New Research on Heroin Dependence
Buprenorphine maintenance: office-based treatment with addiction clinic support.
Ortner R, Jagsch R, Schindler SD, Primorac A, Fischer G, And The General Practitioner Addiction Team A.Eur Addict Res. 2004;10(3):105-11.
Department of General Psychiatry, University Hospital of Vienna, Vienna, Austria.
Introduction: Buprenorphine has already been registered in 27 European countries for maintenance therapy in opioid-dependent patients. In our office-based prescription study we applied sublingual buprenorphine, initiating the treatment at the addiction clinic with subsequent treatment at the offices of general practitioners (GPs) to evaluate its efficacy and feasibility in two different treatment settings.
Methods: Sixty opioid-dependent patients were studied for a period of 15 weeks. The first 3 weeks of treatment initiation took place at the addiction clinic, followed by 12 weeks of treatment by GPs. Mean outcome measures were retention rate and additional consumption of illicit substances in addition to the evaluation of whether buprenorphine can be prescribed successfully by GPs. Results: The retention rate was 57% (n = 34). No significant differences occurred between the treatment phases at the specialized addiction unit and the GPs' offices. During the 15-week period a significant improvement in well-being and a significant reduction in craving for heroin (p < 0.001) and cocaine (p < 0.001) could be calculated for patients stabilized on a mean dose of 16 mg buprenorphine. Furthermore a significant reduction in additional consumption of opioids (p < 0.001) was found. Discussion: Our results show the involvement of office-based prescription, which should further encourage colleagues to treat opioid-dependent subjects with buprenorphine to make more treatment options for this target group available.
Changes in route of drug administration among continuing heroin users: Outcomes 1 year after intake to treatment.
Gossop M, Stewart D, Marsden J, Kidd T, Strang J.Addict Behav. 2004 Aug;29(6):1085-94.
National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8AF, UK.
This study investigates the type and extent of changes in route of drug administration among heroin users after treatment: whether injectors move to other routes of use; whether changes in route for one drug influence routes used for other drugs; and associations between changes in route of administration and other substance use outcomes. The sample comprised 641 heroin users recruited to 54 UK treatment programmes. At intake, the main routes of heroin use were injecting (61%) and "chasing the dragon" (37%). After 1 year, 81% of those using heroin took it by the same route as at intake, while 19% reported a change, with 14% switching from injecting to chasing. Changes from injecting to chasing were associated with improvements in other substance use behaviours. Changes in route represent an important aspect of drug-taking behaviours. Interventions to prevent the change to injecting should be developed and offered to noninjectors. "Reverse transitions" (from injecting to chasing) may represent a useful intermediate treatment goal for drug injectors who cannot achieve abstinence.
Addiction characteristics as prognostic factors in opiate dependence treated with naltrexone.
Madoz-Gurpide A, Barbudo E, Leira M, Navio M, Villoria L, Ochoa E.Actas Esp Psiquiatr. 2004 Jul-Aug;32(4):199-210.
Centro de Salud Mental San Blas, Madrid.Spain.Article in Spanish.
Introduction. Addiction characteristics as prognostic factors in opiate dependence treatment were studied. Thus, several factors related to previous opiate consumption record were considered (current heroin route, amount of heroin, onset age of heroin consumption, time of heroin consumption, other drug consumption record). Objective. To establish the prognostic value of addiction characteristics in a naltrexone program for opiate dependence. Methods. To achieve this objective, an observational, retrospective study was designed with a design of a treatment group with no control group. 945 subjects diagnosed of opiate dependence who were consecutively hospitalized voluntarily in the naltrexone program of the Hospital Ramon y Cajal of Madrid during 1991-1995 form a part of the study population. Descriptive and survival techniques were used to analyze the data. Results. Previous intravenous heroin route, chronic heroin consumption record, onset age of heroin use younger than 17 or older than 25, and other drug consumption especially benzodiazepine and also cocaine provide a prognostic value for a worse outcome. High quantities of heroin consumption also tend to be associated with a poorer evolution. Conclusions. Several addiction characteristics (current previous route, onset age of heroin consumption, quantity of heroin consumption, time of heroin consumption, other drug consumption) have a prognostic value for treatment evolution. Further studies are necessary to provide a more complete knowledge of addiction characteristics as prognosis factors in opiate dependence treatment.
