Opioid addicts at admission vs. slow-release oral morphine, methadone, and sublingual buprenorphine maintenance treatment participants.

With use of a randomized study design, quality of life (QOL) and physical symptoms of opioid addicts at admission were compared with slow-release oral morphine, methadone, and sublingual buprenorphine maintenance program participants after 6 months of treatment. The study was conducted from February to July 2004 in the outpatient drug user treatment center at University Department of Psychiatry at Innsbruck, providing maintenance treatment programs and detoxification in Tyrol, Austria. One hundred twenty opioid users seeking treatment were compared with 120 opioid-dependent patients retained for 6 months on a slow-release oral morphine, methadone, or sublingual buprenorphine maintenance program. The German version ("Berlin Quality of Life Profile") of the Lancashire Quality of Life Profile was used, and illicit opioid use was determined by urinalysis. Physical symptoms were measured by using the Opioid Withdrawal Scale. Urinalyses revealed a significantly lower consumption of cocaine and opioids in all three substitution groups than in patients at admission (p < 0.001 and p < or = 0.004, respectively). Both the buprenorphine and the methadone maintenance group showed significantly more favorable values than opioid clients at admission for stomach cramps (p < or = 0.002), muscular tension (p < or = 0.027), general pain (p < or = 0.001), feelings of coldness (p < or = 0.000), heart pounding (p < or = 0.008), runny eyes (p < or = 0.047), and aggressions (p < or = 0.009). Patients who received slow-release oral morphine treatment generally showed the least favorable QOL scores compared with patients at admission or sublingual buprenorphine and methadone clients. Patients in the sublingual buprenorphine or methadone program showed nearly the same QOL scores. The buprenorphine and the methadone maintenance group showed significantly more favorable values than opioid clients at admission regarding leisure time (p < or = 0.019), finances (p < or = 0.014), mental health (p < or = 0.010), and overall satisfaction (p < or = 0.010). Slow-release oral morphine is a well-established treatment for pain, but more research is required to evaluate it as a treatment for heroin dependence. The present data indicate that slow-release oral morphine could have some disadvantages compared with sublingual buprenorphine and methadone in QOL, physical symptoms, and additional consumption. The results further suggest that buprenorphine treatment is as effective as methadone in effects on quality of life and physical symptoms.

Gender differences in health-related quality of life on admission to a maintenance treatment program.

We compared the gender differences in health-related quality of life (QOL) on admission to a maintenance program. 103 opioid users (65 men and 38 women) admitted to a maintenance treatment program during 2000-2002 were studied. During this period we assessed the QOL status using the German version ('Berlin Quality of Life Profile') of the Lancashire Quality of Life Profile. Physical symptoms were measured using the Opioid Withdrawal Scale. 312 urine screening tests were carried out to evaluate consumption. The female group showed significantly less additional consumption of other opiates (p = 0.043) compared with the male group. The male group showed significantly better QOL scores in self-esteem (p = 0.015), psychical health (p = 0.027), and law and security (p = 0.008). The outcome measures for withdrawal scores showed significantly less symptoms for males in twitching of muscles (p = 0.034), vomiting (p = 0.002), depressions (p = 0.004) and poor appetite (p = 0.008). In summary, both genders showed only a few significant differences on admission in terms of QOL and physical symptoms. The predominant effects of drug use appear to eclipse the gender-related role pattern. Further exploration of gender and QOL could have important theoretical and treatment implications.

Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment.

BACKGROUND: To compare the effects on quality of life (QOL) of oral methadone with sublingual buprenorphine. METHODS: We performed an open-label, non-randomized, two-site (methadone-buprenorphine) study. During 6 months we assessed the quality of life status of 53 opioid-dependent patients admitted to a methadone or buprenorphine maintenance programme using the German version (Berlin Quality of Life Profile) of the Lancashire Quality of Life Profile. Physical symptoms were measured using the Opioid Withdrawal Scale. Five hundred and thirty urine screening tests were carried out randomly to detect additional consumption. RESULTS: Sixty-seven opioid-dependent subjects (38 on methadone and 29 on buprenorphine) were enrolled in the study, and 53 completed it (30 subjects treated with buprenorphine and 23 subjects with racemic methadone). The subjects were comparable on all baseline measures. At the first follow-up (week 8), the buprenorphine-maintained group showed significantly less additional consumption of opioids (P = 0.013) compared with the methadone group. Patients retained in the buprenorphine or methadone programme (week 24) showed no significant differences in all quality of life scores. At the end of the study period, the buprenorphine-maintained group showed significantly less additional consumption of opioids (P = 0.001) and cocaine (P = 0.018) compared with the methadone group. The outcome measures for withdrawal symptoms after 24 weeks of treatment with buprenorphine showed slight advantages in stomach cramps, fatigue or tiredness, feelings of coldness and heart pounding. CONCLUSIONS: These results suggest that buprenorphine treatment is as effective as methadone regarding effects on quality of life and withdrawal symptoms. Buprenorphine has the potential to reduce the harm caused by drug abuse. Further research is needed to determine if buprenorphine is more effective than methadone in particular subgroups of patients.

