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Biomedical subjects

G H van Brussel

Publications and source records attributed to G H van Brussel.

At least 19 recordsLinked to original sources
PubMed2003

[Strengthening the medical aspect of addiction care].

The Dutch Association for Addiction Medicine and the umbrella organisation GGZ Nederland (sector organisation for mental health and addiction care) have compiled a report entitled 'Strengthening medical care in the addiction care sector'. The report argues why medical care needs to be strengthened and provides guidance as to how the present shortcomings in quality and quantity can be dealt with. Addiction is now considered to be a medical condition with patients instead of clients. This means that the care, including the financial aspects, needs to be organised in the same way as all other forms of regular health care. Furthermore, the training in addiction medicine needs to be given a clearer status in the form of departments, professorships, training institutes and certification. Within the context of this report the responsibility of addiction centres needs to be emphasised. Vacancies in the many forms of social work could be exchanged for well-trained nurses and physicians, without the need for extra financial assistance.

Certification↗
PubMed2001

[Limited role of naltrexone in the treatment of opiate addiction].

Naltrexone has been used for many years as an opiate antagonist for maintenance treatment to prevent relapse in opiate addiction and, more recently, for rapid opiate detoxification with and without general anaesthesia. Naltrexone is useful for rapid detoxification without anaesthesia. However, the detoxification procedure under anaesthesia lacks a scientific basis. There is no clear evidence of the efficacy of naltrexone maintenance treatment. Poor compliance and possible receptor sensitisation means there may be a potentially increased risk of mortality through opiate overdose following cessation of naltrexone treatment and relapse into addiction.

Drug Therapy, Combination↗
PubMed2001

Estimating the number of opiate users in amsterdam by capture-recapture: the importance of case definition.

One of the objectives of Amsterdam's methadone maintenance treatment is maximising its coverage among problematic opiate users. In order to evaluate what proportion is reached, the capture-recapture method is conducted to estimate the prevalence of problematic opiate use. Samples of opiate users in contact with police, hospital or treatment are used. The treatment sample is limited to the low threshold treatment sample (treatment with minimal requirements to the clients). Based on differences of log likelihood ratio, Akaike's and Bayesian information criteria, log linear models are selected. The size of the population of problematic opiate users in 1997 is estimated to be 4130 (95% confidence interval: 3753-4566). Within 3 months 50% was registered: 16% at the police, 2.5% at the hospital and 40% at treatment. This study shows that the Amsterdam methadone treatment programs succeed in reaching a high proportion of problematic opiate users. The estimation of the prevalence of problematic opiate users is considered to be valid. However, if, instead of the low threshold treatment, the total treatment sample had been used, the population of interest and the sampled population would not match correctly, and prevalence would have been overestimated.

Bayes Theorem↗
PubMed2001

The impact of harm-reduction-based methadone treatment on mortality among heroin users.

OBJECTIVES: The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users. METHODS: A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study. Poisson regression was used to identify methadone maintenance treatment characteristics (dosage, frequency of program attendance, and type of program) that are significantly and independently associated with mortality due to natural causes and overdose. RESULTS: From 1985 to 1996, 89 participants died of natural causes, and 31 died as a result of an overdose. After adjustment for HIV and underweight status, there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR] = 2.38, 95% confidence interval [CI] = 1.28, 4.55). Leaving treatment was also related to higher overdose mortality, but only among injection drug users (RR = 4.55, 95% CI = 1.89, 10.00). CONCLUSIONS: Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage.

Adult↗
PubMed2000

Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study.

AIMS: To assess relationships between characteristics of methadone maintenance treatment and long-term cessation of injecting (> or = 1 year). DESIGN AND PARTICIPANTS: The incidence of cessation of injecting and relapse from non-injecting to injecting was estimated among 488 participants of the Amsterdam cohort study among drug users. We used a nested matched case-control design to identify methadone treatment characteristics significantly and independently related to cessation of injecting. To ensure detailed and valid assessment of methadone treatment, data of the Central Methadone Register were linked with cohort data. For 339 of 488 subjects of the initial study group methadone data were available. FINDINGS: The incidence of cessation of injecting increased from 2.2/100 person years in 1985-89 to 5.5/100 per year in 1995-97 (Ptrend = 0.005). Relapse to injecting was high: 17.2/100 person years (no trend). Methadone dosage and frequency of methadone programme attendance in themselves were not significantly related to cessation of injecting. However, an individual increase of 5 mg or more per year (OR 4.20, 95% CI 1.54-11.46) and receiving methadone mainly via the outpatient clinic for drug-abusing prostitutes and foreigners (OR 0.18, 95% CI 0.05-0.59) were independent predictors of cessation of injecting. After cessation of injecting, there were no HIV-seroconversions during the period of non-injecting (129 person years). After relapse to injecting there was one seroconverter; however, follow-up was small (23 person years). The HIV-incidence of those who continued injecting was 3.2/100 per year. CONCLUSIONS: Steadily increasing the methadone dosage in a harm reduction setting may be useful in supporting injecting drug users in the process of cessation of injecting and reducing the spread of HIV-infection.

