Shih‐Ku Lin
- School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Department of General PsychiatryChang Gung Memorial HospitalTaoyuanTaiwan
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Jiménez-Treviño L, Martínez-Cao C, Sánchez-Lasheras F, Iglesias C, Antuña MJ, Riera L, Sáiz-Martínez PA, Bobes J. A 35-year follow-up study of patients admitted to methadone treatment between 1982-1984 in Asturias, Spain. Adicciones 2023; 35:303-314. [PMID: 34882240 DOI: 10.20882/adicciones.1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective was to evaluate outcomes in a heroin-dependent population 35 years after first enrolment in methadone maintenance treatment (MMT). An ad hoc protocol was used to assess drug misuse, treatment, and drug-related morbidity in the survivor sample. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated. A total of 214 heroin-dependent patients entered MMT between 1982 and 1984 in the Asturias Public Health Service. Information was received on 195 subjects, of whom 146 were deceased. Men accounted for 77.5% of the study cohort. Over the 35-year follow-up period, the SMR was 11.75 (95% CI = 9.95 - 13.77). In the survivor sample, 5.7% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 38.77% and hepatitis B/C in 73.46%. No differences were found between sexes in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 35-year follow-up compared with 5.26% of males. In conclusion, our study confirms the high long-term mortality rate of heroin addicts, even after enrollment in MMT.
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Affiliation(s)
- Luis Jiménez-Treviño
- Universidad de Oviedo Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) Servicio de Salud del Principado de Asturias (SESPA) Instituto de Neurociencias del Principado de Asturias (INEUROPA).
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Rocco P. Prevalence of ADHD in a Sample of Heroin Addicts Receiving Agonist Treatment-Study Conducted in a Public Addiction Service. Int J Environ Res Public Health 2023; 20:2602. [PMID: 36767966 PMCID: PMC9915126 DOI: 10.3390/ijerph20032602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that can persist into adulthood. The co-occurrence of ADHD and substance use disorders is very frequent and has received considerable attention in recent clinical/scientific investigations. However, few studies have investigated the prevalence of ADHD in heroin addicts. This study aimed to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) in a sample of heroin addicts treated with opioid agonists and to report this clinical experience in a public service for addiction. Outpatients over 18 years old and being treated with opioid agonists for heroin addiction were enrolled. Each patient took part in a psychiatric examination and completed an ASRS (Adult ADHD Self-Report Scale) self-assessment. Subjects with positive results were called in for another psychiatric visit, and the Brown ADD scale was used as a second-level test for ADHD; furthermore, the Mini International Neuropsychiatric Interview (MINI) and Hypomania/Mania Checklist (HCL-32) were used for differential diagnoses and to assess comorbidities. In total, 111 patients were enrolled. All were followed up by the psychiatrist, who is also the author of this report and the person who formulated the diagnoses. The prevalence of ADHD in this sample was 18%. Among the 20 patients diagnosed with ADHD, 5 (25%) were female and 15 (75%) were male. The most frequent psychiatric comorbidity was major depression, found in 11 patients (55%), of which 4 presented with hypomania (bipolar disorder). In this sample, making diagnoses was very difficult. Frequently, multiple comorbidities further complicated these cases. In conclusion, the results of this study are consistent with the literature: There seems to be a significant prevalence of ADHD even among heroin addicts, and often, the diagnosis is difficult to make. We also do not know the exact effect of opioid agonist therapy on ADHD symptoms. Hypotheses have been put forward, but studies are needed.
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Affiliation(s)
- Pasqualina Rocco
- Addiction Treatment Center, Local Health Service N. 2, Veneto, Via dei Carpani, 16/Z, 31033 Treviso, Italy
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Giustiniani J, Rothen S, Penzenstadler L, Colombo L, Calzada G, Thorens G, Zullino D. Does slow release oral morphine have impact on craving and impulsivity in heroin dependent individuals? Int Clin Psychopharmacol 2023; 38:16-22. [PMID: 35833289 PMCID: PMC9722371 DOI: 10.1097/yic.0000000000000418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Craving and impulsivity are addiction components which explain why heroin-dependant individuals (HDI), continue using heroin despite not wanting to do so. Opioid maintenance treatment (OMT), such as slow-release oral morphine (SROM), is the most effective treatment for opioid dependence. However, the impact of SROM on craving and impulsivity remains unclear. In this observational study, 23 HDI receiving SROM, their usual OMT, took part in the experiment. Each of the participants filled in the perceived level of craving with a visual analog scale. Their impulsivity was assessed via three laboratory tasks, the stop-signal reaction time, the Balloon Analogue Risk Task and delay discounting. Each evaluation was performed before and after SROM administration. Craving was significantly reduced after administration of SROM (difference 2.83; P = 0.0010), whereas there were no significant differences in performance in the three laboratory tasks. In the long term, we observed an improvement on delay discounting correlated with the duration and dosage of SROM. The acute impact of SROM appears to significantly reduce craving, without impacting impulsivity. Observation of the correlation between delay discounting and the duration and dosage of OMT is of great interest and should be studied further.
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Affiliation(s)
- Julie Giustiniani
- Addictology Division, Mental Health and Psychiatry Department, Geneva University Hospitals
| | - Stéphane Rothen
- Addictology Division, Mental Health and Psychiatry Department, Geneva University Hospitals
- Research Center for Statistics, University of Geneva, Geneva School of Management and Economics
| | - Louise Penzenstadler
- Addictology Division, Mental Health and Psychiatry Department, Geneva University Hospitals
| | - Laura Colombo
- Addictology Division, Mental Health and Psychiatry Department, Geneva University Hospitals
| | - Gérard Calzada
- Addictology Division, Mental Health and Psychiatry Department, Geneva University Hospitals
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Gabriel Thorens
- Addictology Division, Mental Health and Psychiatry Department, Geneva University Hospitals
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Daniele Zullino
- Addictology Division, Mental Health and Psychiatry Department, Geneva University Hospitals
- Faculty of Medicine, Geneva University, Geneva, Switzerland
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You WR, Lin LC, Lin WC, Tsai MC. Differences in orexin-A level in the functional brain network of HUD patients undergoing harm reduction therapy. Medicine (Baltimore) 2022; 101:e30093. [PMID: 35984180 PMCID: PMC9387983 DOI: 10.1097/md.0000000000030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Orexins regulate the reward-seeking pathway and also play a role in drug addiction. The aim of this study was an investigation of the changes in serum level of orexin-A as well as changes in the functional brain network in heroin use disorder (HUD) patients undergoing harm reduction therapy (HRT). Twenty-five HUD patients undergoing HRT that included methadone and buprenorphine, and 31 healthy control (HC) subjects, were enrolled for this study. Serum orexin-A levels and brain-derived neurotrophic factor were measured with assay kits. The functional brain network in HUD patients and HC was investigated and assessed using seed-based analysis and functional brain MRI scans. t Tested orexin-A levels were found to be significantly higher in HUD patients undergoing HRT than in HCs (P < .05). Analysis showed the functional activity of the right ventral anterior insula (RVAI) in HUD patients to be significantly lower than in HCs (P < .05, Family-Wise Error) corrected). In addition, the internetwork functional connectivity was significantly lower in the left nucleus accumbens and left dorsal anterior insula in the HUD subjects than in HCs (P < .05, Family-Wise Error corrected). In this study, no significant correlation between orexin-A levels and functional brain networks was found. However, the results suggest that HRT might increase orexin-A levels and decrease functional activity in RVAI in HUD patients.
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Affiliation(s)
- Wan-Ru You
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liang-Chun Lin
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chang Tsai
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- *Correspondence: Meng-Chang Tsai, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan (e-mail: )
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Douton JE, Horvath N, Mills-Huffnagle S, Nyland JE, Hajnal A, Grigson PS. Glucagon-like peptide-1 receptor agonist, liraglutide, reduces heroin self-administration and drug-induced reinstatement of heroin-seeking behaviour in rats. Addict Biol 2022; 27:e13117. [PMID: 34802173 PMCID: PMC10825889 DOI: 10.1111/adb.13117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 01/16/2023]
Abstract
Drug addiction is a chronic brain disease characterized by the uncontrolled use of a substance. Due to its relapsing nature, addiction is difficult to treat, as individuals can relapse following even long periods of abstinence and, it is during this time, that they are most vulnerable to overdose. In America, opioid overdose has been increasing for decades, making finding new treatments to help patients remain abstinent and prevent overdose deaths imperative. Recently, glucagon-like peptide-1 (GLP-1) receptor agonists have shown promise in reducing motivated behaviours for drugs of abuse. In this study, we test the effectiveness of the GLP-1 analogue, liraglutide (LIR), in reducing heroin addiction-like behaviour, and the potential side effects associated with the treatment. We show that daily treatment with LIR (0.1 mg/kg sc) increases the latency to take heroin, reduces heroin self-administration, prevents escalation of heroin self-administration and reduces drug-induced reinstatement of heroin-seeking behaviour in rats. A 1-h pretreatment time, however, was too short to reduce cue-induced seeking in our study. Moreover, we showed that, while LIR (0.1, 0.3, 0.6 and 1.0 mg/kg sc) supported conditioned taste avoidance of a LIR-paired saccharin cue, it did not elicit intake of the antiemetic kaolin in heroin-naïve or heroin-experienced rats. Further, 0.1 mg/kg LIR did not produce great disruptions in food intake or body weight. Overall, the data show that LIR is effective in reducing heroin taking and heroin seeking at doses that do not cause malaise and have a modest effect on food intake and body weight gain.
