Perinatal Effects of Combined Use of Heroin, Methadone, and Amphetamine during Pregnancy and Quantitative Measurement of Metabolites in Hair.

Filed under: Methadone Clinics

Pediatr Neonatol. 2012 Apr; 53(2): 112-7
Su PH, Chang YZ, Yang C, Ng YY, Chen JY, Chen SC

There has been very limited research on the clinical features of newborns exposed to combined use of heroin, methadone, and amphetamine in the uterus. We describe a technique for the quantification of drug metabolites in neonatal hair samples.In a tertiary neonatal care center in Taiwan, three neonates whose mothers self-reported heroin abuse with methadone treatment during pregnancy were studied. Involuntary exposure to amphetamine was not suspected before the births. To assess long-term illicit drug exposure during pregnancy, a quantifying technique of gas chromatography/mass spectrometry (GC/MS) for hair samples from neonates was developed to replace current methods for urine and blood specimens.All three mothers were addicted to heroin and prescribed oral methadone treatment during pregnancy. Two males and one female were born and then admitted to the neonatal intensive care unit because of apparent neonatal abstinence syndrome (NAS) after birth. Additional hypertonicity and cerebral dysfunction were also diagnosed by electroencephalography in one case. Supportive care was given to the neonates, unless special treatments were needed in responding to tachypnea, fetal distress, or withdrawal symptoms. During follow-up periods from 10 months to 15 months, the signs of NAS remained and delays in milestones of development were observed. Further follow-up on the infants’ neurobehavioral development is necessary. Measurement results of neonates’ hair samples revealed high levels of metabolites of heroin, methadone, and amphetamine, reflecting the amount of illicit drug exposure 2-3 months before delivery.The current study suggested the possibility of polydrug exposure, which was previously unknown in pregnant women in Taiwan. Measurement of neonatal hair samples could provide a basis for clinical evaluation and potential corresponding treatment.
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Comparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery.

Filed under: Methadone Clinics

Acta Anaesthesiol Taiwan. 2012 Mar; 50(1): 19-24
Khezri MB, Yaghobi S, Hajikhani M, Asefzadeh S

To compare the analgesic efficacy and side effects of magnesium and fentanyl as an additive to intrathecal bupivacaine.Ninety adult patients scheduled for femur surgery under spinal anesthesia were randomly allocated to one of the following three groups to receive intrathecally: bupivacaine 15 mg combined with 0.5 mL magnesium 10%; bupivacaine 15 mg combined with 0.5 mL fentanyl; or bupivacaine 15 mg combined with 0.5 mL distilled water (control). The time to first analgesic request, sensory and motor blockade onset time, duration of sensory and motor blockade, analgesic requirement in the first 12 hours after surgery, and the incidences of hypotension, bradycardia, hypoxemia and ephedrine were recorded.Magnesium caused a significant delay in the onset of both sensory and motor blockade compared with the fentanyl (95% CI 3 to 4; p < 0.001) and control (95% CI 3.5-5; p < 0.001) groups. The duration of spinal analgesia in group F (fentanyl) was significantly greater than in group C (control) (95% CI 365-513; p < 0.001) and group M (magnesium) (95% CI 385-523; p < 0.001). The total amount of methadone consumption over 12 hours was significantly lower in the magnesium and fentanyl groups than in the control group (5 mg vs. 5.666 ± 1.728 mg; p = 0.04).Addition of intrathecal magnesium sulfate to spinal anesthesia induced by bupivacaine significantly prolonged the onset of both sensory and motor blockade compared with fentanyl. Although magnesium failed to prolong the time to first analgesic requirement as seen with fentanyl, it reduced the total consumption of opioids in the first 12 hours postoperatively compared with the control group. Source

White Matter Abnormalities Correlating with Memory and Depression in Heroin Users under Methadone Maintenance Treatment.

Filed under: Methadone Clinics

PLoS One. 2012; 7(3): e33809
Lin WC, Chou KH, Chen CC, Huang CC, Chen HL, Lu CH, Li SH, Wang YL, Cheng YF, Lin CP

Methadone maintenance treatment (MMT) has elevated rates of co-morbid memory deficit and depression that are associated with higher relapse rates for substance abuse. White matter (WM) disruption in MMT patients have been reported but their impact on these co-morbidities is unknown. This study aimed to investigate changes in WM integrity of MMT subjects using diffusion tensor image (DTI), and their relationship with history of heroin and methadone use in treated opiate-dependent individuals. The association between WM integrity changes from direct group comparisons and the severity of memory deficit and depression was also investigated. Differences in WM integrity between 35 MMT patients and 23 healthy controls were evaluated using DTI with tract-based spatial statistical analysis. Differences in DTI indices correlated with diminished memory function, Beck Depression Inventory, duration of heroin use and MMT, and dose of heroin and methadone administration. Changes in WM integrity were found in several WM regions, including the temporal and frontal lobes, pons, cerebellum, and cingulum bundles. The duration of MMT was associated with declining DTI indices in the superior longitudinal fasciculus and para-hippocampus. MMT patients had more memory and emotional deficits than healthy subjects. Worse scores in both depression and memory functions were associated with altered WM integrity in the superior longitudinal fasciculus, para-hippocampus, and middle cerebellar peduncle in MMT. Patients on MMT also had significant WM differences in the reward circuit and in depression- and memory-associated regions. Correlations among decreased DTI indices, disease severity, and accumulation effects of methadone suggest that WM alterations may be involved in the psychopathology and pathophysiology of co-morbidities in MMT.
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Methadone clinic coming to Covington, despite city's fight against it

Filed under: Methadone Clinics

City officials in Covington have tried to stop a methadone clinic from moving to their city to no avail. After months in court NKY Med LLC has won the battle to put its drug addiction clinic at the former Sav-A-Lot location at 1717 Madison Avenue.
Read more on FOX19

Proposed Duluth methadone clinic loses Minnesota's OK

Filed under: Methadone Clinics

The Minnesota Department of Human Services commissioner has overruled a previous decision by her department, denying the Superior Treatment Center a “determination of need” — a required component to open a second methadone treatment clinic in Duluth.
Read more on Duluth News Tribune

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