PubMed Health⌕ Search

Biomedical subjects

Alex Wodak

Publications and source records attributed to Alex Wodak.

27 records · Page 2Linked to original sources
PubMed2003

Pilot randomized double blind placebo-controlled study of dexamphetamine for cocaine dependence.

AIMS: To establish the feasibility of conducting a placebo-controlled clinical trial of dexamphetamine replacement therapy for cocaine dependence and to obtain preliminary data. DESIGN: Double-blind randomized placebo-controlled trial. PARTICIPANTS: Thirty cocaine-dependent injecting drug users. INTERVENTION: Subjects were assigned randomly to receive 60 mg/day dexamphetamine (n = 16) or placebo (n = 14) for 14 weeks. MEASUREMENTS: Immunoassay and mass spectrometric techniques were used to identify cocaine metabolites in urine. Subjects were screened using the Composite International Diagnostic Interview and DSM-IV. The Opiate Treatment Index, Brief Symptom Inventory, Severity of Dependence Scale and visual analogue craving scales were used to collect pre- and post-self-report data. FINDINGS: Treatment retention was equivalent between groups; however, outcomes favoured the treatment group with no improvements observed in the placebo control group. The proportion of cocaine-positive urine samples detected in the treatment group declined from 94% to 56% compared to no change in the placebo group (79% positive). While the improvements were not significant between groups, within-group analysis revealed that the treatment group reduced self-reported cocaine use (P = 0.02), reduced criminal activity (P = 0.04), reduced cravings (P < 0.01) and reduced severity of cocaine dependence (P < 0.01) with no within-group improvements found in the placebo group. CONCLUSIONS: A definitive evaluation of the utility of dexamphetamine in the management of cocaine dependence is feasible and warranted.

Adult↗
PubMed2003

Modelling hepatitis C virus incidence, prevalence and long-term sequelae in Australia, 2001.

BACKGROUND: To plan an appropriate public health response to the hepatitis C virus (HCV) epidemic requires that estimates of HCV incidence and prevalence, and projections of the long-term sequelae of infection, are as accurate as possible. In this paper, mathematical models are used to synthesize data on the epidemiology and natural history of HCV in Australia to estimate HCV incidence and prevalence in Australia to end 2001, and project future trends in the long-term sequelae of HCV infection. METHODS: Mathematical models of the HCV epidemic in Australia were developed based on estimates of the pattern of injecting drug use. Estimates of HCV infections due to injecting drug use were then adjusted to allow for HCV infections resulting from other transmission routes. Projections of the long-term sequelae of HCV infection were obtained by combining modelled HCV incidence with estimates of the progression rates to these outcomes. RESULTS: It was estimated that there were 210 000 (lower and upper limits of 157 000 and 252 000) people in Australia living with HCV antibodies at the end of 2001, with HCV incidence in 2001 estimated to be 16 000 (11 000-19 000). It was estimated that 6500 (5000-8000) people were living with HCV-related cirrhosis in 2001, that 175 (130-210) people developed HCV-associated liver failure, and that there were 50 (40-60) incident cases of HCV-related hepatocellular carcinoma (HCC). It was estimated that in 2001 22 500 quality adjusted life years were lost to chronic HCV infection, the majority (77%) in people with early (stage 0/1) liver disease. DISCUSSION: Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.

Australia↗
PubMed2002

Methadone and heroin prescription: babies and bath water.

Criticism of methadone treatment abounds in all countries where this intervention is available. Although such criticism is often justified, it is critical to recognize that methadone is the most effective, safe, and cost-effective intervention available, is supported by innumerable studies, and provides considerable benefit to drug users, their families and communities. The major causes of the pervasive deficiencies of methadone treatment is the severe and consistent under-funding and hostile environment, both inevitable by-products of the global commitment over recent decades to an expensive, ineffective, and often counter-productive drug policy overly reliant on supply reduction. Methadone treatment is often criticized by drug war supporters not because of its limitations, but because its very effectiveness highlights the meagre benefits of supply reduction. The compelling arguments to expand pharmacotherapies for heroin dependence by rigorously evaluating prescription heroin treatment should not be based on the real or perceived deficiencies of methadone treatment. Rather, these arguments should be based on the need to provide evidence-based treatment for drug users which has the capacity, range of options, and quality expected in other health care services. The paramount aim should be to improve the current deplorable rates of death, disease, crime, and severe distress now evident in an increasing number of countries.

Attitude↗