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Affiliation(s)
- Joaquin E Douton
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nelli Horvath
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sara Mills-Huffnagle
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer E Nyland
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Patricia S Grigson
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Chen YJ, Lu JT, Huang CW, Wu WH, Lee KF, Liu HT, Shih-Hsin Wu L. Pharmacogenetic study of methadone treatment for heroin addiction: associations between drug-metabolizing gene polymorphisms and treatment efficacy. Pharmacogenet Genomics 2022; 32:31-38. [PMID: 34380995 DOI: 10.1097/fpc.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Opioid dependence is currently one of the most serious problems affecting the social norms and public health system. Methadone maintenance therapy (MMT) is being widely used in treating heroin-dependent patients. The mechanism of methadone metabolism and disposition has been shown to involve cytochrome P450 (CYP450) and P-glycoprotein. The aim of this study was to explore the relationships among genetic polymorphisms, BMI and effective dose of methadone used in MMT within a northern Taiwan cohort. METHODS One hundred heroin-dependent patients were enrolled in the study. The clinical data gathered included methadone dose, sex and BMI. DNA was collected from the oral swab of the participants to analyze the relevant alleles. RESULTS An effective methadone dose correlated with sex, BMI and the presence of ABCB1 2677GG (rs2032582) and CYP2B6 516GG (rs374527). Furthermore, the CYP2B6 516GG homozygote was related to a higher average dose of methadone (GG: 68.50 ± 32.43; GT: 52.28 ± 25.75; TT: 44.44 ± 29.64; P < 0.02), whereas the ABCB1 2677GG homozygote was related to a lower dose (GG: 51.09 ± 20.83; GT: 69.65 ± 37.51; TT: 62.52 ± 30.44; P < 0.05). We examined the predictive effect of polymorphisms combined with sex and BMI on methadone dose by conducting multiple linear regressions. Our data predicted the average dose of methadone in approximately 30% of heroin-dependent patients. CONCLUSION The interactions between genetic polymorphisms and clinical features proved useful in identifying the effective dose of MMT for heroin-dependent patients in Taiwan more precisely.
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Affiliation(s)
- Yen-Jung Chen
- Department of Psychiatry, Luodong Poh-Ai Hospital, Yilan
| | - Ju-Ting Lu
- Institute of Biochemistry, Tzu Chi University, Hualien
| | | | - Wei-Hsin Wu
- Department of Psychiatry, Keelung Hospital, Ministry of Health and Welfare, Keelung
| | | | - Hsin-Tzu Liu
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien
| | - Lawrence Shih-Hsin Wu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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Abstract
OBJECTIVE Chronic exposure to illicit opioid drugs can cause serious health and social problems. However, less is known about the differential effect of various opioid treatments, such as methadone and buprenorphine, on neurocognitive domains such as compulsivity and impulsivity, despite their relevance to the treatment of opioid dependence. METHODS A total of 186 participants were recruited with a cross-sectional design: i) illicit heroin users (n = 27), ii) former heroin users stabilized on methadone MMT (n = 48), iii) a buprenorphine maintenance treatment (BMT) group (n = 18), iv) an abstinent (ABS) group with a history of opioid dependence who were previously stabilized on MMT or BMT (n = 29) and v) healthy controls (HC) (n = 64). We used the Intra-Extra Dimensional Shift (IED) and Cambridge Gambling Task (CGT) paradigms for measuring compulsivity and impulsivity constructs respectively. RESULTS Heightened compulsivity persisted in the heroin, buprenorphine and abstinent groups. Heroin, methadone and buprenorphine groups exhibited impaired behavioral responses to feedback, consisting of increased deliberation time and poorer risk adjustment. Higher compulsivity measures were negatively associated with opioid dose which may reflect sedation effects. CONCLUSIONS Our results suggest that compulsivity and impulsivity are core neurocognitive dimensions for opioid dependence which differ in their presentation according to the stage of treatment. Participants taking higher morphine equivalent doses performed better in compulsivity measures. These findings have implications for the treatment of opioid dependence and longitudinal studies are warranted.
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Affiliation(s)
- S Tolomeo
- Department of Psychology, National University of Singapore, Singapore, Singapore.
| | - F Davey
- NHS Fife Research and Development Department, Queen Margaret Hospital, Dunfermline, UK
| | - J Douglas Steele
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - A Baldacchino
- Division of Population and Behavioural Sciences, University of St Andrews, St Andrews, UK
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Calzada G, Giustiniani J, Gois T, Kuntz A, Khazaal Y, Zullino D. [Learning to expand medical heroin prescribing modalities with Covid-19]. Rev Med Suisse 2021; 17:1111-1114. [PMID: 34106535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The choice of opioid-assisted treatments for patients with heroin dependence is particularly diverse in Switzerland. Since 1994, diacetylmorphine assisted treatments are available. The rules for prescribing and dispensing diacetylmorphine, as laid down by the FOPH, are particularly strict, requiring patients to attend the treatment center several times a day. Thanks to a legislative amendment by the Federal Council, it became possible to extend the dispensing of diacetylmorphine during the Covid-19 epidemic, allowing patients to take the treatment with them for longer periods and thus reducing the number of visits to the clinic. The time freed up could then be invested in other activities, allowing therapies to be refocused more on the patients' life project.
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Affiliation(s)
- Gerard Calzada
- Service d'addictologie, Département de psychiatrie, HUG, 1211 Genève 14
| | - Julie Giustiniani
- Service d'addictologie, Département de psychiatrie, HUG, 1211 Genève 14
| | - Tiago Gois
- Service d'addictologie, Département de psychiatrie, HUG, 1211 Genève 14
| | - André Kuntz
- Centre cantonal d'addictologie, Réseau fribourgeois de santé mentale, rue de Morat 8, 1700 Fribourg
| | | | - Daniele Zullino
- Service d'addictologie, Département de psychiatrie, HUG, 1211 Genève 14
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Fang CP, Liu TH, Chung RH, Tsou HH, Kuo HW, Wang SC, Liu CC, Liu SC, Chen ACH, Liu YL. Genetic variants in NECTIN4 encoding an adhesion molecule are associated with continued opioid use. PLoS One 2020; 15:e0234549. [PMID: 32555608 PMCID: PMC7302666 DOI: 10.1371/journal.pone.0234549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 05/28/2020] [Indexed: 01/17/2023] Open
Abstract
Methadone is a synthetic opioid used as maintenance treatment for patients addicted to heroin. Skin irritation is one of the adverse events caused by opioid use. 344 methadone maintenance treatment (MMT) patients were recruited with records and measurements on methadone dose, plasma methadone concentrations, and treatment emergent symptom scales (TESS). 15 patients reported with skin irritation. Five SNPs located within the NECTIN4 genetic region were genotyped. The NECTIN4 gene within the adherens junction interaction pathway was associated with methadone dose in pathway-based genome wide association analyses (P = 0.0008). Three highly-linked SNPs, rs11265549, rs3820097, and rs4656978, were significantly associated with methadone dose (P = 0.0003), plasma concentrations of R,S-methadone (P = 0.0004) and TNF-α (P = 0.010) in all 344 MMT patients, and with self-report skin irritation symptom scores (P = 0.010) in the 15 MMT patients who reported with skin irritation. To identify the possible roles of plasma level of Nectin-4 in the responses to MMT and opioid use, additional age- and gender-matched 51 controls and 83 methadone-free abstinent former heroin users were recruited. Plasma level of Nectin-4 was the highest in MMT patients among the three groups. The results suggest involvement of genetic variants on NECTIN4 in methadone dose. Plasma Nectin-4 level is likely an indicator for continued use of opioids.
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Affiliation(s)
- Chiu-Ping Fang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Tung-Hsia Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Ren-Hua Chung
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Hsiao-Hui Tsou
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Hsiang-Wei Kuo
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chia-Chen Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shu Chih Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Andrew C. H. Chen
- Department of Psychiatry, the Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, United States of America
- The Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine at Hofstra University, Manhasset, New York, United States of America
| | - Yu-Li Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Yang S, Gao B, Gu J, Gong Y, Yu B, Han J, Dong P, Jia P, Yang S. Relationship between social capital and heroin use behaviors among patients in methadone maintenance treatment in Sichuan Province, China: A cross-sectional study. Medicine (Baltimore) 2020; 99:e19963. [PMID: 32541447 PMCID: PMC7302679 DOI: 10.1097/md.0000000000019963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Covertly using heroin during methadone maintenance treatment (MMT) is very common among heroin-dependent patients, which has posed threats to the physical health of heroin-dependent patients and social safety. Covertly using heroin may be influenced by many factors, especially social capital. Therefore, we aimed to investigate the relationship between behaviors of covertly using heroin during MMT and social capital heroin-dependent patients in Sichuan Province, China. A cross-sectional study was conducted between October and November 2018, with a total of 581 heroin-dependent patients participating in the study. In addition to socio-demographic characteristics and heroin use related behaviors, the questionnaire also included the measures of social capital: social network (SN), social support (SP), community participation (CP) and social trust (ST). Multivariate logistic regression analyses were used to estimate the association between different measures of social capital and heroin use. The prevalence of covertly using heroin of heroin during MMT was 31.0% among our participants in the 6 months before the study. After adjusting for socio-demographic factors and heroin-use related variables, SN (OR = 0.85, 95% CI: 0.76-0.95), SP (OR = 0.89, 95% CI: 0.83-0.95), and ST (OR = 0.88, 95% CI: 0.81-0.95) were significantly associated with heroin use. Results suggest that social capital may have a protective effect on behavior of covertly using heroin during MMT, which should be consider in the interventions for heroin-dependent patients, in order to reduce the incidence of heroin use during MMT as well as improve the compliance of MMT.
