OPIOIDS 2009 / COCAINE 2009 <101>
Database EMBASE
Accession Number 0020180662
Authors Castells X. Kosten T.R. Capella D. Vidal X. Colom J. Casas M.
Institution
(Castells, Kosten, Capella, Vidal, Colom, Casas) Psychiatry Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain.
Country of Publication
United Kingdom
Title
Efficacy of opiate maintenance therapy and adjunctive interventions for opioid dependence with comorbid cocaine use disorders: A systematic review and meta-analysis of controlled clinical trials.
Source
The American journal of drug and alcohol abuse. 35(5)(pp 339-349), 2009. Date of Publication: 2009.
Abstract
AIMS: To determine the efficacy of Opiate Maintenance Therapy (OMT) and adjunctive interventions for dual heroin and cocaine dependence by means of a meta-analysis. METHOD: We searched for and retrieved randomized controlled clinical trials. We used RevMan 5.0 with random effects modeling for statistical analysis and for comparisons of relative risk, effect sizes, and confidence intervals. Subsequent moderator variables and sensitivity analyses were performed. RESULTS: Thirty-seven studies, which have enrolled 3,029 patients, have been included in this meta-analysis. High doses of OMT were more efficacious than lower ones in the achievement of sustained heroin abstinence (RR = 2.24 [1.54, 3.24], p < .0001) but had no effect on cocaine abstinence. At equivalent doses, methadone was more efficacious than buprenorphine on cocaine abstinence (RR = 1.63 [1.20, 2.22], p = .002) and also appeared to be superior on heroin abstinence (RR = 1.39 [1.00, 1.93], p = .05). Several pharmacological and psychological potentiation strategies have been investigated. An improvement on sustained cocaine abstinence was achieved with indirect dopaminergic agonists (RR = 1.44 [1.05, 1.98], p = .03) and with contingency management (CM) focusing on cocaine abstinence (RR = 3.11 [1.80, 5.35], p < .0001). CONCLUSIONS: Dual opioid and cocaine dependence can be effectively treated with OMT in combination with adjunctive interventions. Higher OMT doses are preferable to lower ones and methadone to buprenorphine. OMT can be enhanced with indirect dopaminergic drugs and with CM focusing on cocaine abstinence.
Publication Type Journal: Article
Journal Name The American journal of drug and alcohol abuse
Volume 35
Issue Part 5
Page 339-349
Year of Publication 2009
Date of Publication 2009
OPIOIDS 2009 <586>
Database Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R)
Unique Identifier 20025779
Status In-Data-Review
Authors McLean S. Bruno R. Brandon S. de Graaff B.
Authors Full Name McLean, Stuart. Bruno, Raimondo. Brandon, Susan. de Graaff, Barbara.
Institution
School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia.
Title
Effect of filtration on morphine and particle content of injections prepared from slow-release oral morphine tablets.
Source
Harm Reduction Journal. 6:37, 2009.
Journal Name
Harm Reduction Journal
Other ID
Source: NLM. PMC2803777
Country of Publication
England
Abstract
BACKGROUND: Injections of mixtures prepared from crushed tablets contain insoluble particles which can cause embolisms and other complications. Although many particles can be removed by filtration, many injecting drug users do not filter due to availability, cost or performance of filters, and also due to concerns that some of the dose will be lost. METHODS: Injection solutions were prepared from slow-release morphine tablets (MS Contin((R))) replicating methods used by injecting drug users. Contaminating particles were counted by microscopy and morphine content analysed by liquid chromatography before and after filtration. RESULTS: Unfiltered tablet extracts contained tens of millions of particles with a range in sizes from < 5 mum to > 400 mum. Cigarette filters removed most of the larger particles (> 50 mum) but the smaller particles remained. Commercial syringe filters (0.45 and 0.22 mum) produced a dramatic reduction in particles but tended to block unless used after a cigarette filter. Morphine was retained by all filters but could be recovered by following the filtration with one or two 1 ml washes. The combined use of a cigarette filter then 0.22 mum filter, with rinses, enabled recovery of 90% of the extracted morphine in a solution which was essentially free of tablet-derived particles. CONCLUSIONS: Apart from overdose and addiction itself, the harmful consequences of injecting morphine tablets come from the insoluble particles from the tablets and microbial contamination. These harmful components can be substantially reduced by passing the injection through a sterilizing (0.22 mum) filter. To prevent the filter from blocking, a preliminary coarse filter (such as a cigarette filter) should be used first. The filters retain some of the dose, but this can be recovered by following filtration with one or two rinses with 1 ml water. Although filtration can reduce the non-pharmacological harmful consequences of injecting tablets, this remains an unsafe practice due to skin and environmental contamination by particles and microorganisms, and the risks of blood-borne infections from sharing injecting equipment.
