OPIOIDS 2006<516>
Database EMBASE
Accession Number 2006491540
Authors Haasen C. Van Den Brink W.
Institution
(Haasen) Department of Psychiatry, UniversityMedicalCenter Eppendorf, Center for Interdisciplinary Addiction Research, Hamburg, Germany.
(Van Den Brink) University of Amsterdam, Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam, Netherlands.
(Haasen) Department of Psychiatry, UniversityMedicalCenter Eppendorf, Martinistr. 52, Hamburg, Germany.
Country of Publication
United Kingdom
Title
Innovations in agonist maintenance treatment of opioid-dependent patients.
Source
Current Opinion in Psychiatry. 19(6)(pp 631-636), 2006. Date of Publication: Nov 2006.
Abstract
PURPOSE OF REVIEW: To provide an overview of published studies on agonist maintenance treatment options for opioid-dependent patients. RECENT FINDINGS: The recent publication of controlled trials confirms earlier clinical evidence of the efficacy of diamorphine (heroin) in the treatment of opioid dependence. Findings show not only efficacy with respect to improvement of health, reduction of illicit drug use, reduction of criminality and stabilization of social conditions, but also cost effectiveness in the treatment of chronic treatment-resistant heroin addicts. SUMMARY: Agonist maintenance treatment has become the first-line treatment for chronic opioid dependence. High-quality studies demonstrate the effectiveness of a growing number of different agonist maintenance treatments for opioid dependence such as methadone and buprenorphine. In addition, there is new evidence for the effectiveness of other agonists, mainly slow-release morphine, intravenous and inhalable diamorphine and possibly oral diamorphine. Maintenance treatment with intravenous or inhalable diamorphine should be implemented into the healthcare system to treat a group of severely dependent treatment-resistant patients. Furthermore, the opioid-dependent patients not under treatment need to be engaged in maintenance treatments through other harm reduction measures. Agonist maintenance treatment is very effective in stabilizing the health condition and social situation, while also reducing harm, thereby increasing life expectancy and quality of life. copyright 2006 Lippincott Williams & Wilkins, Inc.
ISSN 0951-7367
Publication Type Journal: Review
Journal Name Current Opinion in Psychiatry
Volume 19
Issue Part 6
Page 631-636
Year of Publication 2006
Date of Publication Nov 2006
OPIOIDS 2006<529>
Database EMBASE
Accession Number 2006471473
Authors Bhamb B. Brown D. Hariharan J. Anderson J. Balousek S. Fleming M.F.
Institution
(Bhamb, Brown, Anderson, Balousek, Fleming) University of Wisconsin, Madison, WI, United States.
(Hariharan) Medical College of Wisconsin, Milwaukee, WI, United States.
(Bhamb) Department of Family Medicine, 777 South Mills St, Madison, WI53715, United States.
Country of Publication
United Kingdom
Title
Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain.
Source
Current Medical Research and Opinion. 22(9)(pp 1859-1865), 2006. Date of Publication: Sep 2006.
Abstract
Objective: To assess the use of opioids by primary care physicians for the treatment of chronic pain. Methods: A written survey was completed by 248 primary care physicians. Outcomes of interest included type of opioids prescribed, common pain diagnoses treated, opioid prescribing concerns, treatment of patients with a history of substance use disorders and clinic-based protocols for pain management. Results: The mean age of the physicians who completed the questionnaire was 41 years. The majority were between the ages of 30 and 49 years (68%) with an equal number of men and women. Seventy percent were family physicians, 28.7% internists and less than 2% were community physicians and geriatricians. Physician concerns regarding opioid therapy included prescription drug abuse (84.2%), addiction (74.9%), adverse effects (68%), tolerance (60.7%), and medication interaction (32%). The survey found that the majority of the physicians were comfortable in prescribing narcotics to patients with terminal cancer. However, they were less comfortable prescribing narcotics to patients with low back pain and persons with a current or past history of drug or alcohol abuse. Physician management practices suggested that urine toxicology tests were under-utilized with only 6.9% reporting obtaining this test before prescribing opioids and only 15.0% performing urine toxicology tests on patients already prescribed opioids. Logistic regression analysis revealed that whether or not physicians routinely conducted urine toxicology screens was significantly (p = 0.015) predicted by whether they had a system to track patients on opioids when prescribing narcotics. The primary limitation of the study is the reliance on physician self-report rather than objective measures of physician behavior. Conclusions: The survey suggests physicians are concerned about drug abuse, addiction, adverse effects, tolerance, and medication interaction. Their comfort level in prescribing opioids varies with the patient characteristics. Urine toxicology testing is underutilized in the primary care setting. copyright 2006 Librapharm Limited.
