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PubMed1995

Methadone dosing and pregnancy: impact on program compliance.

A retrospective, inception cohort, nonrandomized control design was employed to evaluate the effects of daily vs twice daily dosing of methadone on opiate/cocaine use, and noncompliance with urine toxicology requests in methadone-maintained pregnant women, n = 45. Earlier program entry was associated with decreased opiate and cocaine use and increased compliance with urinalysis requests. The single dose and split-dose groups differed in urine toxicology compliance rates, 23.8 vs 0.5%, as well as percentages of urines positive for cocaine, 15.3 vs 0.3%, only in Trimester III.

Ambulatory Care↗
PubMed1997

Patient perceptions of psychological and physiological withdrawal symptoms and positive factors associated with gradual withdrawal from methadone maintenance treatment: a prospective study.

Psychological and physiological withdrawal symptoms and some positive factors were studied in 10 methadone maintenance treatment patients during methadone dose reduction. The subjective ratings were made during a period of 10 days around each reduction occasion, 3 days before dose reduction and 7 days after (i.e., within the periods). To permit comparisons of the subjects' ratings between earlier and later stages of the dose reduction process, a division has been made between the first half and the second half of the total reduction occasions (i.e., between the periods). Three of the patients completed the dose reduction, while the others interrupted their withdrawal attempts. The results show that the aggregate psychological symptoms were rated low, but that, as expected, they increased significantly from the first to the second half of the dose reduction. A significant increase of the psychological symptoms also occurred from the days before each reduction to the days after. The aggregate physiological symptoms were rated very low. A significant increase in rated withdrawal intensity is found within the reduction occasions. There were no significant changes with regard to the aggregate positive factors, either within or between the reduction occasions.

Adult↗
PubMed1999

Drug dependence and abuse potential of tramadol.

AIM: To assess the drug dependence and abuse liability of tramadol. METHODS: Subjects of opiate addicts with history of tramadol abuse were 219. Physical dependence of tramadol was assessed using opiate withdrawal scale (OWS), psychic dependence was assessed by association test of Addiction Research Center Inventory-Chinese Version (ARCI-CV); the degrees of craving experienced for tramadol was self-reported on visual analogue scale (VAS). RESULTS: The scores of OWS of tramadol were 0.05-1.07; 3 scores on scales in particular being used the identify euphoric effects--MBG, sedative effects--PCAG, and psychotomimetic effects--LSD of ARCI were 7.3, 6.1, and 3.4, respectively (F = 38.1, P < 0.01); 57.1% of tramadol abuse subjects had craving for tramadol (chi 2 = 75.86, P < 0.01). CONCLUSION: Tramadol produced high abuse potential among opiate addicts.

Adult↗
PubMed2001

[Subjective wellbeing and somatic markers in methadone substitution. Evaluation of 61 heroin addicts].

AIM: In 61 patients with the ICD-10 diagnosis "heroin dependence" an evaluation of subjective well-being with consideration given to coexisting symptoms prior to and 4 months after initiation of methadone maintenance. METHOD: The Lancashire Quality of Life Profile and, for the clinical physical side effects, the opioid withdrawal scale proposed by Bradley and Seldenburg, were used. Additionally, urinalysis was performed. RESULTS: Statistically appreciable differences were found between the two groups in terms of drug-specific side effects, somatic satisfaction scales, and consumption of medications and co-use of addictive drugs. Further statistically evident inter-group differences were seen with regard to mental well-being. CONCLUSION: Overall, methadone maintenance leads to a rapid improvement in subjective well-being and to a relevant reduction in concurrent physical symptoms.

Adult↗
PubMed1992

Plasma methadone measurements and their role in methadone detoxification programs.

We monitored eight patients who were receiving a decreasing dose of methadone for treatment for opioid addiction (detoxification). Patients with plasma concentrations of methadone less than 0.05 mg/L experienced withdrawal symptoms, relapsed, and re-abused illicit drugs. Four patients took extra methadone (illicitly obtained) during detoxification. None of the eight patients in our study were successfully weaned off methadone: all left the methadone detoxification program before the completion of treatment. Two patients subsequently returned to a fixed methadone program elsewhere, and four relapsed and returned to illicit drug misuse. Plasma measurements may help clinicians assess patients during methadone detoxification.