Adolescent↗
PubMed1999

Methadone maintenance treatment modalities in relation to incidence of HIV: results of the Amsterdam cohort study.

STUDY OBJECTIVE: To evaluate methadone maintenance treatment modalities, prescribed within the concept of harm reduction, in relation to incidence of HIV infection among drug users with a history of methadone treatment in Amsterdam, The Netherlands. DESIGN: Prospective observational cohort study among 582 HIV-negative drug users. To ensure valid and detailed assessment of methadone treatment, data from the Central Methadone Register in Amsterdam were linked to the Amsterdam cohort study among drug users. METHODS: Poisson regression analysis was used to identify independent and significant predictors of incidence of HIV. MAIN RESULTS: During 1906 person years, 58 drug users seroconverted, the overall incidence of HIV being 3.0 per 100 person years with a declining trend for current injectors. An increase in frequency of methadone programme attendance [relative risk (RR), 2.4; 95% confidence interval (CI), 1.2-4.6, compared with no change] and increase in methadone dosage (RR, 0.8; 95% CI, 0.6-1.0, per category of change of 10 mg/day) were significantly associated with incidence of HIV in multivariate analysis. Methadone dosage and frequency of programme attendance in itself were not significant predictors. Other multivariate significant risk factors were homelessness, current injecting and in-patient hospital care. CONCLUSIONS: Among drug users who receive methadone maintenance treatment in a harm-reduction setting, which includes ancillary services such as needle-exchange programmes and HIV testing and counselling, prescription of high methadone dosages is not sufficient to stop the spread of HIV. However, an individual increase of the methadone dosage and measures to achieve high treatment retention could contribute to the prevention of HIV among drug users.

Adolescent↗
PubMed1998

Determination and pharmacokinetics of dextromoramide in methadone maintenance therapy.

To study the pharmacokinetics of dextromoramide in long-term opiate addicts on methadone maintenance therapy (MMT) a reverse-phase HPLC technique was developed to monitor dextromoramide and methadone concentrations in plasma simultaneously. After liquid-liquid extraction from plasma, dextromoramide and methadone were determined using a Supelcosil LC-ABZ column and a mobile phase of KH2 phosphate buffer (25 mM, pH 2.5) mixed with acetonitrile (80:20, v/v) and UV detection at 206 nm. The method was found to be sufficiently sensitive, specific and reproducible to apply in six subjects on MMT for many years, receiving orally administered dextromoramide as adjuvant. Pharmacokinetic data sets for dextromoramide in each subject were conducted and analysed further, indicating short elimination half-life values (71 min, range 31-152 min). Contrary to previous studies, in all subjects tested the pharmacokinetics of dextromoramide are best described using an one-compartment model.

Adult↗
PubMed1998

Differentiation in the Amsterdam methadone dispensing circuit: determinants of methadone dosage and site of methadone prescription.

AIMS: To evaluate the Methadone Dispensing Circuit in Amsterdam by identifying determinants of methadone dosage and client characteristics in the different types of methadone programmes. DESIGN AND PARTICIPANTS: Four hundred and forty-four participants of a cohort study of drug users in Amsterdam who had consented to link data of the Central Methadone Register to the cohort data. FINDINGS: From 1985 to 1994, methadone dosage increased from 41 to 59 mg/day. The mean methadone dosage was higher for ethnic West Europeans, Germans, older drug users, HIV-positive drug users, those with a longer duration of prostitution, current injectors, those with a longer duration of injecting, longer duration of methadone use, higher frequency of being dispensed methadone and clients of the prostitutes' and foreigners' outpatient clinic. For clients of the general practitioner, at the police station and in prison the methadone dosage was lower. We found different sets of client characteristics in those receiving methadone at the methadone outpost, the methadone bus, the prostitutes' and foreigners' outpatient clinic, the general practitioner and the outdoor addiction clinic. CONCLUSIONS: These results indicate that the Amsterdam system is highly differentiated in a way that is largely concordant with the intended general policy on methadone treatment.