Intravenous drug injection habits: drug users' self-reports versus researchers' perception.

The present study was designed to obtain human data on the speed of intravenous (i.v.) injection of cocaine, heroin, and morphine as well as on the rate of onset of their subjective effects and their duration in order to improve the accuracy of animal and human experimental models of i.v. drug abuse. To that end, a questionnaire was submitted both to clients of a substitution therapy outpatient clinic and to members of the drug abuse research community. It was found that i.v. drug abusers injected cocaine, heroin, or morphine much faster and also experienced the drug effects much faster than assumed by the drug abuse researchers. The time course of the reemergence of craving was also greatly misjudged by the researchers. On the other hand, the i.v. drug users' self-reports were internally consistent and corresponded well to data obtained in several different human behavioral laboratories. Interestingly, more than half of the i.v. drug users reported that injection speed was not important when injecting cocaine (57%), heroin (72%) or morphine (73%) under conditions that guarantee a maximum effect, suggesting that the rate of the rise in the brain concentration of a drug of abuse is less important for its reinforcing effect and, thus, for its abuse liability, than previously assumed, at least within the time frame of an i.v. drug injection.

[Subjective wellbeing and somatic markers in methadone substitution. Evaluation of 61 heroin addicts]. / Subjektives Wohlbefinden und somatische Merkmale bei Methadonsubstitution. Evaluierung bei 61 Heroinabhängigen.

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.

A survey of drug deaths in western Austria.

We evaluated the drug deaths in western Austria during the period from 1981 to 1991. The increase of fatal cases is partly due to a change in statistical methods and the definition of 'drug victims'. In this paper a survey is given concerning the drug deaths investigated forensically and toxicologically in our area of responsibility.

Methadone-substitution and driving ability.

A general statement about the driving ability of HIV-positive as well as HIV-negative addicts undergoing methadone-substitution treatment cannot be made with certainty. Even isolated observations are not significant; only an individually performed assessment, free of prejudice and conscientiously done is decisive. The formal assertion that addiction equals driving-inability, which is largely practised at present, is inadmissible and therefore harmful to the therapeutic efforts for rehabilitation.

[Fatalities in drug-dependent patients. A critical analysis]. / Todesfälle von Drogensüchtigen. Eine kritische Analyse.

The disquieting increase in the mortality of drug addicts observed in recent years cannot be ascribed to only one or a few well defined causes, such as the spread of the HI virus or AIDS, changes in drug consumption habits of multiple dependents or ineffective therapeutic measures. Primarily, an interaction of medical, social and psychological causes is emerging. In a well-defined addict population, 35 deaths of intravenous drug users were registered in the period 1987-1990. By comparison, 7 deaths were recorded in the same geographical area between 1983 and 1986. A report of the UN Commission on Narcotic Drugs shows that in Western Europe, mortality in this high-risk group has doubled annually in the past few years.

Benzodiazepines and other psychotropic drugs abused by patients in a methadone maintenance program: familiarity and preference.

Physicians often face the problem that they have to treat anxiety and insomnia in patients who are dependent on narcotics or other substances. Reports about different reinforcing properties of different benzodiazepines and increasing concern about their misuse, often in combination with other drugs, call for studies that help to establish recommendations for choosing psychopharmacologic agents in the treatment of these patients. Opiate addicts enrolled in a methadone maintenance program were interviewed about their subjective "liking" of all psychotropic substances with which they had personal experience. The results confirm previous reports that certain benzodiazepines, especially flunitrazepam and diazepam, stand out from others in terms of positive reinforcing properties. Overall, the attractiveness of benzodiazepines as drugs of abuse for poly-drug abusers is lower than that of other sedative/hypnotics.

Trends in HIV infection among intravenous drug users in Innsbruck, Austria.

The first HIV test among intravenous drug users (IVDUs) at the AIDS clinic and/or the drug dependency clinic of the University of Innsbruck was the basis for the calculation of the proportions of those testing HIV seropositive annually over the period 1985-1990. The numbers testing HIV seropositive at the drug dependency clinic declined drastically, from 72.2% in 1985 to 12.5% in 1990 (chi 2 = 29.62, p less than 0.0001), whereas they rose at the AIDS clinic during this period, from 48.4% to 100% (chi 2 = 5.82, p = 0.016). Overall 132 of the 268 (49.2%) individuals examined tested HIV seropositive. There were 102 individuals of the original 146 seronegative IVDUs who were retested, for an overall incidence rate of HIV seroconversion of 5.8/100 persons-years. Risk of seroconversion was associated with a steady sexual partnership with an HIV seropositive IVDU and with an age of less than or equal to 25 years at study entry (13.1 versus 8.7/100 persons-years). No seroconversions occurred in the subgroup of patients treated by the methadone maintenance treatment program. The cumulative incidence (Kaplan-Meier) rate for HIV seropositivity after 64 months was 22%, lower than the proportions testing HIV seropositive found in 1985 at each of the two clinics, which suggests that the speed of the spread of the epidemic of HIV infection among IVDUs has slowed in our region. Counseling of IVDUs should emphasize the risks of sexual acquisition, particularly among persons with steady relationships who may not perceive their risk.