Publication Type Journal Article.
Date of Publication 2009
Year of Publication 2009
Volume 6
Page 37
OPIOIDS 2009 <590>
Database Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R)
Unique Identifier 19159475
Status PubMed-not-MEDLINE
Authors Gartry CC. Oviedo-Joekes E. Laliberte N. Schechter MT.
Authors Full Name Gartry, Candice C. Oviedo-Joekes, Eugenia. Laliberte, Nancy. Schechter, Martin T.
Institution
CIHR Canadian HIV Trials Network and the Centre for Health Evaluation & Outcome Sciences (CHEOS), Vancouver, BC, Canada.
Title
NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America.
Source
Harm Reduction Journal. 6:2, 2009.
Journal Name
Harm Reduction Journal
Other ID
Source: NLM. PMC2639576
Country of Publication
England
Abstract
BACKGROUND: Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction.The NAOMI study is a Phase III randomized clinical trial comparing injectable heroin maintenance to oral methadone. The study has ethics board approval at its Montreal and Vancouver sites, as well as from the University of Toronto, the New York Academy of Medicine and Johns Hopkins University.The main objective of the NAOMI Study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade opioid agonist is more effective than methadone alone in recruiting, retaining, and benefiting chronic, opioid-dependent, injection drug users who are resistant to current standard treatment options. METHODS: The case study submitted chronicles the challenges of getting a heroin assisted treatment trial up and running in North America. It describes: a brief background on opioid addiction; current standard therapies for opioid addiction; why there is/was a need for a heroin assisted treatment trial; a description of heroin assisted treatment; the beginnings of creating the NAOMI study in North America; what is the NAOMI study; the science and politics of the NAOMI study; getting NAOMI started in Canada; various requirements and restrictions in getting the study up and running; recruitment into the study; working with the media; a status report on the study; and a brief conclusion from the authors' perspectives. RESULTS AND CONCLUSION: As this is a case study, there are no specific results or main findings listed. The case study focuses on: the background of the study; what it took to get the study started in Canada; the unique requirements and conditions of getting a site, and the study, approved; working with the media; recruitment into the study; a brief status report on the study; and a brief conclusion from the authors' perspectives. TRAIL REGISTRATION: ClinicalTrials.gov registration number: NCT00175357.
Publication Type Journal Article.
Date of Publication 2009
Year of Publication 2009
Volume 6
Page 2
OPIOIDS 2009 <597>
Database Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R)
Unique Identifier 19930013
Status In-Process
Authors Senbanjo R. Wolff K. Marshall EJ. Strang J.
Authors Full Name Senbanjo, Richard. Wolff, Kim. Marshall, E Jane. Strang, John.
Institution
KCA Community Drug Services, Ashford, Kent, UK.
Title
Persistence of heroin use despite methadone treatment: poor coping self-efficacy predicts continued heroin use.
Source
Drug & Alcohol Review. 28(6):608-15, 2009 Nov.
Journal Name
Drug & Alcohol Review
Country of Publication
England
Abstract
AIM: To evaluate the association between coping self-efficacy and persistent use of heroin by patients enrolled in a methadone treatment program. DESIGN AND METHODS: Cross-sectional survey. One hundred and ninety-one patients attending outpatient methadone clinics in South-East England, United Kingdom. Validated questionnaires were used to assess drug use (Maudsley Addiction Profile), alcohol use (Alcohol Use Disorders Identification Test), mental health (Hospital Anxiety and Depression Scale) and coping self-efficacy (brief 8-item Drug Taking Confidence Questionnaire). RESULTS: Half of the participants (95/191) reported heroin use in the preceding 14-day period. Heroin use during methadone treatment was associated with financial problems (P = 0.008), spending time with other drug users (P < 0.001), cocaine use (P = 0.002), low mood (P = 0.002) and dissatisfaction with the daily methadone dose (P = 0.014). Compared with 'Heroin-abstinent' patients, the 'Heroin' group reported significantly lower mean coping self-efficacy scores (t = 9.8, d.f. = 182, P < 0.001, effect size 1.17). After correcting for the effects of co-variants in a logistic regression model, the main determinants of persistent heroin use were 'coping self-efficacy' [B -0.05; standard error (SE) 0.008; Wald 36.6; odds ratio (OR) 0.95, 95% confidence interval (CI) 0.94, 0.97; P < 0.001] and 'dissatisfaction with methadone dose' (B 0.93; SE 0.46; Wald 4.1; OR 2.5, 95% CI 1.03, 6.25; P = 0.042). Satisfaction with methadone dose showed no association with self-efficacy. DISCUSSION AND CONCLUSIONS; While heroin use during methadone treatment can partly be explained by inadequate dosing, our data suggest a more complex picture with significant contribution from poor coping self-efficacy. Efforts aimed at enhancing and maintaining the patients' self-efficacy and social skills are likely to improve heroin and other drug use outcomes with added benefits for treatment completion rates and the throughput of methadone programs.