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Affiliation(s)
- Shifan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Bo Gao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou
| | - Yi Gong
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Jiayu Han
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peijie Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Peng Jia
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
- Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
- International Initiative on Spatial Lifecourse Epidemiology (ISLE)
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16
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Abstract
Determining the clinically optimal dose in methadone maintenance therapy (MMT) is a time-consuming procedure, which considers clinical signs and symptoms.To perform a quantitative trait locus association for identifying genetic variants for MMT dosage that underlie heroin addiction and methadone metabolism and then integrate several genotypic and phenotypic factors are potential predictors for clinically optimal MMT dose for personalized prescription.In total, 316 heroin-dependent patients undergoing MMT were recruited at the Addiction Center of the China Medical University Hospital. A multinomial logistic regression model was used to assess associations between genetic polymorphisms and MMT dosing. The data were randomly separated into training and testing sets. In order to enhance the prediction accuracy and the reliability of the prediction model, we used areas under the receiver operating characteristic curves to evaluate optimal MMT dose in both training and testing sets.Four single nucleotide polymorphisms, namely rs806368 in CNR1, s1386493 in TPH2, s16974799 in CYP2B6, and rs2229205 in OPRL1, were significantly associated with the maximum MMT dose (P < .05). The genetic risk score (GRS) was associated with maximum MMT dose, and after adjustments for age, sex, and body mass index, the GRS remained independently associated with the maximum MMT dose. The area under the receiver operating characteristic curve of the combined GRS and craving score was 0.77 for maximum MMT dose, with 75% sensitivity and 60% specificity.Integrating the GRS and craving scores may be useful in the evaluation of individual MMT dose requirements at treatment initiation. Optimal dose prediction allows clinicians to tailor MMT to each patient's needs.
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Affiliation(s)
- Hsin-Wen Chang
- Department of Public Health, China Medical University, Taichung
- Center for General Education, Hsuan Chuang University, Hsinchu City
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung
| | - Chieh-Liang Huang
- Brain Disease Research Center
- Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Ruey-Yun Wang
- Department of Public Health, China Medical University, Taichung
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Wang CW, Chuang HY, Chiang HC, Huang PC, Yu ML, Dai CY. Risk of hepatitis C virus infection in injecting and noninjecting drug users receiving opioid substitution therapy. J Chin Med Assoc 2020; 83:454-460. [PMID: 32358454 DOI: 10.1097/jcma.0000000000000312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is the most common viral infection among illicit drug users in the world. Although intervention of needle and syringe program and opioid substitution therapy had engaged to prevent HCV infection, the prevalence of HCV infection does not seem to decline. The aim of this study was to estimate the risk of HCV infection in injecting drug users (IDUs) and noninjecting drug users (NIDUs) receiving opioid substitution therapy. METHODS We recruited 1179 heroin-dependent patients (age: 20-66 years) under opioid substitution therapy from 2012 to 2015 in a Psychiatric Center, Southern Taiwan. The data of HCV, hepatitis B virus and HIV infection and liver biochemical examination were obtained. We used multivariate logistic regression analysis to predict the risk of HCV infection. RESULTS There were 93.1% of IDUs and 68.1% of NIDUs positive for HCV infection. In IDUs, HIV infection, age of heroin initiation, duration and dose of heroin use, frequency of detoxification, and number of criminal conviction were significantly associated with HCV infection. In NIDUs, snort/sniff heroin exhibited a significantly increased risk of HCV infection. Intravenous injecting (odds ratio [OR] = 23.10, 95% CI = 8.04-66.40, p < 0.001), intravenous injecting combined snort/sniff (OR = 12.95, 95% CI = 3.90-42.97, p < 0.001), and snort/sniff (OR = 4.14, 95% CI = 1.30-13.18, p = 0.016) were significantly associated with increased risk of HCV infection compared with smoking. The trend was significant (p for trend <0.001). CONCLUSION In Taiwan, IDUs had harmful characteristics compared with NIDUs and both had extremely high prevalence of HCV infection. We provided evidence that snort/sniff is a possible way of leak in HCV infection despite needle-syringes supplement program been provided. Opioid substitution therapy program should include HCV assessment and treatment in the new direct-acting antiviral therapy era.
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Affiliation(s)
- Chih-Wen Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Internal Medicine, Kaohsiung Municipal Hsiao Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan, ROC
| | - Hung-Yi Chuang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Hung-Che Chiang
- College of Medicine, China Medical University, Taichung, Taiwan, ROC
| | - Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan, ROC
- Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, ROC
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Scheibe A, Shelly S, Gerardy T, von Homeyer Z, Schneider A, Padayachee K, Naidoo SB, Mtshweni K, Matau A, Hausler H, Marks M. Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa. Addict Sci Clin Pract 2020; 15:13. [PMID: 32085807 PMCID: PMC7035721 DOI: 10.1186/s13722-020-00186-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.
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Affiliation(s)
- Andrew Scheibe
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
| | - Shaun Shelly
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Tara Gerardy
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Zara von Homeyer
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Andrea Schneider
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | | | | | - Klaas Mtshweni
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Ayanda Matau
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Harry Hausler
- TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa
| | - Monique Marks
- Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa
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Lu Q, Zou X, Liu Y, Gong C, Ling L. Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China. Int J Environ Res Public Health 2019; 16:ijerph16152800. [PMID: 31390750 PMCID: PMC6695604 DOI: 10.3390/ijerph16152800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 11/16/2022]
Abstract
Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%-89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%-89% of the tapering phase increased the odds of heroin abstinence.
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Affiliation(s)
- Qian Lu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xia Zou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yin Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Cheng Gong
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Chang KC, Lee KY, Lu TH, Hwang JS, Lin CN, Ting SY, Chang CC, Wang JD. Opioid agonist treatment reduces losses in quality of life and quality-adjusted life expectancy in heroin users: Evidence from real world data. Drug Alcohol Depend 2019; 201:197-204. [PMID: 31247504 DOI: 10.1016/j.drugalcdep.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study estimated the long-term changes of opioid agonist treatment (OAT) in quality of life (QOL) and quantified the quality-adjusted life years (QALY) from the loss of quality-adjusted life expectancy (QALE) in heroin users. METHODS A total of 1283 heroin users stratified by OAT were linked to the National Mortality Registry for 8 years (2006-2014) to obtain survival functions, which were extrapolated to lifetime by applying a rolling extrapolation algorithm to survival ratio between the sub-cohorts and age- and sex-matched referents simulated from vital statistics of Taiwan. We performed cross-sectional measurement of EQ-5D on 349 participants, including those with a valid state of OAT or non-OAT plus newly recruited consecutive patients, during 2015-2017 for utility values, while the QOL of referents were abstracted from the 2009 National Health Interview Survey. The QALE was calculated by summing the products of the mean QOL and survival rate throughout life. The QALE difference between the cohort and corresponding referents was the loss-of-QALE. RESULTS QOL of the OAT group was significantly better than that of the non-OAT group in every domain of the EQ-5D, which was quantified to be 0.23 for utility after controlling for other variables. After extrapolation to 70 years, the estimated QALE and loss-of-QALE were 17.8 and 18.2 QALY for OAT subjects, respectively, while those of the non-OAT group were 9.2 and 27.9 QALY. CONCLUSIONS Receiving OAT could reduce QALE lost by 9.7 QALYs compared with non-OAT after accounting for QOL differences along time and different age and sex distributions.
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Affiliation(s)
- Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, 539 Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan; Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Kuan-Ying Lee
- Jianan Psychiatric Center, Ministry of Health and Welfare, 539 Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan.
| | - Tsung-Hsueh Lu
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei 11529, Taiwan.
| | - Chia-Ni Lin
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Shuo-Yen Ting
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161 YuPin Rd., Caotun Township, Nantou 542, Taiwan.
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 901 Zhonghua Rd., Yongkang Dist., Tainan 71004, Taiwan; Department of Health Psychology, Chang Jung Christian University, No.1, Changda Rd., Gueiren District, Tainan 71101, Taiwan.
| | - Jung-Der Wang
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan; Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, 138 ShengLi Rd., North Dist., Tainan 704, Taiwan.
