A naturalistic follow-up study of French-speaking opiate-maintained heroin-addicted patients: effect on biopsychosocial status.

The purpose of this study was to evaluate the impact of opiate maintenance pharmacotherapy (OMP) on the biopsychosocial status of opiate-addicted patients in a cultural environment (France) that is not favorable to OMP and where methadone is not available. Buprenorphine and laudanum (opium tincture), which, to our knowledge, has not been reported previously in the scientific literature for OMP, were used in this study of a group of 18 opioid-dependent subjects. At time of initiation of OMP, mean age was 33 years, sex ratio male: female was 14:4, average duration of drug use was 11.2 years. Six patients received laudanum p.o., 15 g daily; 12 patients received buprenorphine sublingual 2 to 4 mg daily. This group of patients was selected because of persistent relapse and impairment after an average of 5.7 drug-free-oriented treatments over a period of 6.8 years. Initial evaluation and follow-up were made by way of a 150-min semi-structured interview using the Lifetime Retrospective Evaluation Score Table (LREST) and the Addiction Severity Index (ASI). Results showed that body weight and scores for physical and psychological health, socioprofessional status, and family relationships improved significantly after 14 months of OMP. These results show that highly impaired opiate-addicted patients doing poorly in drug-free treatment can respond to OMP even though methadone is not available and the idea of OMP is not favored.

[Effect of treatment with methadone on utilization of medical care by addicts seropositive for the AIDS virus. Results of a descriptive study, Bayonne, 1996]. / Influence des traitements par la méthadone dans la prise en charge médicale des toxicomanes séropositifs pour le virus du SIDA. Résultats d'une étude descriptive, Bayonne, 1996.

Since two years, 80 patients received methadone maintenance treatment in Bayonne Médecins du Monde Center. In this population, 48% are HIV positive... The aim of this study is to determine the impact of methadone maintenance treatment on the medical status of a group of HIV positive subjects. In addition to the Addiction Severity Index collected data and quality of life evaluation by the TEAQV, the following data are collected: compliance to appointments HIV clinic, CD4 status, evolution of weight, observance of HIV medicine. Preliminary results are presented, showing precisely and confirming the good influence of methadone maintenance treatment on medical care of patients with HIV and AIDS. This kind of study, before and during the maintenance treatment (base line, third month and every six months) appears as a very important stake: for this patients with HIV and AIDS, in term of personal and medical status, for us, in term of methadone treatment impact, and health public care.

[Descriptive studies of the use of the Addiction Severity Index in France]. / Données descriptives issues de l'utilisation de l'Addiction Severity Index en France.

The Addiction Severity Index (ASI) is an instrument that provides, in a 45-minutes semi-structured interview, a multidimensional assessment of substance abuse patients. It was designed in 1980 by A.T. McLellan et al., from Philadelphia PA, in North-America and introduced in France by our group in 1990. Over the past five years we have used it in different substance abuse populations including alcohol users. The goal of this paper is to review the adaptation procedure into French context and to present ASI data from different substance abuse sub-groups: opioïd dependent subjects seeking treatment and former heroïn addicted patients in maintenance treatment. After description of the ASI, presentation of the training procedure for its optimized use and methodological issues, we present for each opiate dependent group acceptability data, results of some of the ASI's 240 items and the severity scores. The Addiction Severity Index provides assessment of problem severity in seven functional areas in which substance abusers are commonly impaired and unable assessment of need for treatment. Objective and subjective patient data are collected in the following seven areas: medical, employment/ support, alcohol, drug use, legal, family/social relationship, and psychiatric. The ASI is both broad in the extent of its evaluation and yet easy to use for appropriately trained interviewers. Use of the ASI over the past five years allows us to underline the following characteristics: in the clinical setting the ASI unable a common descriptive analysis for need and adaptation for treatment of different patients populations; in the research setting the ASI is particularly suited for epidemiological studies of addiction and description, analysis or evaluation research.

