PubMed Health⌕ Search

Biomedical subjects

E C Strain

Publications and source records attributed to E C Strain.

At least 37 records · Page 2Linked to original sources
PubMed1995

Buprenorphine treatment of opioid dependence: clinical trial of daily versus alternate-day dosing.

Buprenorphine, a mu-opioid partial agonist, has demonstrated efficacy for the treatment of opioid dependence comparable to that of methadone. The clinical utility of buprenorphine would be enhanced if it could be dosed on a less than daily basis. The current study is a parallel-group outpatient clinical trial of daily versus alternate-day dosing with 8 mg sublingual (s.l.) buprenorphine. Participants were randomly assigned to daily (n = 51) or alternate-day (n = 48) schedules of active medication administration for an 11-week double-blind trial. Patients assigned to alternate-day buprenorphine received placebo every other day. Primary outcome measures were retention in treatment and urine specimens positive for opiates. Clinic attendance, dose adequacy ratings, withdrawal symptomatology, and urine specimens positive for cocaine were secondary outcome measures. Neither endpoint analysis with the intent-to-treat sample nor time course analysis with treatment completers revealed any statistically significant differences between the dosing schedules on any outcome measure. Examination of 95% confidence intervals suggested a non-significant trend for the daily dosing schedule to have superior clinical efficacy at the dose tested. Nevertheless, these results are generally consistent with previous studies of less than daily dosing with buprenorphine and support the conclusion that an alternate-day dosing schedule can be effective in and acceptable to a substantial portion of patients.

Adult↗
PubMed1995

Buprenorphine effects in methadone-maintained volunteers: effects at two hours after methadone.

Buprenorphine is an opioid partial agonist being developed for possible use in the treatment of opioid dependence. In a previous study up to 8 mg of buprenorphine administered 20 hr after a daily dose of methadone in methadone-maintained volunteers produced neither agonist-like nor antagonist-like effects. The purpose of this study was to examine the effects of buprenorphine challenges given 2 hr after a daily methadone dose in maintained volunteers. Seven male volunteers maintained on 30 mg of methadone daily underwent pharmacologic challenges two to three times per week. Medication challenges consisted of double-blind i.m. injections of buprenorphine (0.5-8.0 mg), the opioid antagonist naloxone (0.1 and 0.2 mg), the prototypic opioid mu agonist hydromorphone (5 and 10 mg) or saline. Assessments of physiologic measures, volunteers' self-reports and observer ratings of drug effects were collected in a laboratory session for 2 hr after drug administration, and then for 8 additional hr postsession. Results from the laboratory session showed that on subject and observer ratings naloxone produced typical antagonist-like effects, hydromorphone produced mild agonist-like effects and buprenorphine produced antagonist-like effects. Interestingly, buprenorphine's antagonist activity was not directly dose-related; its most prominent antagonist effects occurred at the 1- and 2-mg doses. These results are consistent with buprenorphine's action as a partial mu opioid agonist and demonstrate that antagonist-like effects can occur under some conditions suggesting buprenorphine should have a low abuse liability in methadone-maintained patients.

Adult↗
PubMed1994

Caffeine dependence syndrome. Evidence from case histories and experimental evaluations.

OBJECTIVE: The extent to which daily caffeine use is associated with a substance dependence syndrome similar to that associated with other psychoactive drugs is unknown. The purpose of this study was to assess volunteers who reported problems with their use of caffeine for evidence suggesting a diagnosis of caffeine dependence based on the generic criteria for substance dependence from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). DESIGN: Case-series evaluations. SETTING: An academic research center. PARTICIPANTS: Self-identified adults who believed they were psychologically or physically dependent on caffeine. MAIN OUTCOME MEASURE: Diagnoses made by a psychiatrist using a structured clinical interview that included a section on caffeine dependence based on genetic criteria for DSM-IV substance dependence. SECONDARY OUTCOME MEASURE: Double-blind caffeine-withdrawal evaluation. RESULTS: Ninety-nine subjects were screened for the study, and 16 were identified as having a diagnosis of caffeine dependence. Median daily caffeine intake was 357 mg, and 19% of subjects consumed less than the national (US) daily average of caffeine. Criteria used for making diagnoses (and rates of their prevalence) were as follows: withdrawal (94%), use continued despite knowledge of a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by caffeine use (94%), persistent desire or unsuccessful efforts to cut down or control use (81%), and tolerance (75%). Eleven subjects underwent the double-blind caffeine-withdrawal evaluation portion of the study, and nine (82%) of the 11 showed objective evidence of caffeine withdrawal, including eight of 11 with functional impairment. CONCLUSIONS: These results, together with other experimental evidence, suggest that caffeine exhibits the features of a typical psychoactive substance of dependence. It is valuable to recognize caffeine dependence as a clinical syndrome, since some people feel compelled to continue caffeine use despite desires and recommendations to the contrary.