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Schaefer EA, Anderson MA, Kim AY, Sfeir MM. Case 15-2019: A 55-Year-Old Man with Jaundice. N Engl J Med 2019; 380:1955-1963. [PMID: 31091378 DOI: 10.1056/nejmcpc1900592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Esperance A Schaefer
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Mark A Anderson
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Arthur Y Kim
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Maroun M Sfeir
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
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Abstract
BACKGROUND Opioid overdose is a leading cause of death in persons experiencing homelessness (PEH), despite effective medications for opioid use disorder (OUD). In 2016, the San Francisco Street Medicine Team piloted a low barrier buprenorphine program with the primary goal of engaging and retaining PEH with OUD in care as a first step toward reducing opioid use and improving overall health. OBJECTIVE To characterize the patients; assess treatment retention, retention on buprenorphine, and opioid use; and to describe adverse events. METHODS Retrospective chart review of patients receiving at least one buprenorphine prescription from Street Medicine (November 2016-October 2017). We abstracted demographic, medical, substance use, prescription, and health care utilization data from medical records. We assessed retention in care at 1, 3, 6, 9 and 12 months, defined as a provider visit 1 week prior to or any time after each time point. We considered patients to be retained on buprenorphine if they had active buprenorphine prescriptions for more than 2 weeks of the month. We estimated opioid use by the percentage of patients with any opioid-negative, buprenorphine-positive urine toxicology test. We reviewed emergency department and hospital records for adverse events, including deaths and nonfatal opioid overdoses. RESULTS Among the 95 persons eligible for analysis, mean age was 39.2, and 100% reported injecting heroin and homelessness. Medical and psychiatric comorbidities and co-occurring substance use were common. The percentages of patients retained in care at 1, 3, 6, 9 and 12 months were 63%, 53%, 44%, 38%, and 26%, respectively. The percentages of patients retained on buprenorphine at 1, 3, 6, 9 and 12 months were 37%, 27%, 27%, 26%, and 18%, respectively. Twenty-three percent of patients had at least one opioid-negative, buprenorphine-positive test result. One patient died from fentanyl overdose, and four patients presented on six occasions for non-fatal overdoses requiring naloxone. CONCLUSIONS This program engaged and retained a subset of PEH with OUD in care and on buprenorphine over 12 months. While uninterrupted treatment and abstinence are reasonable outcomes for conventional treatment programs, intermittent treatment with buprenorphine and decreased opioid use were more common in this pilot and may confer important reductions in opioid and injection-related harms.
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Affiliation(s)
- Jamie Carter
- Lincoln Community Health Center, 1301 Fayetteville St, Durham, NC, 27707, USA.
| | - Barry Zevin
- Street Medicine and Shelter Health, San Francisco Department of Public Health, 101 Grove St, San Francisco, CA, 94102, USA
| | - Paula J Lum
- UCSF Division of HIV, Infectious Disease and Global Medicine, Zuckerberg San Francisco General, 1001 Potrero Ave, San Francisco, CA, 94110, USA
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Huang KY, Hsu CH, Yu KC, Yeh YH, Han KC, Wei HT. Traditional Chinese Medicine-facilitated switch from methadone to buprenorphine-naloxone for treatment of heroin dependence: a case report. J TRADIT CHIN MED 2019; 39:281-284. [PMID: 32186053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The switch from methadone to buprenorphine-naloxone for individuals with heroin dependence is associated with several obstacles and challenges. Such patients may experience discomfort from discontinuing methadone, precipitated withdrawal symptoms induced by buprenorphine-naloxone, and poor psychosocial adjustments such as anticipatory anxiety regarding severe opioid withdrawal. We herein describe a 46-year-old man with a history of heroin dependence who underwent Traditional Chinese Medicine (TCM)-facilitated switching from methadone to buprenorphine-naloxone. No precipitated withdrawal was induced by buprenorphine-naloxone. The drug-switching process was successful and smooth. He maintained abstinence from heroin for the following year. In this case, we applied TCM for enhancement of methadone metabolism and detoxification, analgesic effects, and anxiolytic and hypnotic effects during the drug switch. We observed that TCM effectively facilitated the switch from methadone to buprenorphine-naloxone in our case. Further studies regarding TCM-facilitated treatment for heroin dependence should be conducted.
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Affiliation(s)
- Kuei-Yu Huang
- Department of Chinese Medicine, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei 108, Taiwan China
- Institute of Traditional Medicine, National Yang-Ming University, Taipei 112, Taiwan China
| | - Chung-Hua Hsu
- Department of Chinese Medicine, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei 108, Taiwan China
- Institute of Traditional Medicine, National Yang-Ming University, Taipei 112, Taiwan China
| | - Kai-Chiang Yu
- Department of Chinese Medicine, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei 108, Taiwan China
| | - Yuh-Hsiang Yeh
- Department of Chinese Medicine, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei 108, Taiwan China
| | - Kao-Ching Han
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei 108, Taiwan China
| | - Han-Ting Wei
- Department of Psychiatry, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei 108, Taiwan China
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Maremmani AGI, Pacini M, Maremmani I. What we have learned from the Methadone Maintenance Treatment of Dual Disorder Heroin Use Disorder patients. Int J Environ Res Public Health 2019; 16:E447. [PMID: 30717435 PMCID: PMC6388207 DOI: 10.3390/ijerph16030447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022]
Abstract
Mental Disorders and Heroin Use Disorder (HUD) often co-occur and constitute correlated risk factors that the authors believe are best considered from a unitary perspective. In this article we review and discuss data collected by the V.P. Dole Research Group in Dual Disorder (V.P. Dole DD-RG) patients according to the following six discussion points: (1) Treatment of personality disorders during Methadone Maintenance Treatment (MMT); (2) Treatment of Mood Disorders during MMT; (3) Treatment of Anxiety Disorders during MMT; (4) Treatment of Psychotic Disorders during MMT; (5) Treatment of violence during MMT; (6) Treatment of Alcohol Use Disorder (AUD) during MMT. In treating Mood Disorder in HUD patients, we must bear in mind the interactions (potentiation and side effects) between psychopharmacology, used substances and agonist opioid medications; the use of psychiatric medications as an anti-craving drug, and the possible use of agonist and antagonist opioid medications in treating the other mental disorders. In treating chronic psychosis in HUD patients, we must consider the potentiation and side effects of antipsychotic drugs consequent on HUD treatment, worsening addiction hypophoria and inducing a more severe reward deficiency syndrome (RDS) in hypophoric patients. Violence and AUD during MMT can benefit from adequate dosages of methadone and co-medication with Sodium gamma-hydroxybutyrate (GHB). The experience of our V.P. Dole DD-RG suggests the following: (a) DD is the new paradigm in neuroscience in deepening our understanding of mental health; (b) To successfully treat DD patients a double competence is needed; (c) In managing DD patients priority must be given to Substance Use Disorder (SUD) treatment (stabilizing patients); (d) Antidepressant use is ancillary to SUD treatment; antipsychotic use must be restricted to acute phases; mood stabilizers must be preferred; any use of Benzodiazepines (BDZs) must be avoided.
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Affiliation(s)
- Angelo G I Maremmani
- Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy.
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, 55045 Lucca, Italy.
- G. De Lisio, Institute of Behavioral Sciences, 56127 Pisa, Italy.
| | - Matteo Pacini
- G. De Lisio, Institute of Behavioral Sciences, 56127 Pisa, Italy.
| | - Icro Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, 55045 Lucca, Italy.
- G. De Lisio, Institute of Behavioral Sciences, 56127 Pisa, Italy.
- V.P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56126 Pisa, Italy.
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Graham JM, Evans B. Severe Uncontrolled Pain in Buttock in a Patient on Naltrexone: A Diagnostic Challenge. Anaesth Intensive Care 2019; 33:808-11. [PMID: 16398390 DOI: 10.1177/0310057x0503300618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 26-year-old woman with a history of intravenous drug use was admitted to hospital with worsening pain in the right buttock radiating to the lateral part of the thigh and to the calf with no suspicion of cauda equina compression. Eventually, a diagnosis of sacroiliitis was made and appropriate antibiotics were administered. Provision of analgesia for this patient was difficult. On admission her medications included naltrexone, venlafaxine and tramadol. Initially naltrexone was continued and analgesia provided by epidural local anaesthetic and clonidine, intravenous ketamine and oral agents. After several days, naltrexone was ceased and opioids were used in addition to the other analgesics. The epidural analgesia was only partially effective, perhaps because of inadequate blockade of the L4-S1 nerve roots, which carry sensation from the sacroiliac joint. Naltrexone is a long-acting opioid antagonist. If opioid analgesia is planned, it is necessary to cease naltrexone for 24 to 72 hours. In an emergency, if non-opioid techniques prove ineffective, short-acting opioids can be titrated to effect in a monitored environment.
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Affiliation(s)
- J M Graham
- Department of Anaesthesia and Intensive Care, Western Hospital, Melbourne, Victoria
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Syvertsen JL, Agot K, Ohaga S, Bazzi AR. You can't do this job when you are sober: Heroin use among female sex workers and the need for comprehensive drug treatment programming in Kenya. Drug Alcohol Depend 2019; 194:495-499. [PMID: 30529906 PMCID: PMC6334295 DOI: 10.1016/j.drugalcdep.2018.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 01/01/2023]
Abstract
AIMS Globally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services. METHODS In a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use. RESULTS Among 32 women, median age was 28 (range: 18-37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender "morale" and "courage" to engage in sex work and "fight" potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks. CONCLUSIONS Drawing on the concept of "paradoxical autonomy," we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210-1106, USA; Department of Anthropology, University of California, Riverside, 1320B Watkins Hall, Riverside, CA 92521, USA.
| | - Kawango Agot
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
| | - Spala Ohaga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
| | - Angela Robertson Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118, USA.