ISSN 0300-7995
Publication Type Journal: Review
Journal Name Current Medical Research and Opinion
Volume 22
Issue Part 9
Page 1859-1865
Year of Publication 2006
Date of Publication Sep 2006
OPIOIDS 2006<533>
Database EMBASE
Accession Number 2006468594
Authors Shi J. Liu Y.-L. Fang Y.-X. Xu G.-Z. Zhai H.-F. Lu L.
Institution
(Shi, Xu, Zhai, Lu) National Institute on Drug Dependence, PekingUniversity, Beijing 100083, China.
(Liu) College of Pharmacy, SoochowUniversity, Suzhou 215123, China.
(Fang) Clinical Pharmacology and Therapeutics Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States.
(Lu) Behavioral Neuroscience Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States.
Country of Publication
United Kingdom
Title
Traditional Chinese medicine in treatment of opiate addiction.
Source
Acta Pharmacologica Sinica. 27(10)(pp 1303-1308), 2006. Date of Publication: Oct 2006.
Abstract
Traditional Chinese medicine (TCM) includes Chinese medicine and acupuncture. Chinese medicine consists of natural products including plants, animals and minerals. TCM has been practiced in China for more than 2000 years, and for the past 200 years has been used in treatment of drug addiction. Ten Chinese medicines for the treatment of opiate addiction have been approved by the Chinese State Food and Drug Administration (SFDA), and at least 6 are in clinical trials. The general therapeutic principle of Chinese medicine developed was based on its unique theory of "reinforcing healthy Qi and resolving and removing effects of toxicity". Acupuncture, another essential part of TCM, which was developed based on the principle that "functions of the human body are controlled by the 'Jing-Luo' and 'Qi-Xue' system", has been used not only in China, but also in Europe, the USA and other countries, for controlling opiate addiction. There are some advantages in using TCM for opiate detoxification, including less harmful side effects, high safety and ideal effects in the inhibition of protracted withdrawal symptoms and relapse. Co-administration of TCM with modern medicine shows some synergistic effects in detoxification. Many TCM for detoxification also have efficacy in the rehabilitation of abnormal body functions induced by chronic drug use, including improving immune function, increasing working memory and preventing neurological disorder. Given that TCM is effective in the prevention of relapse and causes fewer side effects, it may be used widely in the treatment of opiate addiction. copyright2006 CPS and SIMM.
ISSN 1671-4083
Publication Type Journal: Review
Journal Name Acta Pharmacologica Sinica
Volume 27
Issue Part 10
Page 1303-1308
Year of Publication 2006
Date of Publication Oct 2006
OPIOIDS 2006<546>
Database EMBASE
Accession Number 2006448488
Authors Wang X. Xin H. Liu Y. Wang Y. Zheng H. Jiang Z. Wan C. Wang Z. Ding J.M.
Institution
(Wang, Wang, Liu, Wang, Zheng, Jiang, Wan, Wang) West China Medical Center, Sichuan University, Chengdu, Sichuan 610041, China.
(Wang, Wang, Liu, Wang, Zheng, Jiang, Wan, Wang) National Laboratory of Biotherapy and Chronobiology, Public Health Department of China, China.
(Xin) School of Physics, Sichuan University, Chengdu, Sichuan, China.
(Wang, Ding) Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
Country of Publication
United Kingdom
Title
Altered expression of circadian clock gene, mPer1, in mouse brain and kidney under morphine dependence and withdrawal.
Source
Journal of Circadian Rhythms. 4, 2006. Article Number: 9. Date of Publication: 22 Aug 2006.