Opiate withdrawal and electro-stimulation. Double blind experiments.

A rapid detoxification technique for heroin addicts is described. The technique uses an impulsional electric current developed by Limoge. The treatment is nonaggressive, very well tolerated by the addicts and leads to a good psychotherapeutic relationship with the medical staff. A successful physical detoxification is achieved in more than 80% of the cases (this figure is based on 400 patients treated by the method). The technique was subjected to two double-blind experiments. The first experiment tested the real efficacity of the electrical stimulation. The difference between the group of subjects stimulated and the unstimulated control group had a "p-value" which was significant at the 0,5% level. This leads us to believe that the electrical stimulation has a real positive effect. The second experiment reconfirmed the efficacity of the stimulation and showed that 24 hour continuous stimulation was not sufficient to produce a lasting effect. After about 50 hours stimulation a Naloxone test produced little or no reaction in the patients.

[Quantitative evaluation of sharing practices of materials at risk for infectious virus contamination by intravenous opiate users seeking treatment--application of the RAB(Risk for AIDS Behavior) self-administered questionnaire]. / Evaluation quantitative des pratiques de partage de matériel à risque de contamination infectieuse virale chez les usagers d'opiacés par voie intraveineuse faisant une demande de soins--utilisation de l'auto-questionnaire RAB.

The objective of this study was to quantify the occurrence of AIDS risk related sharing activities in i.v. opiate users seeking treatment using a self administered questionnaire. Subjects were recruited among first time consultants of an outpatient clinic and assessed using the Risk for AIDS Behavior questionnaire (RAB), a self administered questionnaire that assesses both needle-sharing and unprotected sexual activity; the Beck Depression Inventory (BDI) a self administered questionnaire that assesses depressive symptoms; and the Addiction Severity Index (ASI), a 45-min, structured interview that provides assessments of problem severity in seven functional areas commonly impaired among drug abusers. Among the 102 patients who came in for treatment, all 66 subjects reporting i.v. drug abuse agreed to participate. The study was based on the data collected from these 66 subjects of whom 49 were males (74%) and mean age +/- SD was 31 +/- 5. Fifty-eight-percent of theses subjects reported having shared needles or related paraphernalia over the past 6 months. Despite informational campaigns on the risks of sharing and despite the well spread knowledge of such a risk, most i.v. opiate users seeking treatment report having shared at least once over the previous 6 months.

[Evaluation of the use of psychotropic drugs from urine samples from subjects attending for the first time a clinic specializing in opium addiction]. / Evaluation de l'usage des psychotropes à partir d'échantillons urinaires chez des sujets s'adressant pour la première fois à une consultation spécialisée pour toxicomanie opiacée.

OBJECTIVES: Determine how well drug abusers requesting care accept urine sampling and the reliability of this method for evaluating drug use. METHODS: Subjects attending a specialized drug abuse clinic for the first time were requested to provide a urine sample for semiquantitative analysis using an immunological technique to identify the following substances: barbiturates, benzodiazepines, opiates, cocaine, amphetamines, cannabis, and dextropropoxyphen. RESULTS: All 98 subjects included in the study accepted the urine sample. More than 80% of the samples were positive for 1, 2 or 3 substances. The most frequent were, in decreasing order, opiates, cannabis, benzodiazepines and dextropropoxyphen. Among the opiate-positive subjects (70%), 80% were positive for 2 other substances, usually cannabis and benzodiazepines. Two-thirds of the cocaine-positive cases were observed among the most recently seen subjects. Among the 27 opiate-negative subjects, 16 stated they used buprenorphine. CONCLUSION: Within the setting of this study, urine sampling appeared to be well accepted by drug abusers. Urinalysis gave an objective evaluation of drug use and can be useful on an individual level providing complementary information to the overall examination. Urine sampling can also provide indicators for studying the evolution of drug use practices in different populations, both in a clinical and non-clinical setting.