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Coppola M, Sacchetto G, Mondola R. Craving for heroin: difference between methadone maintenance therapy patients with and without ADHD. Trends Psychiatry Psychother 2019; 41:83-86. [PMID: 30994787 DOI: 10.1590/2237-6089-2017-0159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 08/06/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder persisting in adulthood in 40-60% of cases. Clinical and neuroimaging studies suggest that patients affected by both drug addiction and ADHD show higher rates of craving for drug than patients without ADHD. We designed a pilot open-label study to investigate the effects of ADHD on craving for heroin in methadone maintenance therapy patients. METHOD Patients were recruited from outpatient facilities in an addiction treatment unit in the municipality of Alba, Italy. They were assessed using the Structured Clinical Interview for DSM-5 (SCID-5), the SCID-5 for Personality Disorders (SCID-5-PD), the Diagnostic Interview for Adult ADHD, second edition (DIVA 2.0), and the Clinical Opiate Withdrawal Scale (COWS). Categorical variables were examined using the chi-square test, and continuous variables, the t-test and Mann-Whitney's U test for normally and non-normally distributed data, respectively. Data distribution was evaluated using Shapiro-Wilk's test. Significance was set at p=0.05. Bonferroni correction was applied (0.0063) to avoid type I error. RESULTS A total of 104 patients were included in the study: 14 affected by ADHD (13.5%) and 90 were not affected (86.5%). Patients with ADHD showed higher intensity of craving for heroin than patients without ADHD in the absence of withdrawal symptoms. CONCLUSION Drug addiction and ADHD share various neurobiological mechanisms that mutually influence the evolution of both disorders. In particular, dopamine dysfunction within various brain circuits may influence impulsivity levels, motivation, inhibitory control, executive functions, and behavior and, consequently, the intensity of craving.
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Zhang G, Yang Y, Ye R, Zhang D, Shan D, Hu Y, Dai B, Liu Z. Effect of community-based extension clinics of methadone maintenance therapy for opiate-dependent clients: A prospective cohort study in Dehong Prefecture, Yunnan Province of China. Medicine (Baltimore) 2018; 97:e13323. [PMID: 30461647 PMCID: PMC6392930 DOI: 10.1097/md.0000000000013323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Methadone maintenance therapy (MMT) is effective in treatment of opiate dependents. However, there is a gap between the coverage of standard MMT clinics and the need of opiate dependents. Establishment of extension clinics of methadone maintenance therapy (EMMT) will increase the coverage and improve MMT accessibility. We implemented a prospective cohort study to understand the effects of establishment of community-based EMMT clinics comparing with MMT clinics in Yunnan Province.A total of 462 opiate-dependent clients were interviewed from the community-based EMMT clinics and standard MMT clinics located in 5 counties of Mangshi, Ruili, Longchuan, Yingjiang, and Lianghe in Yunnan Province. The information on the demographic characteristics, drug risk behaviors, quality of life (QOL), and urine testing results for morphine of the clients was collected and compared between the EMMT and MMT clinics. A survival analysis method was utilized to know the retention situation of the newly enrolled clients with Kaplan-Meier method during 9 months treatment.Among the EMMT clients, 96.9% were male; 31.4% were Han; 61.4% were married; 39.0% had primary school education; 95.5% lived with their family or relatives; 96.9% who arrived the clinic less than 15 min; 52.9% had used drugs for more than 10 years; and 16.7% injected drug. After 9 months therapy, there was no difference in the changes of life quality such as physical and psychological features, social relationships, environmental function, and total QOL and well-being between those of EMMT and MMT clinics. The positive detection rate of urine-morphine testing among newly enrolled clients of EMMT clinics decreased as the period of treatment lengthened. The average time of retention for newly enrolled EMMT clients who are still receiving the treatment was 175 days. And the average time from initiations to drop-out of treatment for newly enrolled EMMT clients was 122 days. The 9-month retention rates of the clients were 52.1% and 60.9% at EMMT and MMT clinics, respectively.The effect on EMMT retention was the same as that of MMT. Establishment of EMMT clinics was an effective strategy to expand the coverage of MMT and increase the retention of opiate dependents in the rural areas of the counties.
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Affiliation(s)
- Guang Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Yuecheng Yang
- Dehong Prefectural Center for Disease Control and Prevention, Mangshi, Yunnan Province
| | - Runhua Ye
- Dehong Prefectural Center for Disease Control and Prevention, Mangshi, Yunnan Province
| | - Dapeng Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Duo Shan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Yifei Hu
- Department of Child, Adolescent and Maternal Health, School of Public Health, Capital Medical University, Beijing
| | - Bing Dai
- Pingdu County Center for Disease Control and Prevention, Pingdu, Shandong Province, China
| | - Zhongfu Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
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Wang SC, Chung RH, Kuo HW, Liu TH, Fang CP, Liu SC, Liu CC, Tsou HH, Chen ACH, Liu YL. GRK5 Is Associated with the Regulation of Methadone Dosage in Heroin Dependence. Int J Neuropsychopharmacol 2018; 21:910-917. [PMID: 30060048 PMCID: PMC6165957 DOI: 10.1093/ijnp/pyy066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/24/2018] [Accepted: 07/25/2018] [Indexed: 12/25/2022] Open
Abstract
Background There is no countable biomarker for opioid dependence treatment responses thus far. In this study, we recruited Taiwanese methadone maintenance treatment patients to search for genes involving the regulatory mechanisms of methadone dose by genome-wide association analyses. Methods A total of 344 Taiwanese methadone maintenance treatment patients were included in a genome-wide association study. The involvement of GRK5 in opioid dependence was then further confirmed by gene expression study on lymphoblastoid cell lines derived from 3 independent age- and gender-matched groups: methadone maintenance treatment patients, medication-free former heroin abusers, and normal controls. Results The results indicated that GRK5, the gene encoding an enzyme related to μ-opioid receptor desensitization, is associated with methadone dose by additive model of gene-based association analysis (P=6.76×10-5). We found that 6 of the 55 single nucleotide polymorphisms from the genome-wide genotype platform and 2 single nucleotide polymorphisms from the 29 additionally selected single nucleotide polymorphisms were significantly associated with methadone maintenance dose in both genotype and allele type (P ≤ .006), especially in patients who tested negative in the urine morphine test. The levels of GRK5 gene expression were similar between methadone maintenance treatment patients and medication-free former heroin abusers. However, the normal controls showed a significantly lower level of GRK5 gene expression than the other groups (P=.019). Conclusions The results suggested an important role for GRK5 in the regulatory mechanisms of methadone dose and course of heroin dependence.
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Affiliation(s)
- Sheng-Chang Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Ren-Hua Chung
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Hsiang-Wei Kuo
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Tung-Hsia Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Chiu-Ping Fang
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Shu Chih Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Chia-Chen Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Hsiao-Hui Tsou
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
| | - Andrew C H Chen
- Department of Psychiatry, the Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
- The Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine at Hofstra University, Manhasset, New York
| | - Yu-Li Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Yang HT, Wang RY, Huang SY, Huang CL, Su KP. Genetic polymorphisms of FADS1, FADS2, and FADS3 and fatty acid profiles in subjects received methadone maintenance therapy. Prostaglandins Leukot Essent Fatty Acids 2018; 136:117-121. [PMID: 28161285 DOI: 10.1016/j.plefa.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 01/29/2023]
Abstract
Abnormal fatty acid metabolism and the related enzymes had been observed to be associated with psychiatric disorders. We investigated FADS gene family genetic polymorphisms and variations of lipid profiles in patients with heroin dependence receiving 6-month methadone maintenance therapy (MMT). We recruited 89 MMT drug abusers and analyzed 3 tag single nucleotide polymorphisms (SNPs) from Fatty acid desaturases (FADS), FADS1, FADS2 and FADS3. The fatty acid profiles of erythrocyte membranes were analyzed based on genetic variations. Six-month MMT therapy were significantly associated with decreased C20: 5n3 and C22:4n6 levels in the whole group of drug abusers. The decreases of C22: 6n3 after MMT therapy were associated with specific genetic variations, including FADS1 C/C, FADS2 T/T and FADS3 C/C genotypes. The variations on n3 and n6 PUFA composition were significantly shown in different alleles of FADS in MMT drug abusers. Further studies are needed to elucidate the role of fatty acid metabolism on rehabilitation by MMT.
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Affiliation(s)
- Hui-Ting Yang
- Department of Nutrition and Institute of Nutrition, China Medical University, Taiwan
| | - Ruey-Yun Wang
- Department of Public Health, China Medical University, Taiwan
| | - Shih-Yi Huang
- School of Nutrition and Health Sciences, Taipei Medical University, Taiwan
| | - Chieh-Liang Huang
- Department of Psychiatry and Mind-Body Interface Lab (MBI Lab), China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry and Mind-Body Interface Lab (MBI Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan.
