Oral long acting antipsychotic penfluridol as a harm reduction treatment in a patient suffering from untreated schizophrenia and multiple drug dependence: A case report.

Psychiatric disorders, including schizophrenic spectrum disorders, are common in People Who Use Drugs (PWUD). Promoting adherence to medication among PWUD with dual diagnosis is challenging. We present the case of a treatment-disrupted patient suffering from schizophrenia with co-occuring multiple drug dependence to whom penfluridol - an oral long acting typical antipsychotic - was proposed at the Supervised Drug Consumption Room (SDCR) of Paris. Penfluridol quickly improved patient's psychotic symptoms, increased engagement in addiction care and helped maintaining the patient in "Housing First" program. In harm reduction structure, penfluridol can be seen as a "hook treatment" while maintaining therapeutic alliance and favoring patients' engagement in specific care.

Direct acting antiviral-based treatment of hepatitis C virus infection among people who inject drugs in Georgia: A prospective cohort study.

BACKGROUND: People who inject drugs (PWID) are often excluded from HCV treatment programs due to concerns about their ability to adhere to care. Georgia has a high prevalence of HCV infection (5.4% of chronic cases in general population) with an epidemic concentrated among PWID. We evaluated adherence to care and sustained virologic response (SVR) among PWID in Georgia. METHODS: In this observational study, participants with recent injecting drug use (previous 6 months) and chronic HCV attending a needle- and syringe-program were included. Participants received sofosbuvir and ribavirin +/- pegylated interferon, with peer-based support during treatment. The primary endpoint was undetectable HCV RNA 12 weeks post-treatment (SVR12). Factors associated with SVR were assessed using logistic regression. RESULTS: Among 244 participants [HCV genotype (GT) 3, 52%; GT2, 25%; GT1, 19%; mixed GT, 4%]; 55% had cirrhosis. Overall, 24% were receiving OST and 50% injected drugs in the previous month. 98% (239 of 244) completed treatment, with 88% (210 of 239) having never delayed a medical appointment and 79% (189 of 239) never missing a dose of medication. Overall, SVR was 84.8% (207 of 244). SVR was 88.5% (207 of 234) among participants who attended 12-week follow up appointment for HCV RNA testing. In multivariate analyses, SVR was significantly associated with adherence (no missed doses) to treatment [vs. missed doses; adjusted OR (aOR) 2.77; 95% confidence interval (95%CI), 1.01-7.51), and genotype (vs. GT1; GT2, aOR 0.27; 95%CI 0.06-1.21; GT3, aOR 1.09; 95%CI 0.27-4.50; and mixed GT, aOR 0.14; 95%CI 0.02-0.97). CONCLUSION: In this real-life study in a middle-income country, PWID treated for HCV and receiving a simple peer-support intervention demonstrated an excellent treatment response and good adherence, not associated with injecting drug use during treatment and OST at treatment initiation.

Anxiety disorders are associated with early onset of heroin use and rapid transition to dependence in methadone maintained patients.

Early onset of heroin use is a severity marker of heroin use disorder. We studied the interaction between early onset and rapid transition to heroin dependence recorded with retrospective interviews in 213 patients with severe heroin dependence and history of methadone maintenance treatment. General linear models were used to identify independent factors associated with early onset, factors associated with rapid transition to dependence, and a multivariate model was used to study the interaction of those two dimensions. Lifetime history of anxiety disorders and age at onset of cannabis use are shared common risk factors and are associated with the interaction.

Hepatitis C among people who inject drugs in Tbilisi, Georgia: an urgent need for prevention and treatment.

BACKGROUND: Drug use and hepatitis C virus (HCV) are both major public health issues in Georgia. However, the access to HCV prevention and care is still very limited in the country. This study was conducted to examine the HCV epidemic among people who inject drugs (PWID) in Tbilisi and to assess the treatment needs of this most-at-risk population. METHODS: Respondent-driven-sampling was used to obtain a sample of PWID in Tbilisi. Each participant was interviewed face-to-face and underwent an HCV antibody-based rapid diagnostic test. If a test was positive, a further evaluation was performed, including direct detection of HCV by PCR, genotyping and liver fibrosis assessment by transient elastography. People needing urgent treatment were defined as those who were currently infected and had severe liver fibrosis (liver stiffness above 10kPa). Prevalences were calculated crude and then weighted to adjust for the sampling method. Risk factors for liver fibrosis were studied using generalized linear models. RESULTS: A total of 216 PWID were recruited in October 2012. The mean age was 39.6 and 7.9% were female. HCV antibodies were found in 91.9% of the participants and 82.0% had a chronic infection. Among the chronically infected participants, genotype 3 was predominant (66.9%) and 10.4% had viruses from two different genotypes. Severe liver fibrosis was found in 24.2% of the infected participants (only in men) and was significantly associated with the duration of drug use and coinfection with hepatitis B. CONCLUSION: Georgian PWID are very exposed to HCV and have high levels of severe liver fibrosis. Hence, harm reduction services should be scaled-up in Georgia and HCV treatment programmes should be implemented straight away and should include active drug users. Other risk factors for liver fibrosis, such as hepatitis B, should be specifically addressed in this population.