Abstract
Every physiological function in the human body exhibits some form of circadian rhythmicity. Under pathological conditions, however, circadian rhythmicity may be dusrupted. Patients infected with HIV or addicted to drugs of abuse often suffer from sleep disorders and altered circadian rhythms. Early studies in Drosophila suggested that drug seeking behavior might be related to the expression of certain circadian clock genes. Our previous research showed that conditioned place preference with morphine treatment was altered in mice lacking the Period-1 (mPer1) circadian clock gene. Thus, we sought to investigate whether morphine treatment could alter the expression of mPer1, especially in brain regions outside the SCN and in peripheral tissues. Our results using Western blot analysis showed that the mPER1 immunoreactivity exhibited a strong circadian rhythm in the brains of the control (Con), morphine-dependent (MD), and morphine-withdrawal (MW) mice. However, the phase of the circadian rhythm of mPER1 expression in the brains of MD mice significantly differed from that of the Con mice (p<0.05). In contrast to mPER1 expression in the brain, the circadian rhythm of mPER1 immunoreactivity in the kidneys was abolished after morphine administration, whereas the Con mice maintained robust circadian rhythmicity of mPER1 in the kidney. Therefore, the effect of morphine on the circadian clock gene mPer1 may vary among different organs, resulting in desynchronization of circadian function between the SCN and peripheral organs. copyright 2006 Wang et al; licensee BioMed Central Ltd.
ISSN 1740-3391
Publication Type Journal: Article
Journal Name Journal of Circadian Rhythms
Volume 4
Year of Publication 2006
Date of Publication 22 Aug 2006
OPIOIDS 2006<575>
Database EMBASE
Accession Number 2006436266
Authors Dunn J. Robertson D. Davis P. Khosrawan B. Christian S.
Institution
(Dunn) Camden and Islington Mental Health and Social Care Trust, 457 Finchley Road, LondonNW3 6HN, United Kingdom.
(Robertson, Christian) South Camden Drug Service, Margarete Centre, London, United Kingdom.
(Davis) Department of Psychology, Camden and Islington Substance Misuse Services, Margarete Centre, London, United Kingdom.
(Khosrawan) North Camden Drug Service, London, United Kingdom.
Country of Publication
United Kingdom
Title
Setting up a methadone maintenance clinic in a hostel in London's West End.
Source
Psychiatric Bulletin. 30(9)(pp 337-339), 2006. Date of Publication: Sep 2006.
Abstract
Aims and method: A satellite methadone prescribing service was set up in a hostel in London's West End. The aim was to investigate if it were feasible to engage and retain these hard-to-reach, chaotic, polydrug users in treatment. A basic needs assessment was undertaken with staff and clients at the hostel. Treatment outcomes were assessed at 16 weeks using the Maudsley Addiction Profile. Results: At 16 weeks 87% of the original cohort (26 out of 30) were still in treatment. There were also significant reductions in mean heroin use (from 29.7 to 14.5 out of the past 30 days, P<0.001) and in the frequency of injecting (from 25.9 to 15.9 days, P < 0.001). Clinical implications: This outreach clinic offers a model for developing services to homeless people with substance misuse problems.
ISSN 0955-6036
Publication Type Journal: Article
Journal Name Psychiatric Bulletin
Volume 30
Issue Part 9
Page 337-339
Year of Publication 2006
Date of Publication Sep 2006
OPIOIDS 2006<582>
Database EMBASE
Accession Number 2006422743
Authors Newman R.G.
Institution
(Newman) The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, Yeshiva University, 555 West 57th Street, New York, NY 10019, United States.
Country of Publication
United Kingdom
Title
Expansion of opiate agonist treatment: An historical perspective.
Source
Harm Reduction Journal. 3, 2006. Article Number: 20. Date of Publication: 21 Jul 2006.
Abstract
Untreated opiate addiction remains a major health care crisis in New York and in most other urban centers in America. Optimism for closing the gap between need and demand for treatment and its availability has greeted the recent approval of a new opiate medication for addiction, buprenorphine - which unlike methadone may be prescribed by independent, office-based practitioners. The likelihood of buprenorphine fulfilling its potential is assessed in the light of the massive expansion of methadone treatment more than 30 years earlier. It is concluded that the key, indispensable ingredient of success will be true commitment on the part of Government to provide care to all those who need it. copyright 2006 Newman; licensee BioMed Central Ltd.
