Opioid Crisis Along Mexico's Northern Border: Treatment Needs Mexican Opioid Crisis.

BACKGROUND: Heroin production for external markets and low rates of use in Mexico have had a long history. A recent shift toward an increase in use and related problems calls for the evaluation of treatment needs in order to draw recommendations for policies. METHODS: The objectives were to identify predictors of choice of treatment and barriers to care among persons that had been with no treatment. The study included a convenience sample of 600 face-to-face interviews of people 18 years of age and older and a rapid HIV and HCV tests in three cities on Mexico's Northern Border: Ciudad Juárez, San Luis Río Colorado and Tijuana. The choice of treatment (methadone, other pubic or private treatments with no experience with methadone maintenance and only self-help or religious care), was analyzed though a multiple logistic multimodal regression analysis. Informed consents to be interviewed and for HIC and HIV were signed by interviewers. RESULTS: The majority of persons interviewed were males (89.7%) with an average age of 40. Having emigrated to the United States and a greater length of heroin use predicted seeking methadone treatment versus public or private treatment or informal care. The most important barriers to care were lack of information and stigma. HIC, HIV and other infectious and chronic diseases including depression were often unattended. CONCLUSIONS: There is a need to reform treatment policies in order to cover this w emerging and demanding problem.

[Alternative and complementary therapies in fibromyalgia syndrome]. / Komplementäre und alternative Verfahren beim Fibromyalgiesyndrom.

INTRODUCTION: Interdisciplinary S3 level guidelines were devised in cooperation with 8 medical, 2 psychological and 2 patient support groups. Results were elaborated in a multilevel group process. METHODS: On the bases of the "Cochrane Library" (1993-2006), "Medline" (1980-2006), "PsychInfo" (2006) and "Scopus" (2006) controlled studies and meta-analyses of controlled studies were analyzed. RESULTS: Only few controlled studies were found supporting in part the effectiveness of CAM therapies in the treatment of fibromyalgia syndrome. Due to the lack of information on long term efficacy and cost-effectiveness, only limited recommendations for CAM therapies can be given. CONCLUSION: Within a multicomponent therapy setting, selective CAM therapies (acupuncture, vegetarian diet, homeopathy, Tai Chi, Qi Gong, music-oriented and body-oriented therapies) can be recommended for a limited period of time.

[Recognizing and treating drug addicts. Part 2. Differential diagnosis, therapy]. / Erkennung und Behandlung von Drogen-Abhängigen. Teil 2: Differentialdiagnose, Therapie.

Persons addicted to opiates often have fresh injection scars on the skin directly above the veins in the arms and legs. These appear as well as scars from abscesses and burns, tattoos, advanced tooth decay and signs of chronic hepatitis. An intensive consumption of hallucinogens is often connected to an inclination toward apathy and a loss of contact to reality (amotivational syndrome). It is necessary to have a sufficiently wide spectrum of therapeutic and rehabilitation measures being offered, due to the wide range of variants one can expect in the personality structure and the primary disturbance. The slogan of "therapy instead of punishment" leads nowhere. Long-term in-patient programmes, still presently favoured in our country, are not sufficient and are being increasingly more frequently rejected by the addicts themselves. Out-patient therapy trends, which are both extremely necessary and promising, are to be found in the close co-operation between physicians and specialists in social therapy while utilizing community resources. Two examples for such a programme are discussed (Hesse, Marx). A more concentrated improvement of out-patient therapy and rehabilitation of drug addicts is only possible when the chemical-toxicological diagnosis of addicting substances in urine becomes a routine process in the medical laboratory, e.g. by enzyme immunological methods.

Utilization and perceived effectiveness of complementary and alternative medicine in patients with dystonia.

The use of complementary and alternative medicine (CAM) is increasing worldwide, especially by patients with chronic diseases. To date, no data are available about utilization and perceived effectiveness of CAM in patients with dystonia. A questionnaire survey on utilization and costs of CAM was completed by 180 members of the German Dystonia Society, a patient advocate group. In total, 131 dystonia patients (73%) were current or former users of CAM, 55 patients used CAM in addition to botulinum toxin A injections, and 86 patients had experience with three or more CAM methods. The options used most widely were acupuncture (56%), relaxation techniques (44%), homeopathy (27%), and massages (26%). Among users of specific CAM methods, breathing therapy, Feldenkrais, massages, and relaxation techniques were perceived as most effective. On average, patients spent 1,513 Euro on CAM without reimbursement. There was no correlation between costs and perceived effectiveness of different methods. In line with other studies on chronically ill patients, our results show that dystonia patients frequently utilize CAM methods, often in addition to conventional treatment. There is a growing need to evaluate scientifically the effect of CAM methods on symptom severity and quality of life in dystonia, to prevent utilization of costly and ineffective CAM treatments.