Arterial Thromboembolism: Risks, realities and a rational first-line approach.

Filed under: Methadone Clinics

J Feline Med Surg. 2012 Jul; 14(7): 459-70
Fuentes VL

Practical relevance: Feline arterial thromboembolism (ATE) is a common but devastating complication of myocardial disease, often necessitating euthanasia. A combination of endothelial dysfunction and blood stasis in the left atrium leads to local platelet activation and thrombus formation. Embolisation of the thrombus results in severe ischaemia of the affected vascular bed. With the classic ‘saddle thrombus’ presentation of thrombus in the terminal aorta, the diagnosis can usually be made by physical examination. The prognosis is poor for cats with multiple limbs affected by severe ischaemia, but much better where only one limb is affected or motor function is present. Patient group: Cats with left atrial enlargement secondary to cardiomyopathy are typically predisposed, although cats with hyperthyroidism, pulmonary neoplasia and supravalvular mitral stenosis may also be at risk. Management: Analgesia is the main priority, and severe pain should be managed with methadone or a fentanyl constant rate infusion. Congestive heart failure (CHF) requires treatment with furosemide, but tachypnoea due to pain can mimic signs of CHF. Thrombolytic therapy is not recommended, but antithrombotic treatment should be started as soon as possible. Aspirin and clopidogrel are well tolerated. Evidence base: Several observational studies of ATE have been reported. No randomised, blinded, controlled studies have been reported in cats at risk, for either treatment or prevention of ATE, although such a study comparing aspirin and clopidogrel in cats is currently under way.
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The Role of Perceived Belongingness to a Drug Subculture Among Opioid-Dependent Patients.

Filed under: Methadone Clinics

Psychol Addict Behav. 2012 Jun 25;
Moshier SJ, McHugh RK, Calkins AW, Hearon BA, Rosellini AJ, Weitzman ML, Otto MW

Illicit drug use frequently occurs in a context of a drug subculture characterized by social ties with other drug users, feelings of excitement and effectiveness deriving from illicit activities, and alienation from mainstream society. Identification with this subculture is recognized anecdotally as a barrier to recovery, but clear quantification of individual differences in perceived belongingness to the drug subculture has been absent from the literature. The purpose of this study was to describe the development and psychometric properties of a brief self-report measure designed to assess this construct, the Belongingness to Drug Culture Questionnaire (BDCQ). Ninety-six opioid-dependent, methadone-maintained participants completed the BDCQ, related self-report measures, and assessment of drug use patterns. The BDCQ demonstrated high internal consistency (? = .88) and was significantly associated with self-reported days of drug use in the past 30 days, desire to quit, impulsivity, psychopathy, and social, enhancement, and coping drug use motives. These findings encourage continued psychometric evaluation of the BDCQ and study of the role of belongingness in the development and maintenance of substance use disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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Methadone in combination with acepromazine as premedication prior to neutering in the cat.

