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The study attempts to compare the efficacy of diacetylmorphine as against methadone in the treatment of opioid addiction. The results indicate that injectable diacetylmorphine was found to be more effective as compared to methadone.

This study examined the impact of methadone on drug-using and risky sexual behaviors among 557 heroin injection drug users in one of the first methadone programs in China. Structured questionnaires were administered to collect data on methadone utilization, drug use, and risky sexual behaviors. Blood samples were tested for blood-borne infections. Multivariate logistic analyses revealed that, among opioid-addicted individuals, methadone participants were less likely to use or inject drugs and share needles than nonparticipants. They also were less likely to have multiple sexual partners or have unprotected sex. Those currently enrolled in methadone maintenance had lower risk of using and injecting drugs than those who were no longer receiving methadone. Data suggest positive, short-term impact on these important behaviors, but further studies are needed to examine the long-term impact of methadone treatment on disease rates. Keywords: Heroin; Injection drug use; Methadone maintenance therapy; HIV; China

The different ways of measuring and managing acute pain are discussed. A case study of a 33-year old man with a 4-year history of advanced cancer is used to understand acute pain crisis and suggests that more focus be paid in treatment to the psychological, social and existential needs of patient and family.

Buprenorphine may be used to treat opioid dependence in office-based settings, but treatment models are needed to ensure access to psychosocial services needed by many patients. We describe a novel buprenorphine treatment program colocated with methadone maintenance and outpatient chemical dependency services. We conducted a retrospective chart review of the first 40 consecutive patients initiating buprenorphine treatment in this program to determine characteristics associated with treatment retention. Exclusion criteria were current alcohol or benzodiazepine dependence. Secondary drug users and patients who were psychiatrically or medically ill were included. At 6 months, 60% (n = 24) were retained, 13% (n = 5) tested positive for opiates, and 25% (n = 10) tested positive for secondary substances. Patients who were older (odds ratio [OR] per year of age = 1.1, confidence interval [CI] = 1.0-1.2) and those who were employed (OR = 9.8, CI = 1.8-53.1) were more likely to remain in treatment, but other variables were not associated with retention. Our experience demonstrates that buprenorphine can be successfully integrated into outpatient substance abuse treatment. Keywords: Buprenorphine; Opioid dependence; Methadone; Chemical dependency; Drug users

Twenty of the 24 drug users receiving prescribed injectable methadone from a citywide drug treatment service agreed to participate in a semi-structured interview about their drug use and treatment. Participants reported that they were originally prescribed injectable methadone to replace street purchases because they could not tolerate oral methadone or because of an inability to stop injecting. The experience of injectable methadone was reported as having led to significant improvements in drug use and life stability and reductions in risk behavior, but several participants compared injectable methadone unfavorably to injectable heroin, either in the form of street heroin or prescribed diamorphine. Although a number of the respondents reported sufficient stability to contemplate employment and relationships, few spoke about abstinence as a viable goal in the short-term and many participants reported considerable ambivalence about the experience of receiving injectable methadone prescriptions.

This study tests the feasibility, safety, and short-term preliminary effects of a relapse prevention and relationship safety (RPRS) intervention in reducing drug use and the experience of intimate partner violence (IPV) among women on methadone. For this randomized controlled trial, 34 women who met IPV and drug use criteria were randomly assigned to either the RPRS condition (n = 16) or a one-session informational control (IC) condition (n = 18). RPRS participants were more likely than IC participants to report a decrease in minor physical or sexual IPV (OR = 7.1, p = .05), minor psychological IPV (OR = 5.3, p = .03) and severe psychological IPV (OR = 6.07, p = .03) at the 3-month follow-up. Data suggest that RPRS participants were also more likely than IC participants to report a decrease in any drug use at 3 months (OR = 3.3, p = .08). This study provides preliminary evidence that the RPRS intervention is effective in reducing IPV and drug use among women on methadone. Keywords: intimate partner violence; treatment outcome; methadone maintenance

The clinical and pharmacokinetic data between the opioid agonists methadone and buprenorphine (BUP) and antiretroviral therapies are reviewed which provide an approach to optimal management of interactions in patients with opioid dependence and HIV infection. Certain interactions between methadone and antiretroviral medications are known and may have important clinical consequences.