Adult↗
PubMed1994

Buprenorphine versus methadone in the treatment of opioid-dependent cocaine users.

This study compared the efficacy of buprenorphine to methadone for decreasing cocaine use in patients with combined opioid and cocaine use. Participants (n = 51) were enrolled in a 26-week treatment program and randomly assigned to either buprenorphine or methadone. Dosing was double-blind and double-dummy. Patients were stabilized on either 8 mg sublingual buprenorphine or 50 mg oral methadone, with dose increases given in response to continued illicit cocaine use or opioid use through week 16 of treatment. Maximum doses possible were 16 mg buprenorphine and 90 mg methadone. Average doses achieved were 11.2 mg buprenorphine and 66.6 mg methadone; 49% of the patients received the maximum doses possible. Urine samples were collected three times per week, and there was no significant difference in the rate of cocaine positive urines for the intent-to-treat sample (69% for buprenorphine versus 63% for methadone). For patients who remained in treatment through the flexible dosing period (n = 28), there were significant decreases in cocaine positive urines over time (P < 0.01), but no significant differences between groups or group x time effects. Buprenorphine and methadone were equally effective on measures of treatment retention, urine results for opioids, and compliance with attendance and counseling. These results demonstrate no selective efficacy of either buprenorphine or methadone in attenuating cocaine use in this population, but do provide further support for the equivalent efficacy of buprenorphine and methadone in the treatment of opioid dependence.

Adolescent↗
PubMed1994

Outcome after methadone treatment: influence of prior treatment factors and current treatment status.

Post-treatment follow-up assessments were conducted on patients from a clinical trial examining the efficacy of different doses of methadone. The Addiction Severity Index (ASI) was administered at treatment entry and ten weeks after the six-month program. Patients were improved in drug and alcohol use, and in areas of pro-social behaviors, at the time of follow-up. Improvements were not related to in-treatment variables, but were related to resumption of treatment during the follow-up interval. These results demonstrate improvement persists after methadone treatment, and further improvement can be achieved by resumption of further treatment.

Adult↗
PubMed1994

Comparison of buprenorphine and methadone in the treatment of opioid dependence.

OBJECTIVE: This study compared the efficacy of buprenorphine and methadone in the treatment of opioid dependence. METHOD: Participants (N = 164) were relatively treatment-naive, opioid-dependent applicants to a 26-week treatment program who were randomly assigned to either methadone or buprenorphine treatment. Dosing was double-blind and double-dummy. Patients were stabilized on a regimen of either methadone, 50 mg, or buprenorphine, 8 mg, with dose changes possible through week 16 of treatment. Urine samples were collected three times a week, and weekly counseling was provided. RESULTS: Buprenorphine (mean dose = 8.9 mg/day) and methadone (mean dose = 54 mg/day) were equally effective in sustaining retention in treatment, compliance with medication, and counseling regimens. In both groups, 56% of patients remained in treatment through the 16-week flexible dosing period. Overall opioid-positive urine sample rates were 55% and 47% for buprenorphine and methadone groups, respectively; cocaine-positive urine sample rates were 70% and 58%. Evidence was obtained for the effectiveness of dose increases in suppressing opioid, but not cocaine, use among those who received dose increases. CONCLUSIONS: The results of this study provide further support for the utility of buprenorphine as a new medication in the treatment of opioid dependence and demonstrate efficacy equivalent to that of methadone when used during a clinically guided flexible dosing procedure.

Administration, Oral↗
PubMed1993

Dose-response effects of methadone in the treatment of opioid dependence.

OBJECTIVE: To compare the dose effectiveness of low to moderate doses of methadone in a sample of a contemporary population of opioid abusers, because the optimal dosing of methadone in the treatment of opioid dependence remains an issue. DESIGN: A randomized, double-blind, placebo-controlled study. SETTING: A methadone treatment research clinic. PATIENTS: Participants (n = 247) were opioid-dependent patients with a high rate of cocaine use. INTERVENTION: All participants were initially treated with active methadone for a minimum of 5 weeks and then received 15 weeks of stable dosing at 50, 20, or 0 mg per day. Individual counseling and group therapy were included. MEASUREMENTS: Treatment retention and illicit drug use as determined by intensive urine monitoring. RESULTS: Retention was better for patients who remained on active medication. By treatment week 20, retention was 52.4% for the 50-mg, 41.5% for the 20-mg, and 21.0% for the 0-mg group (50 versus 0 and 20 versus 0, P < 0.05; 50 versus 20, P > 0.05). Only the 50-mg treatment group had a reduced rate of opioid-positive urine samples (56.4% versus 67.6% and 73.6% for the 20-mg and 0-mg groups, respectively; P < 0.05) and cocaine-positive urine samples (52.6% versus 62.4% and 67.1% for the 20- and 0-mg groups, respectively; P < 0.05). CONCLUSIONS: There is a dose-response effect for methadone treatment. Doses as low as 20 mg may improve retention but are inadequate for suppressing illicit drug use.