Filed under: Methadone Clinics

Vet Anaesth Analg. 2012 Jun 26;
Bortolami E, Murrell JC, Slingsby LS

Objective? To investigate the safety, sedative and analgesic properties of methadone in combination with acepromazine prior to neutering in cats. Study design? Controlled clinical, block randomized, prospective, blinded study designed for regulatory purposes. Animals? 24 female and 21 male healthy cats. Methods? Cats received one of three opioids combined with acepromazine (0.05?mg?kg(-1) ) intramuscularly (IM) for premedication: Group 1: buprenorphine (0.02?mg?kg(-1) ), group 2: methadone (0.5?mg?kg(-1) ), group 3 butorphanol (0.4?mg?kg(-1) ). Sedation was assessed 30?minutes after premedication using a visual analogue scale (VAS) and simple descriptive scale. Anaesthesia was induced with alfaxalone and maintained with isoflurane in oxygen. Surgical ovariohysterectomy or castration was performed. Pain was assessed using an interactive VAS (IVAS) and mechanical nociceptive threshold (MNT) with a pressure rate onset device. Methadone (0.5?mg?kg(-1) IM) and meloxicam (0.2?mg?kg(-1) subcutaneously) were provided 6 and 8?hours after premedication respectively, or together as rescue analgesia (IVAS above 50). Results? Sedation scores, induction agent dose, pain scores at all time points and rescue analgesia were not statistically different between groups. In methadone treated cats there was no significant variation in MNT over time, suggesting a possible anti-hyperalgesic action, whereas in the other two groups lower thresholds were recorded at various time points after surgery compared to baseline. No cats required rescue analgesia after the second dose of methadone. No perioperative adverse effects occurred. Conclusion and clinical relevance? Methadone provided comparable sedation and analgesia to both buprenorphine and butorphanol when combined with acepromazine. Differences in analgesic efficacy between opioids might have been undetectable because of the surgical model and surgeon competency. Nevertheless, methadone is an effective analgesic in cats and its administration prior to feline neutering may be advantageous.
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Risk factors associated with HIV/HCV infection among entrants in methadone maintenance treatment clinics in China: A systematic review and meta-analysis.

Filed under: Methadone Clinics

Drug Alcohol Depend. 2012 Jun 20;
Zhuang X, Wang Y, Chow EP, Liang Y, Wilson DP, Zhang L

Background: Methadone maintenance treatment (MMT) has rapidly expanded in China, from 8 pilot sites to 696 clinics covering 27 provinces, during 2004-2010. This study evaluates the demographic characteristics and drug use behaviors associated with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) infections among MMT entrants through a systematic review and meta-analysis of published literature. Methods: Thirty-nine eligible articles (1 in English and 38 in Chinese) were selected for this review. We extracted the relevant indicator information from all eligible studies and performed meta-analyses, by stratifying according to sex of the participants, age groups and drug use behaviors. Five provinces (i.e., Yunnan, Guizhou, Sichuan, Guangxi and Xinjiang) with the population size of HIV-infected drug users greater than 10,000 were defined as high transmission areas (HTAs) for HIV infection; whereas the remaining twenty-six Chinese provinces were considered as low transmission areas (LTAs). Results: The odds of being infected by HIV among male drug users were significantly higher than for females in high transmission areas (OR=1.49, 95% CI: 1.11-1.99, k=9), while the opposite results were observed in low transmission areas (OR=0.46, 0.27-0.79, k=11). In comparison, no significant differences in risk behaviors were found between sexes in HTAs and LTAs. Younger age was not associated with risk of HIV infection, but was associated with higher risk of HCV infection (<30 years OR=1.88; 30-40 years OR=2.21, compared with >40 years, k=17). Risk of HIV infection was higher among injectors than non-injectors (OR=4.29, 2.70-6.79, k=14) and for those who inject, there was greater risk among sharers than non-sharers (OR=2.47, 1.44-4.23, k=4). Similar patterns were also observed in HCV infection (injectors: OR=10.82, 7.60-15.40; sharers: OR=3.41, 2.56-4.54, k=7). Conclusions: Characteristics of MMT entrants positive for HIV or HCV in China vary by disease types, geographical region, sex, age, and injecting behavior. These factors need to be considered in targeted interventions for MMT participants, such as age-specific health education and psychological treatment, antiretroviral therapy and needle-syringe exchange programs.
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Methadone clinic target of petition

Filed under: Methadone Clinics

A St. Thomas methadone clinic is the target of a petition to remove what its author calls disgraceful clientele off Talbot St. west. Traci Kennedy, a London resident and area singer, started a petition demanding the city run Clinic 217 out of its …
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NS doctor urges methadone alternative

Filed under: Methadone Clinics

A family doctor who treats opiate addicts in Nova Scotia says the province should cover Suboxone, a drug that helps addicts and is safer than methadone. "We really, really need to have Suboxone as a tool in our clinic," Dr. Bob Mullan told CBC on Tuesday.
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