Ortner R, Jagsch R, Schindler SD, Primorac A, Fischer G, And The General Practitioner Addiction Team A.Eur Addict Res. 2004;10(3):105-11.
Department of General Psychiatry, University Hospital of Vienna, Vienna, Austria.
Introduction: Buprenorphine has already been registered in 27 European countries for maintenance therapy in opioid-dependent patients. In our office-based prescription study we applied sublingual buprenorphine, initiating the treatment at the addiction clinic with subsequent treatment at the offices of general practitioners (GPs) to evaluate its efficacy and feasibility in two different treatment settings.
Methods: Sixty opioid-dependent patients were studied for a period of 15 weeks. The first 3 weeks of treatment initiation took place at the addiction clinic, followed by 12 weeks of treatment by GPs. Mean outcome measures were retention rate and additional consumption of illicit substances in addition to the evaluation of whether buprenorphine can be prescribed successfully by GPs. Results: The retention rate was 57% (n = 34). No significant differences occurred between the treatment phases at the specialized addiction unit and the GPs' offices. During the 15-week period a significant improvement in well-being and a significant reduction in craving for heroin (p < 0.001) and cocaine (p < 0.001) could be calculated for patients stabilized on a mean dose of 16 mg buprenorphine. Furthermore a significant reduction in additional consumption of opioids (p < 0.001) was found. Discussion: Our results show the involvement of office-based prescription, which should further encourage colleagues to treat opioid-dependent subjects with buprenorphine to make more treatment options for this target group available.
Changes in route of drug administration among continuing heroin users: Outcomes 1 year after intake to treatment.
Gossop M, Stewart D, Marsden J, Kidd T, Strang J.Addict Behav. 2004 Aug;29(6):1085-94.
National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8AF, UK.
This study investigates the type and extent of changes in route of drug administration among heroin users after treatment: whether injectors move to other routes of use; whether changes in route for one drug influence routes used for other drugs; and associations between changes in route of administration and other substance use outcomes. The sample comprised 641 heroin users recruited to 54 UK treatment programmes. At intake, the main routes of heroin use were injecting (61%) and "chasing the dragon" (37%). After 1 year, 81% of those using heroin took it by the same route as at intake, while 19% reported a change, with 14% switching from injecting to chasing. Changes from injecting to chasing were associated with improvements in other substance use behaviours. Changes in route represent an important aspect of drug-taking behaviours. Interventions to prevent the change to injecting should be developed and offered to noninjectors. "Reverse transitions" (from injecting to chasing) may represent a useful intermediate treatment goal for drug injectors who cannot achieve abstinence.
Addiction characteristics as prognostic factors in opiate dependence treated with naltrexone.
Madoz-Gurpide A, Barbudo E, Leira M, Navio M, Villoria L, Ochoa E.Actas Esp Psiquiatr. 2004 Jul-Aug;32(4):199-210.
Centro de Salud Mental San Blas, Madrid.Spain.Article in Spanish.
Introduction. Addiction characteristics as prognostic factors in opiate dependence treatment were studied. Thus, several factors related to previous opiate consumption record were considered (current heroin route, amount of heroin, onset age of heroin consumption, time of heroin consumption, other drug consumption record). Objective. To establish the prognostic value of addiction characteristics in a naltrexone program for opiate dependence. Methods. To achieve this objective, an observational, retrospective study was designed with a design of a treatment group with no control group. 945 subjects diagnosed of opiate dependence who were consecutively hospitalized voluntarily in the naltrexone program of the Hospital Ramon y Cajal of Madrid during 1991-1995 form a part of the study population. Descriptive and survival techniques were used to analyze the data. Results. Previous intravenous heroin route, chronic heroin consumption record, onset age of heroin use younger than 17 or older than 25, and other drug consumption especially benzodiazepine and also cocaine provide a prognostic value for a worse outcome. High quantities of heroin consumption also tend to be associated with a poorer evolution. Conclusions. Several addiction characteristics (current previous route, onset age of heroin consumption, quantity of heroin consumption, time of heroin consumption, other drug consumption) have a prognostic value for treatment evolution. Further studies are necessary to provide a more complete knowledge of addiction characteristics as prognosis factors in opiate dependence treatment.