Adult↗
PubMedDate not supplied

Missed opportunities for intervening in the lives of pregnant women addicted to alcohol or other drugs.

This study examined the practices of health care providers in detecting substance abuse among pregnant women and making appropriate referrals for treatment and other services. Data were gathered through personal interviews with 181 addicted women during visits to four sites and through a survey of 94 substance abuse treatment programs in the South. The typical woman in the sample was 31 years old, white, divorced or separated, and had been using alcohol and other drugs for 12.7 years. A majority (65%) had been asked about alcohol and drug use by physicians or nurses during their most recent pregnancies. Of those who were asked, 43% admitted alcohol or drug use, and an additional 13% were using but did not admit it. Very few women (5%) were referred to drug counselors or programs. A majority (59%) were not given information about the effects of alcohol or drug use on pregnancy. Even when prenatal care providers ask addicted women about substance abuse, they often fail to make appropriate referrals to treatment.

Adult↗
PubMedDate not supplied

Clonidine and opiate receptor antagonists in the treatment of heroin addiction.

Good results in detoxification methods have been reached using both together clonidine and opiate receptors antagonists. One hundred fifty-two heroin-abusing patients were studied evaluating withdrawal symptoms after therapy with (a) clonidine only, (b) clonidine and naltrexone, (c) clonidine and naloxone, and (d) placebos. Treatment results, emotional and behavioral changes, and involvement in psychosocial programs were evaluated after a 6-month follow-up. Although opiate antagonists were able to induce slight and transient withdrawal signs and symptoms, there was, in the group of patients treated with clonidine and naltrexone together, a low percentage of catabolites in urine and an improvement in mood and family relationships. Furthermore, the patients that underwent longer naltrexone treatment showed a stronger involvement in psychosocial programs, and even their relatives demonstrated more interest in the recovery program. A decrease in the difficulties of accepting an opiate antagonists treatment and a different evaluation of withdrawal syndrome were the results of an early use of naltrexone.

Adolescent↗
PubMedDate not supplied

Alcohol and other drug abuse in elders.

With the growing population of older persons, ET nurses can expect an increasing number of elderly clients in their practice settings. Elderly persons are not immune to alcohol and other drug abuse. Detection of substance abuse in this population is complex and often missed. The purposes of this article are as follows: (1) examine barriers that may prevent nurses from addressing substance abuse among the elderly population; (2) suggest risks for psychoactive substance abuse in this population; (3) identify warning signs that should alert nurses to the problem; and (4) outline treatment options for substance-abusing clients.

Aged↗
PubMed2003

Improving the detection of drug abuse, alcohol abuse, and depression in community health centers.

Up to 35 percent of primary care patients suffer from substance abuse or mental disorders, and most of these patients receive care from general medical professionals rather than mental health specialists. Accumulating evidence suggests that primary care physicians often fail to recognize, diagnose, and treat their patients with mental and substance use disorders; only about 5 percent of primary care visits result in a mental or substance use diagnosis. The goals of this project were to evaluate the feasibility of screening for drug abuse, alcohol abuse, and major depression at two federally funded urban Community/Migrant Health Centers (C/MHCs), in Newark, New Jersey, and Bronx, New York, and to examine the effects of a clinical tool designed to guide primary care clinicians in the identification and treatment of substance use and depression, assess provider perceptions of the screening form, and determine the concordance between provider and patient reports of assessment and management.

Adult↗
PubMed2006

State of the art in hair analysis for detection of drug and alcohol abuse.