Methadone and buprenorphine are treatments for heroin-dependent patients. Methadone is available through highly-regulated treatment centers while buprenorphine was approved in 2002 for prescription by certified physicians. Just prior to the approval of buprenorphine, we conducted a random postal survey of 770 physicians in New York City to determine willingness to prescribe methadone or buprenorphine for heroin-dependent patients to be picked up at a pharmacy. Among 247 respondents, 36.3% would consider prescribing methadone and 17.9% were unsure, while 25.8% would consider prescribing buprenorphine and 31.8% were unsure. Willingness to prescribe methadone or buprenorphine was associated with more recent year of licensure (p = 0.044; p = 0.033), working in a hospital or clinic as opposed to an office setting (p = 0.009; p = 0.024), and being the director of a clinic or program (p = 0.031; p = 0.008). This preliminary study suggests that a substantial proportion of New York City physicians would prescribe methadone or buprenorphine to heroin-dependent patients. Keywords: Injection drug user, methadone, buprenorphine, physicians, prescription, INTRODUCTION Methadone, a long-acting opiate agonist, has been utilized as opiate maintenance treatment for almost 40 years in the United States. Barring scientific experiments, methadone treatment for opiate dependence has [...]

Factors predicting 2-year retention in methadone maintenance and the impact of repeat treatment episodes on retention are examined. Higher rates of retention in methadone treatment were found which suggest that repeat episodes may not be much beneficial.

The aging 'baby boomer' population has higher rates of substance use than previous cohorts and is predicted to put increased demands on substance abuse treatment services; however, little is known about older illicit drag abusers. This study compared 41 older (age 50-66 years) and 26 younger (age 25-34 years) opioid maintenance patients on psychiatric, substance use, medical, general health, demographic, and psychosocial characteristics using standardized instruments. The health of both groups was compared to age and sex-matched U.S. population norms. Both groups had high rates of lifetime psychiatric and substance abuse/dependence diagnoses, and poor general health compared to population norms. The older group began using illicit substances significantly later in life, and had significantly more medical problems and worse general health than the younger group. The inevitable increasing medical morbidity and physical limitations of an increasingly large older population with substance use problems will challenge treatment providers and planners. Low rates of positive urine opioid tests occurred for both older and younger patients without age-specific services. Keywords: Opioid maintenance treatment; Age; Methadone; Substance abuse; Medical morbidity

In this study, the authors evaluated a low-cost contingency management (CM) procedure for reducing cocaine use and enhancing group therapy attendance in 77 cocaine-dependent methadone patients. Patients were randomly assigned to 12 weeks of standard treatment or standard treatment with CM, in which patients earned the opportunity to win prizes ranging from $1 to $100 for submitting cocaine-negative samples and attending therapy. Patients in the CM condition submitted more cocaine-negative samples and attended more groups than patients in standard treatment. The best predictor of cocaine abstinence at follow-up was duration of abstinence during treatment. On average, patients in the CM condition earned $117 in prizes. Data from this study suggest that some aspects of reinforcement can be implemented in group therapy in community-based clinics.

This paper explores the impact of the adoption of the contingency management approach by the Chemical Dependency Treatment Services of the New York City Health and Hospitals Corporation (HHC). The utilization of this approach grew out of an alliance between NIDA Clinical Trials Network-affiliated clinicians and researchers and a leadership team at the HHC. Interviews and dialogues with administrators, staff, and patients revealed a shared sense that the use of contingency management had: (1) increased patient motivation for treatment and recovery; (2) facilitated therapeutic progress and goal attainment; (3) improved the attitude and morale of many staff members and administrators; and (4) developed a more collegial and affirming relationship not only between patients and staff, but also among staff members. Keywords: Contingency management; Positive reinforcement; Addiction treatment; Methadone; Vocational rehabilitation

The development of the Client Problem Profile and Index are described, and initial concurrent and predictive validity data are presented for a sample of 547 patients in outpatient methadone treatment. Derived from the TCU Brief Intake for drug treatment admissions, the profile covers 14 problem areas related to drug use (particularly cocaine, heroin/opiate, marijuana, other illegal drugs, and multiple drug use), HIV risks, psychosocial functioning, health, employment, and criminality. Analyses of predictive validity show the profile and its index (number of problem areas) were significantly related to therapeutic engagement, during-treatment performance, and posttreatment follow-up outcomes. Low moderate to high moderate effect sizes were observed in analyses of the index's discrimination.

The goal of this article is to analyze (1) how and why French public policy of care to drug users remained until 1995 a policy primarily curative, devoted only to proven drug addicts, directed toward abstinence, and mobilizing mainly the psychotherapeutic techniques inspired by the psychoanalytical paradigm, whereas the majority of the other European countries, answering to the brutal epidemic of AIDS, had, as of the middle of the eighties, started a palliative policy of risk reduction envisaging, among other measurements, the massive distribution of substitute products such as methadone and (2) how and why France brutally revised its positions, in the middle of the nineties, to adopt a policy of harm reduction and by doing this aligned itself, more or less, with the orientations followed by the other European countries. This analysis led the authors to test some of the political science approaches that stress the role of ideas in policy-making processes.