Publication Type Journal Article.
Date of Publication 2009 Nov
Year of Publication 2009
Issue/Part 6
Volume 28
Page 608-15
OPIOIDS 2009 <638>
Database Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R)
Unique Identifier 20155591
Status MEDLINE
Authors Monte AA. Mandell T. Wilford BB. Tennyson J. Boyer EW.
Authors Full Name Monte, Andrew A. Mandell, Todd. Wilford, Bonnie B. Tennyson, Joseph. Boyer, Edward W.
Institution
University of Massachusetts Medical School, Worcester, MA, USA.
Title
Diversion of buprenorphine/naloxone coformulated tablets in a region with high prescribing prevalence.
Source
Journal of Addictive Diseases. 28(3):226-31, 2009 Jul.
Journal Name
Journal of Addictive Diseases
Country of Publication
England
Abstract
The purpose of this article was to characterize practices of buprenorphine/naloxone (B/N) diversion in a region with a high prescribing prevalence. A cross-sectional, open-ended survey was administered to individuals entering opioid addiction treatment programs in two New England states. The authors obtained formative information about the knowledge, attitudes, beliefs, practices, and street economy of B/N diversion. The authors interviewed 51 individuals, 49 of which were aware of B/N medication. Of that number, 100% had diverted B/N to modulate opiate withdrawal symptoms arising from attempted "self-detoxification," insufficient funds to purchase preferred illicit opioids, or inability to find a preferred source of drugs. Thirty of 49 (61%) participants obtained the illicit drug from an individual holding a legitimate prescription for B/N. A high proportion of individuals in the study locations who sought treatment for opioid addiction self-reported the purchase and use of diverted B/N. The diversion of B/N may be minimized by modifying educational, treatment, monitoring, and dispensing practices.
Publication Type
Journal Article.
Date of Publication 2009 Jul
Year of Publication 2009
Issue/Part 3
Volume 28
Page 226-31
OPIOIDS 2009 <659>
Database Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R)
Unique Identifier 20014908
Status MEDLINE
Authors Wang X. Li J. Huang M. Kang L. Hu M.
Authors Full Name Wang, Xue. Li, Jing. Huang, Mingsheng. Kang, Lin. Hu, Min.
Institution
Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
Title
A study on Fu-Yuan Pellet, a traditional chinese medicine formula for detoxification of heroin addictions.
Source
American Journal of Drug & Alcohol Abuse. 35(6):408-11, 2009.
Journal Name
American Journal of Drug & Alcohol Abuse
Country of Publication
England
Abstract
BACKGROUND: Efforts toward researching effective and safe therapies for the treatment of drug addiction and acute heroin withdrawal syndrome remain important objectives in the field of drug addiction. Traditional Chinese medicine (TCM) is viewed as a potential approach to the treatment of drug addiction, and especially to opiate addiction. OBJECTIVES: The objective is to investigate the efficacy and safety of Fu-Yuan Pellet (FYP), a Chinese traditional medicine formula, for the treatment of acute heroin withdrawal syndrome. METHODS: A multicenter, randomized, double-blind, double-dummy, and positive-controlled trial was conducted at 3 drug abuse treatment centers in China. Patients (n = 225) who met a diagnosis of opiate dependence based on DSM IV classification were recruited for this study, ranging in age from 18 to 55 years. Inclusion criteria included a heroin-positive urinalysis, as measured between 8 to 36 hours from last use of heroin, and total withdrawal syndrome scores above 50 before treatment (actual range 65-140). These patients were treated with either FYP or lofexidine in a fixed schedule of doses for 10 days. The total withdrawal syndrome scores and the daily reduction rate were used to measure the effect of FYP vs. lofexidine. RESULTS: Both treatments significantly reduced withdrawal symptoms by day 3, but there was no significant difference overall between lofexidine and FYP in efficacy or safety. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This clinical trial has shown that FYP is effective in the treatment of moderate-to-severe acute heroin withdrawal and has few adverse effects compared to lofexidine. Further study is warranted to determine whether FYP is similar to lofexidine in its potential for reducing stress induced opiate relapse.
Publication Type Journal Article. Multicenter Study. Randomized Controlled Trial.
Date of Publication 2009
Year of Publication 2009
Issue/Part 6