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Smyth BP, Elmusharaf K, Cullen W. Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months. BMC Pediatr 2018; 18:151. [PMID: 29728088 PMCID: PMC5936020 DOI: 10.1186/s12887-018-1137-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/30/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment. METHODS We included all heroin dependent patients aged under 18.5 years commencing OST at one outpatient multidisciplinary adolescent addiction treatment service in Dublin, Ireland. Psycho-social needs were also addressed during treatment. Drug use was monitored by twice weekly urine drugs screens (UDS). Change in the proportion of UDS negative for heroin was examined using the Wilcoxon signed rank test. Attrition was explored via a Cox Regression multivariate analysis. RESULTS OST was commenced by 120 patients (51% female and mean age 17.3 years). Among the 39 patients who persisted with OST until month 12, heroin abstinence was 21% (95% confidence interval [CI] = 9-36%) at month three and it was 46% (95% CI = 30-63%) at month 12. Heroin use declined significantly from baseline to month three (p < 0.001) and from month three to month 12 (p = 0.01). Use of other drugs did not change significantly. People using cocaine during month 12 were more likely to be also using heroin (p = 0.02). Unplanned exit occurred in 25% patients by 120 days. The independent predictors of attrition were having children, single parent family of origin, not being in an intimate relationship with another heroin user and evidence of cocaine use just before treatment entry. CONCLUSIONS We found that heroin dependent adolescent patients achieved significant reductions in heroin use within three months of starting OST and this improved further after a year of treatment, about half being heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine use before and during treatment may be a negative prognostic factor.
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Affiliation(s)
- Bobby P. Smyth
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- National Drug Treatment Centre, 30/31 Pearse St, Dublin 2, Ireland
- HSE Addiction Service, Bridge House, Cherry Orchard Hospital, Dublin 10, Ireland
| | - Khalifa Elmusharaf
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- Academic General Practice, School of Medicine, University College Dublin, Belfield, Dublin 4 Ireland
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Klimas J, Nosova E, Socías E, Nolan S, Brar R, Hayashi K, Milloy MJ, Kerr T, Wood E. Factors associated with discontinuation of methadone maintenance therapy (MMT) among persons who use alcohol in Vancouver, Canada. Drug Alcohol Depend 2018; 186:182-186. [PMID: 29604525 PMCID: PMC6154800 DOI: 10.1016/j.drugalcdep.2018.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/22/2018] [Accepted: 01/27/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND We sought to examine the factors associated with discontinuation of MMT among persons on methadone who use alcohol. METHODS We evaluated the impact of drug-related and other factors on discontinuation of MMT among persons enrolled in MMT and who reported any use of alcohol versus those who were enrolled in two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Extended Cox models with time-dependent variables identified factors independently associated with time to first MMT discontinuation. RESULTS Between December 2005 and 2015, 823 individuals on MMT who also reported using alcohol at least once were included in these analyses. During the study period, 391 (47.5%) discontinued methadone. Daily heroin injection (Adjusted Hazard Ratio [AHR] = 2.67, 95% Confidence Interval [CI]: 2.10-3.40) and homelessness (AHR = 1.42, 95% CI: 1.10-1.83) were positively associated with MMT discontinuation, whereas receiving other concurrent addiction treatment in addition to MMT (AHR = 0.07, 95% CI: 0.05-0.08), as well as >60 mg methadone dose (AHR = 0.48, 95% CI: 0.39-0.60), Hepatitis C virus seropositivity (AHR = 0.65, 95% CI: 0.47-0.90), and HIV seropositivity (AHR = 0.72, 95% CI: 0.57-0.91) were negatively associated with MMT discontinuation. Any/heavy alcohol use was not independently associated with MMT discontinuation. CONCLUSIONS This study reinforces the known risks of continued heroin injection and homelessness for MMT discontinuation among individuals who also consume alcohol and highlights the protective effect of both MMT dose and receipt of concurrent addiction treatment.
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Affiliation(s)
- Jan Klimas
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Ekaterina Nosova
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Eugenia Socías
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Seonaid Nolan
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rupinder Brar
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - M-J Milloy
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Biernacki K, Terrett G, McLennan SN, Labuschagne I, Morton P, Rendell PG. Decision-making, somatic markers and emotion processing in opiate users. Psychopharmacology (Berl) 2018; 235:223-232. [PMID: 29063138 DOI: 10.1007/s00213-017-4760-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/11/2017] [Indexed: 02/06/2023]
Abstract
RATIONALE Opiate use is associated with deficits in decision-making. A possible explanation for these deficits is provided by the somatic marker hypothesis, which suggests that substance users may experience abnormal emotional responses during decision-making involving reward and punishment. This in turn may interfere with the brief physiological arousal, i.e. somatic markers that normally occur in anticipation of risky decisions. To date, the applicability of the somatic marker hypothesis to explain decision-making deficits has not been investigated in opiate users. OBJECTIVES This study assessed whether decision-making deficits in opiate users were related to abnormal emotional responses and reduced somatic markers. METHODS Opiate users enrolled in an opiate substitute treatment program (n = 28) and healthy controls (n = 32) completed the Iowa Gambling Task (IGT) while their skin conductance responses (SCRs) were recorded. Participants' emotional responses to emotion-eliciting videos were also recorded using SCRs and subjective ratings. RESULTS Opiate users displayed poorer decision-making on the IGT than did controls. However, there were no differences between the groups in SCRs; both groups displayed stronger SCRs following punishment than following reward, and both groups displayed stronger anticipatory SCRs prior to disadvantageous decisions than advantageous decisions. There were no group differences in objective or subjective measures of emotional responses to the videos. CONCLUSIONS The results suggest that deficits in emotional responsiveness are not apparent in opiate users who are receiving pharmacological treatment. Thus, the somatic marker hypothesis does not provide a good explanation for the decision-making deficits in this group.
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Affiliation(s)
- Kathryn Biernacki
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia.
| | - Gill Terrett
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Skye N McLennan
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Izelle Labuschagne
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Phoebe Morton
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Peter G Rendell
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
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Moroni F, Mannaioni G. Response to Letter to the Editor by Ernesto de Bernadis. Eur Addict Res 2018; 24:89-90. [PMID: 29902790 DOI: 10.1159/000488720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
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Marotta PL, McCullagh CA. A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013. Eur J Epidemiol 2017; 33:679-688. [PMID: 29234968 DOI: 10.1007/s10654-017-0342-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022]
Abstract
Data at the individual-level provide evidence that opioid substitution treatment (OST) programs protect against mortality for opioid dependent populations. Prior research has not examined the merits of national implementation of opioid substitution programs for reducing mortality at the country-level. This study elucidates longitudinal associations between country-level implementation of opioid substitution treatment programs on mortality rates of drug related deaths (DRD) from 1995 to 2013 in 30 European nations. Cases of DRD were measured using National Definitions for each country from official sources of data. Preliminary analysis of dispersion of cases of DRD using means and variances justified use of the negative binomial regression model with a population offset. Year and country-level fixed effects negative binomial regression models investigated the association between years of implementation of methadone maintenance therapy (MMT), OST in prison, and high dose buprenorphine treatment (HDBT) implementation and mortality rates from drug related deaths after adjusting for unemployment rates, heroin seizures and per capita expenditures on health. Beta coefficients were converted to Incidence Rate Ratios (IRR) and standard errors bootstrapped using non-parametric methods to adjust for bias (SDbs). The mean mortality rate of DRD was 1.81 from 1995 to 2013. In adjusted models, each additional year of MMT (IRR = .61, SD = .04, p < .001; SDbs = .08, p < .001), prison OST (IRR = .90, SD = .01, p < .001; SDbs = .02, p < .001), and HDBT (IRR = .09, SD = .02, p < .001; SDbs = .02, p < .01) was significantly associated with lower rates of DRDs after adjusting for country and year fixed effects. Implementation of OST programs in the general population and in prison settings may have protected against mortality from drug use at the country-level in Europe from 1995 to 2013.
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Affiliation(s)
- Phillip L Marotta
- School of Social Work, New York, NY, USA.
- Columbia University, New York, NY, USA.
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Balaji D, Mlunde LB, Tran OC, Lambdin B, Mbwambo J, Nyandindi C, Matiko E, Copenhaver M, Douglas Bruce R. First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania. AIDS Behav 2017; 21:2093-2100. [PMID: 27752867 DOI: 10.1007/s10461-016-1529-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High prevalence of human immunodeficiency virus (HIV) among females who use drugs in Dar es Salaam, Tanzania, contrasts strikingly with their low enrollment in HIV risk reduction services such as methadone assisted therapy (MAT). We conducted a case-control study to examine factors associated with non-enrollment in MAT, with a focus on gender-based violence. We interviewed 202 female heroin users not enrolled in MAT as cases and 93 females enrolled in MAT. We fitted logistic regression models with MAT enrollment as the outcome of interest. The likelihood of MAT enrollment decreased upon being in a violent relationship [odds ratio (OR) 0.23; 95 % CI 0.11-0.40], with experience of discrimination by a healthcare provider (OR 0.11; 95 % CI 0.04-0.35), and having a partner who also uses drugs (OR 0.05; 95 % CI 0.01-0.26). The results indicate that violence and discrimination are major impediments to MAT enrollment, necessitating implementation of interventions to address them.