Hair differs from other materials used for toxicological analysis because of its unique ability to serve as a long-term storage of foreign substances with respect to the temporal appearance in blood. Over the last 20 years, hair testing has gained increasing attention and recognition for the retrospective investigation of chronic drug abuse as well as intentional or unintentional poisoning. In this paper, we review the physiological basics of hair growth, mechanisms of substance incorporation, analytical methods, result interpretation and practical applications of hair analysis for drugs and other organic substances. Improved chromatographic-mass spectrometric techniques with increased selectivity and sensitivity and new methods of sample preparation have improved detection limits from the ng/mg range to below pg/mg. These technical advances have substantially enhanced the ability to detect numerous drugs and other poisons in hair. For example, it was possible to detect previous administration of a single very low dose in drug-facilitated crimes. In addition to its potential application in large scale workplace drug testing and driving ability examination, hair analysis is also used for detection of gestational drug exposure, cases of criminal liability of drug addicts, diagnosis of chronic intoxication and in postmortem toxicology. Hair has only limited relevance in therapy compliance control. Fatty acid ethyl esters and ethyl glucuronide in hair have proven to be suitable markers for alcohol abuse. Hair analysis for drugs is, however, not a simple routine procedure and needs substantial guidelines throughout the testing process, i.e., from sample collection to results interpretation.

Alcohols↗
PubMed1996

Monitoring for clenbuterol abuse in N. Ireland 1989-1994.

Laboratory testing in N. Ireland for the illegal growth promoting agent, clenbuterol (CBL), is centralized at the Veterinary Sciences Division, Belfast. During the past 6 years a variety of testing schemes have evolved to determine the level of abuse of this drug in the local meat industry. The types of samples from cattle tested during this period altered as pharmacokinetic data for the compound increased. Initially, fluids such as urine and bile were used, however testing switched to more appropriate tissues such as liver, eyes, and hair. The first positive samples were detected in 1990, with 43 out of 121 samples tested showing detectable residues. In the following year, this number increased to 139 out of 286 tests. Despite substantial increases in the number of samples analysed over the succeeding years, the numbers of positive results steadily declined, thus giving strong evidence that abuse was also on the decline. From the data collected over the 6-year period, it became clear that the EU National Surveillance Scheme designed to detect abuse of illegal substances was ineffective and locally designed programmes were required to effectively tackle the problem.

Animals↗
PubMed2000

Effectiveness of screening instruments in detecting substance use disorders among prisoners.

This study examined the effectiveness of several screening instruments in detecting substance use disorders among prison inmates. A sample of 400 male inmates were administered eight different substance abuse screening instruments and the Structured Clinical Interview for DSM-IV (SCID-IV), Version 2.0, Substance Abuse Disorders module. The latter was used as a diagnostic criterion measure to determine the presence of substance use disorders. Based on positive predictive value, sensitivity, and overall accuracy, the Texas Christian University Drug Screen, the Simple Screening Instrument, and a combined instrument-Alcohol Dependence Scale/Addiction Severity Index-Drug Use section were found to be the most effective in identifying substance abuse and dependence disorders.

Adolescent↗
PubMed1990

Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies--ADAMHA. Notice.

The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (53 FR 11986). Starting this month, a similar notice listing all currently certified laboratories will be published monthly, and updated to include laboratories which subsequently apply and complete the certification process. If any listed laboratory fails to maintain its certification, it will be omitted from updated lists until such time as it is restored to full certification under the Guidelines.

Government Agencies↗
PubMed2000

Drug use and validity of substance use self-reports in veterans seeking help for posttraumatic stress disorder.

The present study assessed drug use and the validity of self-reports of substance use among help-seeking veterans referred to a specialty clinic for the assessment of posttraumatic stress disorder (PTSD). Patients (n = 341) were asked to provide a urine sample for use in drug screening as part of an evaluation of PTSD. Self-reports of substance use were compared with same-day supervised urine samples for 317 patients who volunteered to participate in a drug screening. Results suggested that self-reports were generally quite valid. Only 8% of the cases involved patients not reporting substance use detected by urine screens. A total of 42% of the participants were identified as using drugs of abuse (excluding alcohol) through self-report and urine drug screens. Among participants using drugs, PTSD diagnosis was significantly associated with greater marijuana and depressant use as compared with stimulant (cocaine and amphetamines) use.

Adult↗