Adult↗
PubMed1993

Methadone dose and treatment outcome.

Consensus on the optimal dosing of methadone in the treatment of opioid dependence has not yet been achieved, with some programs committed to low dose regimens. This paper presents outcome results for 95 opioid abusers who remained in treatment through a stable dosing period in a double-blind fixed dose clinical trial comparing the relative efficacies of 50 (n = 44) and 20 mg (n = 34) of methadone to methadone-free treatment (n = 17). All patients showed improvements over time on measures of psychosocial functioning and psychological symptoms, emphasizing the important role of non-pharmacologic factors in methadone treatment. Furthermore, orderly dose effect relationships were seen, with patients receiving 50 mg of methadone having significantly lower rates of opioid positive urines (36% vs. 60-73%), and self-reporting a lower frequency of heroin use (3 days vs. 11-12 days per month). These results illustrate the dose-related efficacy of methadone in decreasing illicit opioid use and improving drug-related behavior.

Adolescent↗
PubMed1993

Precipitated withdrawal by pentazocine in methadone-maintained volunteers.

Pentazocine is a partial mu agonist opioid with one-half to one-sixth the parenteral analgesic potency of morphine. The purpose of this study was to characterize the effects of pentazocine in comparison to naloxone (an opioid antagonist), hydromorphone (an opioid mu agonist) and saline in methadone-dependent volunteers by using the same experimental methods used previously in the study of the opioid analgesics buprenorphine, butorphanol and nalbuphine. In a residential laboratory, five volunteer male opioid abusers, maintained on 30 mg p.o. of methadone daily, underwent pharmacological challenges 2 to 3 times per week. Pharmacological challenges consisted of a double-blind i.m. injection of: pentazocine (dose range 7.5-120 mg), hydromorphone (5 and 10 mg), naloxone (0.1 and 0.2 mg) or saline. Injections were given 20 hr after the last dose of methadone. Measures included physiological indices and self-reports and observer ratings of drug effects. Naloxone and hydromorphone produced characteristic antagonist-like and agonist-like effects, respectively, on subjective, observer and physiological indices. Pentazocine produced primarily antagonist-like effects, with higher doses (> = 60 mg) producing significant elevations of visual analog scale ratings of Drug Effects, Bad Effects and Sick; of observer ratings of piloerection, restlessness and adjective scores of opioid withdrawal; as well as increases in blood pressure, heart rate and pupil diameter and decreases in skin temperature. Similar to the previous study of butorphanol, the specific profile of effects produced by pentazocine differed from that produced by naloxone, suggesting non-mu effects may modulate the mu effects of pentazocine.

Adult↗
PubMed1992

Withdrawal syndrome after the double-blind cessation of caffeine consumption.

BACKGROUND: People who stop consuming caffeine may have symptoms, but the incidence and severity of caffeine withdrawal are not known. This study was performed to determine the effects in the general population of ending one's dietary intake of caffeine. METHODS: We studied 62 normal adults whose intake of caffeine was low to moderate (mean amount, 235 mg--the equivalent of 2.5 cups of coffee--per day). They completed questionnaires about symptoms and tests of their mood and performance when consuming their normal diets (base-line period) and at the end of each of two two-day periods during which they consumed caffeine-free diets and under double-blind conditions received capsules containing placebo (placebo period) or caffeine (caffeine period) in amounts equal to their daily caffeine consumption. RESULTS: More subjects had abnormally high Beck Depression Inventory scores (11 percent), high scores on the trait scale of the State-Trait Anxiety Inventory (8 percent), low vigor scores (11 percent) and high fatigue scores (8 percent) on the Profile of Mood States, and moderate or severe headache (52 percent) during the placebo period than during either the base-line period (2, 0, 0, 0, and 2 percent, respectively; P less than 0.05) or the caffeine period (3, 2, 2, 0, and 6 percent; P less than 0.05). More subjects reported unauthorized use of medications during the placebo period (13 percent) than during the caffeine period (2 percent, P = 0.017). Performance of a tapping task was slower during the placebo period than during the base-line and caffeine periods (P less than 0.01). CONCLUSIONS: Persons who consume low or moderate amounts of caffeine may have a withdrawal syndrome after their daily consumption of caffeine ceases.