ISSN 1477-7517
Publication Type Journal: Article
Journal Name Harm Reduction Journal
Volume 3
Year of Publication 2006
Date of Publication 21 Jul 2006
OPIOIDS 2006<583>
Database EMBASE
Accession Number 2006422644
Authors Small D. Drucker E.
Institution
(Small) PHS Community Services Society, 20 West Hastings Street, Vancouver, BCV6B 1G6, Canada.
(Small) Department of Anthropology and Sociology, University of British Columbia, Vancouver, BCV6T 1Z1, Canada.
(Drucker) MontefioreMedicalCenter, AlbertEinsteinCollege of Medicine, Bronx, NY10467, United States.
Country of Publication
United Kingdom
Title
Policy makers ignoring science and scientists ignoring policy: The medical ethical challenges of heroin treatment.
Source
Harm Reduction Journal. 3, 2006. Article Number: 16. Date of Publication: 02 May 2006.
Abstract
A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear - and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify. copyright 2006 Small et al; licensee BioMed Central Ltd.
ISSN 1477-7517
Publication Type Journal: Review
Journal Name Harm Reduction Journal
Volume 3
Year of Publication 2006
Date of Publication 02 May 2006
OPIOIDS 2006<584>
Database EMBASE
Accession Number 2006420816
Authors Gowing L.R. Ali R.L.
Institution
(Gowing, Ali) Drug and Alcohol Services South Australia, Adelaide, SA, Australia.
(Gowing, Ali) University of Adelaide, Adelaide, SA, Australia.
(Gowing) Discipline of Pharmacology, MedicalSchool, University of Adelaide, Adelaide, SA 5005, Australia.
Country of Publication
United Kingdom
Title
The place of detoxification in treatment of opioid dependence.
Source
Current Opinion in Psychiatry. 19(3)(pp 266-270), 2006. Date of Publication: May 2006.
Abstract
PURPOSE OF REVIEW: This review summarizes current research on the management of opioid withdrawal and considers the selection of the approach in different situations. RECENT FINDINGS: The recent publication of three controlled trials makes firm conclusions about the relative effectiveness of newer approaches (antagonist-induced withdrawal under anaesthesia or with minimal sedation; buprenorphine) to the management of opioid withdrawal possible. SUMMARY: Antagonist-induced withdrawal under anaesthesia should not be pursued as it has an increased risk of life-threatening adverse events and has no additional benefits relative to antagonist-induced withdrawal under minimal sedation. Antagonist-induced withdrawal with minimal sedation is feasible and may be suitable for those who intend to enter antagonist-maintenance treatment with a clear commitment to abstinence and good support. Buprenorphine is suitable for quick withdrawal, supports transition to naltrexone maintenance treatment, is safe and effective in outpatient settings and can be extended into maintenance treatment if the detoxification attempt is unsuccessful. Adrenergic agonists (clonidine and lofexidine) remain an effective option for those who do not want to use an opioid and do not intend to transfer to naltrexone maintenance treatment, with lofexidine being preferable for outpatient settings. Through appropriate choice of approach, detoxification can be a gateway to multiple, long-term treatment options. copyright 2006 Lippincott Williams & Wilkins.
ISSN 0951-7367
Publication Type Journal: Review
Journal Name Current Opinion in Psychiatry
Volume 19
Issue Part 3
Page 266-270
Year of Publication 2006
Date of Publication May 2006
OPIOIDS 2006<587>
Database EMBASE
Accession Number 2006418341
Authors Doran C.M. Shanahan M. Digiusto E. O'Brien S. Mattick R.P.
Institution
(Doran) University of Queensland, School of Population Health, Herston Road, Herston, QLD 4006, Australia.
(Shanahan, O'Brien, Mattick) University of New South Wales, National Drug and Alcohol Research Centre, Sydney, NSW 2052, Australia.