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Affiliation(s)
- Divya Balaji
- Yale University, 428 Columbus Avenue, New Haven, CT, 06519, USA
| | - Linda B Mlunde
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
| | | | - Barrot Lambdin
- Pangaea Global AIDS Foundation, Oakland, CA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- RTI-International, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cassian Nyandindi
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eva Matiko
- Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - R Douglas Bruce
- Yale University, 428 Columbus Avenue, New Haven, CT, 06519, USA.
- Pangaea Global AIDS Foundation, Oakland, CA, USA.
- Cornell Scott-Hill Health Center, New Haven, CT, USA.
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Görgens SV. Heroin. J Emerg Med 2017; 52:904. [PMID: 28410961 DOI: 10.1016/j.jemermed.2017.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
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Abstract
More young people are using heroin, and powerful drug additives are causing more overdoses
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Kuo HW, Shih CL, Tsung JH, Liu SW, Chu SK, Yang HC, Tsou HH, Wang ZH, Chen ACH, Liu YL. Pharmacogenomics study on cadherin 2 network with regard to HIV infection and methadone treatment outcome. PLoS One 2017; 12:e0174647. [PMID: 28358908 PMCID: PMC5373543 DOI: 10.1371/journal.pone.0174647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/13/2017] [Indexed: 12/17/2022] Open
Abstract
Heroin dependent patients have a high incidence of HIV infection. In contrast to the gene expression method, we developed a systemic correlation analysis method built upon the results of pharmacogenomics study in a methadone maintenance treatment (MMT) cohort consisting of 344 Taiwanese heroin dependent patients. We identified genetic variants and their encoding proteins that may be involved with HIV infection and MMT treatment outcome. Cadherin 2 (CDH2) genetic determinants were identified through the genome-wide pharmacogenomic study. We found significant correlations among HIV infection status, plasma levels of CDH2, cytokine IL-7, ADAM10, and the treatment responses to methadone. Two single nucleotide polymorphisms located within CDH2 gene showed associations with blood pressure and plasma CDH2 concentration. Plasma concentration of CDH2 showed correlations with the level of cytokine IL-7, status of HIV infection, and urine morphine test result. Plasma level of IL-7 was correlated with corrected QT interval (QTc) and gooseflesh skin withdrawal symptom score, while level of ADAM10 was correlated with plasma concentrations of vitamin D metabolite, nicotine metabolite, and R-methadone. The results suggest a novel network involving HIV infection and methadone treatment outcome.
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Affiliation(s)
- Hsiang-Wei Kuo
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chia-Lung Shih
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Jieh-Hen Tsung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Sheng-Wen Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Shih-Kai Chu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Hsin-Chou Yang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Hsiao-Hui Tsou
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
| | - Zih-Hsiang Wang
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Andrew C. H. Chen
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, United States of America
- The Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine at Hofstra University, Manhasset, New York, United States of America
| | - Yu-Li Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- * E-mail:
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Affiliation(s)
- Sarah E Wakeman
- From Massachusetts General Hospital and Harvard Medical School - both in Boston
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42
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Dute J. European Court of Human Rights. Eur J Health Law 2016; 23:525-537. [PMID: 29210250 DOI: 10.1163/15718093-12341432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Karsinti E, Fortias M, Dupuy G, Ksouda K, Laqueille X, Simonpoli AM, Touzeau D, Avril E, Orizet C, Belforte B, Coeuru P, Polomeni P, Icick R, Jarroir M, Bloch V, Scott J, Lépine JP, Bellivier F, Vorspan F. Anxiety disorders are associated with early onset of heroin use and rapid transition to dependence in methadone maintained patients. Psychiatry Res 2016; 245:423-426. [PMID: 27620325 DOI: 10.1016/j.psychres.2016.04.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 03/14/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
Early onset of heroin use is a severity marker of heroin use disorder. We studied the interaction between early onset and rapid transition to heroin dependence recorded with retrospective interviews in 213 patients with severe heroin dependence and history of methadone maintenance treatment. General linear models were used to identify independent factors associated with early onset, factors associated with rapid transition to dependence, and a multivariate model was used to study the interaction of those two dimensions. Lifetime history of anxiety disorders and age at onset of cannabis use are shared common risk factors and are associated with the interaction.
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Affiliation(s)
- Emily Karsinti
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France.
| | - Maeva Fortias
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Gaël Dupuy
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Kamilia Ksouda
- Laboratoire de Pharmacologie, Faculté de Médecine de Sfax, Tunisia
| | - Xavier Laqueille
- Centre Hospitalier Sainte-Anne, Service d'addictologie, 1, rue Cabanis, Paris, France
| | | | - Didier Touzeau
- APHP, Hôpital Paul Guiraud, CSAPA Clinique Liberté, Ivry-sur-Seine, France
| | | | - Cyrille Orizet
- APHP, Hôpital Européen Georges Pompidou, CSAPA Monte-Cristo, Paris, France
| | - Beatriz Belforte
- APHP, Hôpital Européen Georges Pompidou, CSAPA Monte-Cristo, Paris, France
| | | | | | - Romain Icick
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Marine Jarroir
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Vanessa Bloch
- Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | - Jean-Pierre Lépine
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Frank Bellivier
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
| | - Florence Vorspan
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France
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MacNeil Vroomen J, Eekhout I, Dijkgraaf MG, van Hout H, de Rooij SE, Heymans MW, Bosmans JE. Multiple imputation strategies for zero-inflated cost data in economic evaluations: which method works best? Eur J Health Econ 2016; 17:939-950. [PMID: 26497027 PMCID: PMC5047955 DOI: 10.1007/s10198-015-0734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/22/2015] [Indexed: 05/06/2023]
Abstract
Cost and effect data often have missing data because economic evaluations are frequently added onto clinical studies where cost data are rarely the primary outcome. The objective of this article was to investigate which multiple imputation strategy is most appropriate to use for missing cost-effectiveness data in a randomized controlled trial. Three incomplete data sets were generated from a complete reference data set with 17, 35 and 50 % missing data in effects and costs. The strategies evaluated included complete case analysis (CCA), multiple imputation with predictive mean matching (MI-PMM), MI-PMM on log-transformed costs (log MI-PMM), and a two-step MI. Mean cost and effect estimates, standard errors and incremental net benefits were compared with the results of the analyses on the complete reference data set. The CCA, MI-PMM, and the two-step MI strategy diverged from the results for the reference data set when the amount of missing data increased. In contrast, the estimates of the Log MI-PMM strategy remained stable irrespective of the amount of missing data. MI provided better estimates than CCA in all scenarios. With low amounts of missing data the MI strategies appeared equivalent but we recommend using the log MI-PMM with missing data greater than 35 %.
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Affiliation(s)
| | - Iris Eekhout
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G Dijkgraaf
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hein van Hout
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Uusitalo S, Broers B. Addiction, Heroin-Assisted Treatment and the Idea of Abstinence: A reply to Henden. Bioethics 2016; 30:776-780. [PMID: 27611940 DOI: 10.1111/bioe.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In our previous article on the question whether heroin addicts are able to give informed consent voluntarily to research on heroin-assisted treatment, we criticized the ongoing bioethical discussion of a flawed conceptualization of heroin addicts' options. As a participant in this discussion, Edmund Henden defends the conceptualization as sufficient for determining whether heroin addicts are able to give informed consent to the research on heroin-assisted treatment voluntarily. This discussion on research on heroin-assisted treatment seems to go astray in several respects. In his reply to our article Henden maintains some of the biases, such as the necessity of abstinence in recovery, that seem to prevail in addiction research on a more general level as well. These biases run the danger of having implausible ethical implications on stakeholders in addiction research and treatment. In our reply to him, we will further clarify and discuss the importance of describing the relevant issues in plausible terms that do justice to the realities of the cases of informed consent in research on heroin-assisted treatment and also raise a wider issue of the ethics of wording as well as of the narrow scope, or 'tunnel vision', in addiction research as currently conducted.
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Abstract
OBJECTIVES This study sought to identify factors that may be associated with help-seeking by witnesses during overdoses where naloxone is administered. SETTING Overdose events occurred in and were reported from the five regional health authorities across British Columbia, Canada. Naloxone administration forms completed following overdose events were submitted to the British Columbia Take Home Naloxone programme. PARTICIPANTS All 182 reported naloxone administration events, reported by adult men and women and occurring between 31 August 2012 and 31 March 2015, were considered for inclusion in the analysis. Of these, 18 were excluded: 10 events which were reported by the person who overdosed, and 8 events for which completed forms did not indicate whether or not emergency medical help was sought. PRIMARY AND SECONDARY OUTCOME MEASURES Seeking emergency medical help (calling 911), as reported by participants, was the sole outcome measure of this analysis. RESULTS Medical help was sought (emergency services-911 called) in 89 (54.3%) of 164 overdoses where naloxone was administered. The majority of administration events occurred in private residences (50.6%) and on the street (23.4%), where reported rates of calling 911 were 27.5% and 81.1%, respectively. Overdoses occurring on the street (compared to private residence) were significantly associated with higher odds of calling 911 in multivariate analysis (OR=10.68; 95% CI 2.83 to 51.87; p<0.01), after adjusting for other variables. CONCLUSIONS Overdoses occurring on the street were associated with higher odds of seeking emergency medical help by responders. Further research is needed to determine if sex and stimulant use by the person who overdosed are associated with seeking emergency medical help. The results of this study will inform interventions within the British Columbia Take Home Naloxone programme and other jurisdictions to encourage seeking emergency medical help.