Adult↗
PubMed1992

Acute effects of buprenorphine, hydromorphone and naloxone in methadone-maintained volunteers.

Buprenorphine is an opioid agonist-antagonist being evaluated for treatment of opioid dependence. This study characterized the effects of buprenorphine in comparison to naloxone, hydromorphone and saline, in methadone-dependent volunteers. In a residential laboratory, 6 volunteer male opioid abusers maintained on 30 mg of methadone daily underwent pharmacological challenges 2 to 3 times per week. Pharmacological challenges consisted of a double-blind i.m. injection of: buprenorphine (dose range 0.5-8.0 mg), hydromorphone (5 and 10 mg), naloxone (0.1 and 0.2 mg) or saline. Injections were given 20 hr after the last dose of methadone. Measures included physiologic indices, and self-report and observer ratings of drug effects. Naloxone and hydromorphone produced characteristic antagonist-like and agonist-like effects, respectively, on subjective, observer and physiologic indices. None of the doses of buprenorphine were consistently or systematically identified as an opioid agonist or antagonist on any of the measures. Thus buprenorphine produced minimal effects in methadone-dependent patients. The lack of agonist effects suggests buprenorphine has a low abuse potential in methadone-dependent patients. The lack of antagonist effects suggests buprenorphine can be administered safely to subjects dependent on a low dose of methadone. This lack of effect of buprenorphine distinguishes it from other mixed agonist antagonists previously tested, which produced antagonist effects in this procedure.

Adult↗
PubMed1992

Effects of cocaine alone and in combination with bromocriptine in human cocaine abusers.

This study was conducted to determine whether the acute administration of bromocriptine, a dopamine agonist, modulates the acute pharmacologic effects of i.v. cocaine in humans. Eight current users of i.v. cocaine who were not seeking treatment for their cocaine abuse completed the study while they were inpatients on a research unit. Twelve drug conditions were tested in all subjects in randomized order under double-blind, double-dummy conditions and included cocaine (0, 12.5, 25 and 50 mg, i.v.) in combination with bromocriptine (0, 1.2 and 2.5 mg given orally 2 hr before the cocaine injection). Physiologic and subject- and observer-rated responses were measured. Cocaine alone significantly increased pupil diameter, heart rate and blood pressure, and ratings of drug effect, good effects, liking and rush. Bromocriptine alone significantly increased pupil diameter and heart rate, decreased blood pressure and had only minor effects on subjective measures. There were significant cocaine/bromocriptine interactions on diastolic and mean arterial blood pressure, with combinations producing significantly smaller increases compared to cocaine alone, and on heart rate, with combinations producing significantly larger increases compared to cocaine alone. The physiologic and subjective effects of cocaine were not modified by pretreatment with bromocriptine in any other way that might indicate either a therapeutic benefit or a safety concern. However, bromocriptine alone produced undesirable effects (fainting) that should be considered before administration to outpatient cocaine abusers. Any possible therapeutic benefits of acute administration of bromocriptine in cocaine abuse are not likely to be due directly to modulation of the acute effects of cocaine.

Adult↗
PubMed1991

Clustering of multiple substance use and psychiatric diagnoses in opiate addicts.

Using a standardized psychiatric interview, the prevalence of and interrelationships among various substance use diagnoses and non-substance use psychiatric diagnoses were examined in a population of opiate addicts (n = 66) enrolled in methadone maintenance treatment. Multiple substance use disorders were found in these patients, and more substance use disorders were found in those patients with, versus without, a non-substance use psychiatric diagnosis. Certain substance use disorders were found to cluster. These results suggest that opiate addicts should be evaluated for multiple substance use disorders as well as for non-substance use disorders, and that certain subpopulations may be at increased risk for multiple substance use disorders.

Adult↗
PubMed1991

Early treatment time course of depressive symptoms in opiate addicts.

Self-reported depressive symptoms of opiate addicts were assessed at admission to a methadone treatment program and weekly during the first 4 treatment weeks using the Beck Depression Inventory. A significant decline in scores was found to occur with the first follow-up evaluation done 7 days after admission, with scores remaining stable over subsequent weeks. The study suggests that a more accurate assessment of psychiatric symptoms may be obtained by waiting 1 to 2 weeks after treatment entry as compared with admission assessments.

Adult↗