Biomedical subjects

Joan Blake

Publications and source records attributed to Joan Blake.

4 recordsLinked to original sources

PubMed2004

Prescription opioid abuse in patients presenting for methadone maintenance treatment.

To characterize prescription opioid dependent patients in a methadone maintenance treatment (MMT) program, a detailed retrospective chart review of new admissions (1997-1999, n=178, mean age=34.5+/-0.7 years, 65% male) was conducted. At admission most patients (83%) had been using prescription opioids (+/-heroin). Four groups were identified: 24% had used prescription opioids only; 24% used prescription opioids initially and heroin later; 35% used heroin first and prescription opioids subsequently; and 17% had used heroin only (this group was significantly younger: mean age 26+/-1 years, P=0.0001). Subjects reported regular use of prescription opioids at higher than therapeutic dosages. For example, in the 'prescription opioid only' group the reported mean (+/-S.E.) number of codeine or oxycodone-containing tablets consumed daily was 23 (+/-6) tablets and 21 (+/-3) tablets, respectively. There were no significant differences found amongst the groups in measures of social stability. Those dependent on prescription opioids alone were less likely to use illicit non-opioid drugs or to be associated with injection drug use. Those that used prescription opioids only or initially were more likely to have ongoing pain problems and to be involved in psychiatric treatment. Further research is required to better elucidate the complex relationships between pain, mental health and addiction in order to develop optimal prevention and treatment strategies for prescription opioid dependence.

Adult↗

PubMed2003

Impact of methadone program philosophy changes on early treatment outcomes.

This paper describes the consequences of changing from methadone maintenance treatment focussed primarily on elimination of all illicit drug use and social reintegration to patient-centred care. Counselling (formerly mandatory) became optional, patients were retained in treatment despite continued illicit drug use, the ceiling on methadone doses was removed, patient input became a part of methadone prescribing and the number of patients in treatment more than doubled. Across three cohorts (before, during and after the program was redesigned) the mean daily dose of methadone increased (50.4 mg +/- 2.5, 72.6 mg +/- 2.4, 92.2 mg +/- 4.0, respectively). The number of physician visits increased linearly with cohort while the number of therapist visits was unchanged overall. Two-year treatment retention was not significantly different (73%, 69% and 67%, respectively). In all three cohorts there was a significant reduction in opioid and benzodiazepine use but not cocaine use over the first six months of treatment.

Adult↗

PubMed2002

Changing patient characteristics with increased methadone maintenance availability.

Over the past several years there have been repeated calls for expansion of availability of methadone maintenance in several jurisdictions. Important stakeholders in the expansion of methadone maintenance treatment (MMT) are existing treatment providers. This study describes the impact of the rapid expansion in treatment availability in Ontario on the long-standing MMT program of the Centre for Addiction and Mental Health (CAMH). This expansion occurred through enlarging existing treatment programs, the provision of MMT in private physicians' offices and the establishment of new clinics. With expansion in the community, demand for the clinic-based treatment of the CAMH MMT program did not drop, in fact the patient population was able to continue to grow. There was a broadening of the patient profile in the program including patients who were better educated, more likely to be employed and less likely to be currently injecting (although with a significant history of past injection drug use). Moreover, in the face of these changes, excellent treatment retention was maintained. This suggests that the expansion in treatment availability did not impact negatively on the existing program but rather enabled access for a group of higher functioning opioid dependent patients who were previously being deterred from treatment entry by the large waiting lists and the need for priority access for pregnant and HIV positive heroin users. These findings should provide encouragement for MMT providers in jurisdictions anticipating or undergoing expansion of treatment availability.

Adult↗

PubMed2002

Serum sialic acid as a marker of alcohol consumption: effect of liver disease and heavy drinking.

BACKGROUND: Serum sialic acid (SA) has been suggested as a new marker of alcohol consumption. There are, however, only a few studies on the clinical value of such measurements. The relationship between serum SA and liver disease is also unknown. METHODS: We determined serum SA concentrations in a sample of 51 alcoholics and 20 healthy controls by using high-performance liquid chromatography with an anion-exchange column and pulsed amperometric detection. The alcoholic sample included 32 patients with liver disease, the severity of which was assessed by previously established combined clinical, laboratory, and morphological indices. In addition, there were 19 heavy drinkers without significant liver disease despite a well documented history of excessive alcohol consumption. RESULTS: The (mean +/- SD) SA concentrations (1.449 +/- 0.3019 mmol/liter) were significantly higher in the alcoholics than in the healthy controls (1.154 +/- 0.1702 mmol/liter). With the optimal cutoff limit for serum SA (1.425 mmol/liter), a specificity of 1.00 and sensitivity of 0.51 were obtained. The diagnostic accuracy of serum SA according to receiver operating characteristic analysis was good, with the area under the curve being 0.805 (0.052). Unlike the traditional serum markers of alcohol consumption (gamma-glutamyl transferase, carbohydrate-deficient transferrin, and aspartate amino transferase), serum SA was not found to be different between the alcoholics with or without liver disease. CONCLUSIONS: Our study suggests that serum SA is a sensitive marker of excessive alcohol consumption. Such measurements may also prove to be of value in conditions in which the results of the traditional markers reflect the severity of liver disease rather than alcohol consumption.

Alcohol Drinking↗