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Affiliation(s)
- Graham Ambrose
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Ashraf Amlani
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane A Buxton
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Yang J, Li J, Xu G, Zhang J, Chen Z, Lu Z, Deng H. Elevated Hair Cortisol Levels among Heroin Addicts on Current Methadone Maintenance Compared to Controls. PLoS One 2016; 11:e0150729. [PMID: 27010803 PMCID: PMC4806835 DOI: 10.1371/journal.pone.0150729] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/17/2016] [Indexed: 11/24/2022] Open
Abstract
Whether methadone maintenance treatment (MMT) can improve the basal function of the hypothalamic–pituitary–adrenal (HPA) axis, which is suppressed by long-term heroin consumption, is a matter of debate. The stress state and depression and anxiety symptoms may affect the basal activity of the HPA axis in MMT patients. However, the effect of psychological factors on HPA activity was not simultaneously controlled in previous studies. This study investigated differences in HPA basal activity between MMT patients and controls using psychological variables as covariates. The participants included 52 MMT patients and 41 age-matched, non-heroin-dependent controls. Psychological states were self-reported with the Perceived Stress Scale, Self-Rating Depression Scale and Self-Rating Anxiety Scale. The hair cortisol level was adopted as a biomarker of HPA basal activity and was determined with liquid chromatography tandem mass spectrometry. The results revealed that MMT patients had significantly higher hair cortisol levels than the controls (p<0.05), but the difference was not significant (p>0.05) when the perceived stress, depression and anxiety scores were used as covariates. We concluded that patients with long-term MMT showed higher basal activity of the HPA axis. The high chronic stress state and increase in depression and anxiety symptoms may mask the suppression effect of methadone on the HPA activity.
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Affiliation(s)
- Jin Yang
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, 210096, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Jifeng Li
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, 210096, China
| | - Guanyi Xu
- Center of Methadone Maintenance Treatment, Baixia District Hospital, Nanjing, 210004, China
| | - Jing Zhang
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, 210096, China
| | - Zheng Chen
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, 210096, China
| | - Zuhong Lu
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, 210096, China
| | - Huihua Deng
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, and Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, 210096, China
- * E-mail:
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48
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Luo X, Zhao P, Gong X, Zhang L, Tang W, Zou X, Chen W, Ling L. Concurrent Heroin Use and Correlates among Methadone Maintenance Treatment Clients: A 12-Month Follow-up Study in Guangdong Province, China. Int J Environ Res Public Health 2016; 13:ijerph13030305. [PMID: 27005649 PMCID: PMC4808968 DOI: 10.3390/ijerph13030305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
Abstract
Objective: To assess concurrent heroin use and correlates among Methadone Maintenance Treatment (MMT) clients in Guangdong Province, China. Method: Demographic and drug use data were collected with a structured questionnaire, and MMT information was obtained from the MMT clinic registration system in Guangdong. Human immunodeficiency virus (HIV-) and hepatitis C virus (HCV) infected status and urine morphine results were obtained from laboratory tests. Logistic regressions were employed to investigate the factors associated with concurrent heroin use. Results: Among the 6848 participants, 75% continued using heroin more than once during the first 12 months after treatment initiation. Concurrent heroin use was associated with inharmonious family relationship (OR (odds ratio) = 1.49, 95% CI (confidence intervals): 1.24–1.78), HIV positivity (OR = 1.25, 95% CI: 1.01–1.55), having multiple sex partners (OR = 1.34, 95% CI: 1.07–1.69), having ever taken intravenous drugs (OR = 0.81, 95% CI: 0.69–0.95), higher maintenance dose (OR = 1.13, 95% CI: 1.01–1.28) and poorer MMT attendance (OR<20% = 1.32, 95% CI: 1.13–1.53; OR20%– = 1.33, 95% CI: 1.14–1.54; OR50%– = 1.69, 95% CI: 1.44–2.00). Among those who used heroin concurrently, the same factors, and additionally being older (OR35– = 1.26, 95% CI: 1.11–1.43; OR≥45 = 1.63, 95% CI: 1.30–2.05) and female (OR = 1.60, 95% CI: 1.28–2.00), contribute to a greater frequency of heroin use. Conclusions: Concurrent heroin use was prevalent among MMT participants in Guangdong, underscoring the urgent needs for tailored interventions and health education programs for this population.
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Affiliation(s)
- Xiaofeng Luo
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
| | - Peizhen Zhao
- Guangdong Center for Skin Guangdong Provincial Center for Skin Diseases and STIs Control, No. 2 Lujing Road, Guangzhou 510091, China.
| | - Xiao Gong
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
| | - Lei Zhang
- The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia.
| | - Weiming Tang
- Guangdong Center for Skin Guangdong Provincial Center for Skin Diseases and STIs Control, No. 2 Lujing Road, Guangzhou 510091, China.
| | - Xia Zou
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, China.
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49
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Yee A, Danaee M, Loh HS, Sulaiman AH, Ng CG. Sexual Dysfunction in Heroin Dependents: A Comparison between Methadone and Buprenorphine Maintenance Treatment. PLoS One 2016; 11:e0147852. [PMID: 26820154 PMCID: PMC4731474 DOI: 10.1371/journal.pone.0147852] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/08/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Methadone has long been regarded as an effective treatment for opioid dependence. However, many patients discontinue maintenance therapy because of its side effects, with one of the most common being sexual dysfunction. Buprenorphine is a proven alternative to methadone. This study aimed to investigate sexual dysfunction in opioid-dependent men on buprenorphine maintenance treatment (BMT) and methadone maintenance treatment (MMT). The secondary aim was to investigate the correlation between sexual dysfunction and the quality of life in these patients. METHODS Two hundred thirty-eight men participated in this cross-sectional study. Four questionnaires were used, the Mini International Neuropsychiatric Interview, Opiate Treatment Index, Malay version of the International Index of Erectile Function 15 (Mal-IIEF-15), and World Health Organization Quality of Life-BREF Scale. Multivariate analysis of covariance was used to examine the relationship between MMT and BMT and the Mal-IIEF 15 scores while controlling for all the possible confounders. RESULTS The study population consisted of 171 patients (71.8%) on MMT and 67 (28.2%) on BMT. Patients in the MMT group who had a sexual partner scored significantly lower in the sexual desire domain (p < 0.012) and overall satisfaction (p = 0.043) domain compared with their counterparts in the BMT group. Similarly, patients in the MMT group without a sexual partner scored significantly lower in the orgasmic function domain (p = 0.008) compared with those in the BMT group without a partner. Intercourse satisfaction (p = 0.026) and overall satisfaction (p = 0.039) were significantly associated with the social relationships domain after adjusting for significantly correlated sociodemographic variables. CONCLUSIONS Sexual functioning is critical for improving the quality of life in patients in an opioid rehabilitation program. Our study showed that buprenorphine causes less sexual dysfunction than methadone. Thus, clinicians may consider the former when treating heroin dependents who have concerns about sexual function.
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Affiliation(s)
- Anne Yee
- University Malaya Center of Addiction Sciences, Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- University Malaya Center of Addiction Sciences, Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Huai Seng Loh
- Clinical Academic Unit (Family Medicine), Newcastle University Medicine Malaysia, Nusajaya, Johor, Malaysia
| | - Ahmad Hatim Sulaiman
- University Malaya Center of Addiction Sciences, Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- University Malaya Center of Addiction Sciences, Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Li W, Li Q, Wang D, Xiao W, Liu K, Shi L, Zhu J, Li Y, Yan X, Chen J, Ye J, Li Z, Wang Y, Wang W. Dysfunctional Default Mode Network in Methadone Treated Patients Who Have a Higher Heroin Relapse Risk. Sci Rep 2015; 5:15181. [PMID: 26469876 PMCID: PMC4606802 DOI: 10.1038/srep15181] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/09/2015] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to identify whether heroin relapse is associated with changes in the functional connectivity of the default mode network (DMN) during methadone maintenance treatment (MMT). Resting-state functional magnetic resonance imaging (fMRI) data of chronic heroin relapsers (HR) (12 males, 1 female, age: 36.1 ± 6.9 years) and abstainers (HA) (11males, 2 female; age: 42.1 ± 8.1 years) were investigated with an independent component analysis to address the functional connectivity of their DMN. Group comparison was then performed between the relapsers and abstainers. Our study found that the left inferior temporal gyrus and the right superior occipital gyrus associated with DMN showed decreased functional connectivity in HR when compared with HA, while the left precuneus and the right middle cingulum had increased functional connectivity. Mean intensity signal, extracted from left inferior temporal gyrus of HR patients, showed a significant negative correlation corresponding to the degree of heroin relapse. These findings suggest that altered functional connectivity of DMN may contribute to the potential neurobiological mechanism(s) of heroin relapse and have a predictive value concerning heroin relapse under MMT.
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Affiliation(s)
- Wei Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Wei Xiao
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Kai Liu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Yongbin Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Xuejiao Yan
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Jianjun Ye
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Zhe Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Yarong Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
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