Heroin Addiction and Related Clinical Problems 2008; 10(1):7-14
Sexual Behaviour of Heroin Addicts In Treatment
Brajevic-Gizdic I., Pletikosa M.
Correspondence: Brajevic-Gizdic Igna, MD, Boticevo setaliste 1, 21 000 Split, Croatia. Telephone: 00358 21 217 979, E-mail: igna.brajevic-gizdic@st.htnet.hr
Summary: Addicts are a high risk group for diseases transmissible sexually or through the blood. Their pathological behaviour caused by addiction makes it a priority to collect information about the sexual conduct of addicts, especially those who are trying to cure themselves. It is important to get results about how they assess the risks related to certain kinds of behaviour and how they see the need to be educated about the issue. The aim of this study is to determine the sexual behaviour patterns of heroin addicts who have already begun treatment, while getting insights into how they assess the risks associated with being sexually active, and whether they need to be informed about the whole issue. According to the survey, heroin addicts displayed an uncritical attitude towards the risk assessment of their sexual behaviour and failed to understand that they need to be informed about protection.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):15-20
First Experience of Opioid Therapy with Buprenorphine in Ukraine
Dvoryak S., Grishayeva I.
Correspondence: Sergey Dvoryak, MD, Ukrainian Institute on Public Health Policy, Kiev, Ukraine 53/30 Bozhenko Str., Apt 15 Kiev, 03150 Ukraine. Tel.: +38 044 537 6415. E-mail: dvoryak@uiphp.org.ua
Summary: Ukraine is the country that has the highest rate of HIV/AIDS among IDUs in Europe. The development of opioid maintenance treatment for opioid users is an important public health issue.The earliest utilization of buprenorphine for OMT was made in 2004-5, within the framework of the UNDP Applied Human Rights Project. It was accompanied by research which was a part of the WHO Collaborative Study on Opioid Treatment of Opioid Dependence and HIV/AIDS. There were 67 opioid drug users under observation. This was a prospective observational study with assessments at baseline, and at 3- and 6-month follow-ups. All assessments refer to the period of one month prior to interview. The main aims of outcome evaluation were to explore changes in the following domains: health status and well-being of individuals in opioid treatment; community/social benefits and also programme performance. Improvements in the main indicators were documented after 6 months of treatment. The retention level was 66% and the mean buprenorphine dose was about 8 mg/day. The main conclusion is that buprenorphine treatment is effective in the context of Ukrainian social conditions.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):21-26
Administration of Nalbuphine to Heroin Addicts. Feasibility and Short-Term Effects
Voronkov M., Ocheret D., Bondarenko S., Yu Y. I., Koren S.
Correspondence: Sergey Koren, MD, AIDS Foundation East-West, 15/5 Chayanova St., Moscow 125047 Russia. E-mail: psycab@rambler.ru
Summary: Kappa opioid agonists attenuate some of the neurochemical and behavioural effects of opiates and are under consideration as potential treatments for opiate dependence. We have shown that mixed kappa-agonist mu-antagonist nalbuphine (0.25 mpk im b.i.d.) was effective in reducing opiate consumption in 29 patients with a broad range of ages (29.4±6.4 years) and with a long history of substance abuse (9.3 ±3.6 years). Administration of nalbuphine for at least 14 days, up to at most 6 months, on an outpatient basis, led to a dramatic fall in the consumption of heroin and other totally illicit substances, along with a decline in criminal behaviour, as well as a higher level of retention of patients in the study, but also to improvements in patients’ quality of life. Nalbuphine was safe, effective and highly compatible with the traditional therapy used to combat opiate addiction in Russia. Nalbuphine can also be used to stabilize HIV-positive patients. The study showed that both the current Russian medical infrastructure and medical professionals themselves could successfully contribute to the long-term agonist-antagonist treatment of patients with opiate addiction. We believe that our study warrants the further investigation of nalbuphine in treating opiate addiction.