The aim of this study was to determine treatment adherence relative to frequency of violence and posttraumatic stress disorders (PTSD) among new methadone patients. Ninety-six opiate-abusing patients were evaluated for childhood physical and sexual abuse (CPSA), adulthood exposures to violence (ADVIOL), PTSD, and treatment adherence. Overall, 43% of the subjects dropped out of treatment within 3 months of intake. Occurrence of trauma or PTSD did not predict drop-out rates. A 2 (Gender) x 2 (PTSD) analysis of covariance (ANCOVA) with severity of other drug use on admission as a covariate, however, revealed a main effect for PTSD. F(4, 71) = 7.69, p [is lesser than or equal to] .01, such that those patients with current PTSD revealed significantly more ongoing drug use at 3 months (M = 24.3, SD = 20.9) than those without (M = 8.9, SD = 11.8). Examination of ongoing cocaine use using a 2 (Gender) x 2 (PTSD) ANCOVA also revealed a main effect for PTSD, F(4, 17) = 8.24, p [is lesser than or equal to] .005, such that those patients with current PTSD revealed significantly more ongoing cocaine use at 3 months postadmission (M = 51.6, SD = 37.6) than those without (M = 24.3, SD = 20.9). For both genders, CPSA and ADVIOL were associated with higher rates of PTSD, which in turn predicted poorer treatment adherence as measured by ongoing co-occurring drug abuse 3 months postadmission. Results underscore the need for routine assessment and targeted treatment of trauma in methadone patients.

Greater improvement in posttreatment outcomes has been shown in programs that tailor frequency and type of services to unique client needs. Using a sample of 635 clients (199 females and 436 males) admitted to three community-based methadone treatment programs, this study examined gender differences in services needed and provided during the first 3 months of treatment. Results revealed that compared to males, women entered treatment with more psychological symptoms and AIDS/HIV-risky behaviors; they also presented with less criminal activity, less alcohol use, and higher motivation. Counselors addressed psychological and crisis issues more frequently with women, and counseling strategies were more often directed toward developing problem-solving and communication skills. Counselors also made more medical referrals and reported having better rapport with females. Attention to employment issues and HIV/AIDS sexual-risk behaviors did not differ by gender, even though women had more needs in these areas.

Alliance has been shown to play an important role in treatment of 41 subjects enrolled in 6-month methadone detoxification program. A negative correlation exists between extent of alliance and use of opioids and needle-sharing among individuals. However increased sexual activity was reported in individuals showing greater peer alliance thus putting them at a higher risk of contracting HIV infection.

Few studies have been done on the prevalence of illicit methadone use. Five hundred fifty-nine IV drug users recruited in various ways in Montreal were interviewed concerning their drug use as part of a longitudinal study on HIV infection. Of this number, 133 had heroin as their drug of preference and 426 cocaine. Among the cocaine group, 202 also used heroin. The lifetime prevalence of any illicit methadone use was 59.4% in the heroin group, 26.7% in the cocaine/heroin group, and 3.6% in the cocaine-only group. The 6-month (preceding the interview) prevalence of any illicit use was 42.1%, 6.9%, and 1.3%, respectively, and the prevalence of at least weekly illicit use during that period was 6.3%, 2.0%, and 0%, respectively. The prevalence of illicit methadone use is significant in thepopulation studied. Whether this level of use will be affected by more stringent control on methadone prescription and dispensation remains to be demonstrated. Keywords--methadone; illicit; IV.

To better understand the causes of cocaine abuse among methadone patients, the research compared 207 current cocaine users with 78 currently cocaine-free patients. A majority of both samples were using cocaine at the time of program admission. Although most users ceased or decreased cocaine use after entry, for some this respite was only temporary. Pleasure, stimulation, stress relief and self-medication for depression were the main factors precipitating cocaine use. Most of the current cocaine users held distinctly negative attitudes toward cocaine and were seeking help for their problem. The study makes several recommendations for improved services for cocaine-abusing patients.

Methadone holds promising results in the treatment and rehabilitation of heroin addicts. Careful medical supervision and supporting programs enabled addicts to get into the mainstream of life with no adverse health effects.

Tramadol hydrochloride is a centrally acting analgesic with a partial affinity for the opiate receptor (mu), having an analgesic potency estimated to be one tenth that of morphine. While preclinical investigations suggested that abuse liability associated with tramadol use is low, there are increasing numbers of cases reported to the U.S. Food and Drug Administration of abuse, dependence, and withdrawal associated with tramadol use. A case of a patient with tramadol dependence requiring detoxification with methadone is presented. Acute management of significant tramadol dependence has not yet been reported in the literature. Long-term treatment issues are also discussed. Keywords: Tramadol (Ultram); Detoxification; Methadone; Opiate dependence