Adult↗
PubMed1997

[More of the Surinam and Antilles drug addicts involved in the GG&GD (Community Medical and Health Service) methadone program in Amsterdam should be referred to the family physician for their methadone maintenance].

OBJECTIVE: To study the possibility of referring Surinam and Netherlands Antillean drug users from a 'low-threshold' municipal methadone programme to general practice for methadone maintenance treatment. (Methadone maintenance treatment for drug users leads to a more regulated life and makes it possible to implement measures to ameliorate their living conditions.) Fewer Surinam and Netherlands Antillean drug users are referred to general practice than native Dutch drug users. DESIGN: Descriptive. SETTING: Municipal Health Service, Department of Mental Health, Unit on Drugs, Amsterdam, the Netherlands. METHOD: 141 Surinam and Netherlands Antillean drug users participating in the 'low-threshold' methadone programme were examined on the following items: psychiatric status, drug and alcohol abuse, judicial problems, relationships, personal care, insurance and housing. With these items the level of regulated drug use was assessed and the possible reference to general practice evaluated. RESULTS: 21% of the drugs user group was found to be well regulated. They could have been referred to general practice immediately. Another 18% were also well regulated but they received methadone on a daily basis at the moment of investigation; when they would have proven to manage methadone prescription on a weekly basis, they could also be referred to general practice. 61% could not be referred because they were addicted to benzodiazepines (22%) or alcohol (33%), lived in unsuitable housing (45%), had judicial problems (53%), psychiatric problems (30%) or no insurance (15%), or were very problematic drug users receiving Palfium (dextromoramide) through the 'low-threshold' municipal methadone programme (15%). CONCLUSION: Of Surinam and Netherlands Antillean drug users from a municipal methadone programme, approximately 20% could have been directly referred to general practice for their methadone maintenance treatment and 20% at a later stage, and 60% could not.

Adult↗
PubMed1996

Craving despite extremely high methadone dosage.

A clinical case study is presented of an opiate addict, currently under methadone maintenance treatment (MMT), who claims the need of a higher daily methadone dose. He is admitted to a closed metabolic ward, where he receives 250 mg methadone per day. During 24 h both pharmacokinetic parameters and craving levels are measured simultaneously. Results show extremely high methadone concentrations and its primary metabolite EDDP in plasma and urine. The craving level shows a distinguished peak around the methadone administration on both measured days. Withdrawal symptoms as well as self-reported craving did not correspond at all to the extremely high methadone concentration level in plasma. So we suggest that in individual cases if high methadone doses and plasma methadone levels are not able to diminish craving symptoms, dose adjustment should be accompanied by education regarding daily anticipatory increase of opiate craving.

Dose-Response Relationship, Drug↗
PubMed1994

Public health care policies for drug addicts in Amsterdam.

Recognizing that drug addiction is a chronic health problem for which, in the majority of cases, no curative, effective treatment exists, Amsterdam developed a coherent system of public health measures. Data on the course of the local drug epidemic, including medical complications such as AIDS, tuberculosis and mortality, are presented.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Amsterdam's drug policy and its implications for controlling needle sharing.

In summary, it can be stated that Amsterdam has a wide variety of helping modalities. Approximately 70 percent of the city's 7,000 drug addicts are in contact with this helping system. In The Netherlands, no evidence could be found to support the fear that low-threshold methadone programs keep addicts away from drug-free treatment. Figure 1 shows that the number of addicts entering drug-free treatment doubled in the period 1981-85 (most popular has been the drug-free aftercare). This is even more striking since the estimated number of addicts did not increase in that same period. So, instead of keeping addicts away from treatment, low-threshold programs and outreach activities may have been effective tools in motivating addicts to enter drug-free treatment. Figure 2 shows the rise of the mean age of drug addicts, while figure 3 indicates that the percentage of addicts under 22 years decreases (14.4 percent in 1981 and 5.1 percent in 1986). Since the total number of addicts is quite stable, this may suggest that heroin is becoming less attractive to young people.

Acquired Immunodeficiency Syndrome↗