Publication Type: Preliminary Communication
Heroin Addiction and Related Clinical Problems 2008; 10(1):27-40
González-Saiz F., Rojas O. L., Gómez R. B., Acedos I. B., Martínez J. G., Collantes M. A. G., Fernández A. L., Serum Methadone Levels Study Group
Correspondence: Francisco González-Saiz, Fundación Andaluza para la Atención e Incorporación Social (FADAIS), Avda Hytasa, edificio Toledo II. Plt. 3ª. 41006. Sevilla, Spain, EU. E-mail: pacogonzalez@comcadiz.com
Summary: Introduction: The testing and adjusting of methadone dosing is a clinical procedure that must be individualized to meet the needs of each patient. So far no evidence has been published of a tool capable of providing a global measurement of dose adequacy. For this reason, we have devised the Opiate Dosage Adequacy Scale (ODAS), which is intended as a means of implementing a theoretical construct called ‘dose adequacy’. Aim: To provide evidence of the reliability and validity of the ODAS. Methods: The study was carried out on a total of 300 patients on MMT, randomly selected from 10 public out-patient drug abuse treatment centres. We used ODAS, Addiction Severity Index (ASI), Outcomes Clinical Impression Form (OCIF) and laboratory tests (serum methadone levels, serum EDDP levels, serum a-1 acid glycoproteins levels [AAG] and urinanalysis). Results: Internal consistency for the ODAS was acceptable (a Cronbach = 0.70). Very high inter-rater reliability was found across items (kappa values between 0.95 and 1). The factor analysis yielded a four factor structure exactly coinciding with the dimensions of the ‘dose adequacy’ construct proposed a priori (‘opiate withdrawal syndrome’ ‘craving’ ‘overmedication’ and ‘drug use’. As far as construct validity is concerned, methadone dose adequacy as measured by the ODAS was correlated with clinical stabilization variables (heroin use, OCIF, ASI), while neither the methadone dose nor SML values correlated significantly with these variables. Conclusions: This study provides sufficient evidence for the reliability and validity of the ODAS as a tool for measuring methadone dose adequacy. The results of the construct validity test support the hypothesis put forward by several authors that an individualized clinical assessment of methadone dose adequacy is better able to account for a patient’s condition than either the methadone dose or the patient’s serum level.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):41-48
Maremmani I., Pani P. P., Popovic D., Pacini M., Deltito J., Perugi G.
Correspondence: Icro Maremmani, MD; Vincent P. Dole, Dual Diagnosis Unit, Santa Chiara University Hospital,
Department of Psychiatry, University of Pisa, Via Roma,67 56100 PISA, Italy, EU. Phone +39 0584 790073 Fax +39 0584 72081, E-Mail: maremman@med.unipi.it
Summary: The main goals of opioid treatment in heroin addiction is to eliminate or reduce the use of heroin and other substances of abuse, to promote patients’ social rehabilitation and to improve their quality of life. The purpose of this study is to evaluate the efficacy of buprenorphine and methadone on the quality of life of patients. These subjects were sampled on the basis of the same severity of illness and the same impairment of quality of life at the start of treatment. 50 patients (41 male and 9 female) in buprenorphine treatment and 83 patients (63 males and 20 females) in methadone treatment, were evaluated regarding their retention in treatment, the use of substances, their clinical improvement and their quality of life over a one year period. In markedly ill patients buprenorphine and methadone both successfully and similarly reduce substance abuse and the severity of illness. Patients treated with buprenorphine show a better improvement of quality of life especially regarding improvements in jobs, leisure activities, income and self-acceptance. We conclude that Buprenorphine is a good choice for markedly ill patients with severe impairment in their quality of life parameters.
Publication Type: Regular article
Heroin Addiction and Related Clinical Problems 2008; 10(1):49-56
Methadone: A Fast and Powerful Anti-anxiety, Anti-depressant and Anti-psychotic Treatment
Deglon J. J., Wark E.
Correspondence: Jean-Jacques Deglon, MD, Fondation Phénix, Route Chene 100, case postale 215 - 1224 Chene-Bourgeries, Geneve, Switzerland - E-mail: jjdeglon@gmail.com
Summary: Not Available
Publication Type: Letter to the Editor
Heroin Addiction and Related Clinical Problems 2008; 10(1):55-56
Explaining Agonist Treatment Through Movie Language: The Interesting Allegory of ‘Videodrome’
Pacini M.
Correspondence: Matteo Pacini, MD, "G. De Lisio" Institute of Behavioural Sciences, Via di Pratale, 3 - 56127-Pisa, Italy, EU. E-mail: paciland@virgilio.it
Summary: Not Available
Publication Type: Letter to the Editor