Provider-Initiated HIV Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review.

Filed under: Methadone Treatment

AIDS Behav. 2012 Jul 3;
Kennedy CE, Fonner VA, Sweat MD, Okero FA, Baggaley R, O’Reilly KR

Provider-initiated HIV testing and counseling (PITC) has expanded since 2007 WHO guidelines were established. We conducted a systematic review of PITC in low- and middle-income countries. Peer-reviewed studies were included if they measured pre-post or multi-arm outcomes. Two coders abstracted data using standardized forms. Nineteen studies were included, all from sub-Saharan Africa (N = 15) or Asia (N = 4). Studies were conducted in clinics for antenatal/family planning/child health (N = 12), tuberculosis (N = 4), outpatient (N = 1), sexually transmitted diseases (N = 1), and methadone maintenance (N = 1). HIV testing uptake increased after PITC. Condom use also increased following PITC in most studies; nevirapine uptake and other outcomes were mixed. Few negative outcomes were identified. Findings support PITC as an important intervention to increase HIV testing. PITC’s impact on other outcomes is mixed, but does not appear to be worse than voluntary counseling and testing. PITC should continue to be expanded and rigorously evaluated across settings and outcomes.
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Reduction of the sevoflurane minimum alveolar concentration induced by methadone, tramadol, butorphanol and morphine in rats.

Filed under: Methadone Treatment

Lab Anim. 2012 Jul 2;
Abreu M, Aguado D, Benito J, de Segura IA

This study aimed to estimate the reduction in the minimum alveolar concentration (MAC) of sevoflurane induced by low and high doses of methadone (5 and 10 mg/kg), tramadol (25 and 50 mg/kg), butorphanol (5 and 10 mg/kg) or morphine (5 and 10 mg/kg) in the rat. A control group received normal saline. Sixty-three adult male Sprague-Dawley rats were anaesthetized with sevoflurane (n = 7 per group). Sevoflurane MAC was then determined before and after intraperitoneal administration of the opioids or saline. The duration of the sevoflurane MAC reduction and basic cardiovascular and respiratory measurements were also recorded. The baseline MAC was 2.5 (0.3) vol%. Methadone, tramadol and morphine reduced the sevoflurane MAC (low dose: 31 ± 10, 38 ± 15 and 30 ± 13% respectively; high dose: 100 ± 0, 83 ± 17 and 77 ± 25%, respectively) in a dose-dependent manner. The low and high doses of butorphanol reduced the sevoflurane MAC to a similar extent (33 ± 7 and 31 ± 4%, low and high doses, respectively). Two rats developed apnoea following administration of high-dose butorphanol and methadone. These anaesthetic-sparing effects are clinically relevant and may reduce the adverse effects associated with higher doses of inhalational anaesthetics.
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Cardiorespiratory and neuroendocrine changes induced by methadone in conscious and in isoflurane anaesthetised dogs.

Filed under: Methadone Treatment

Vet J. 2012 Jun 29;
Garofalo NA, Teixeira Neto FJ, Pereira CD, Pignaton W, Vicente F, Alvaides RK

The aim of this study was to compare the cardiorespiratory and neurohormonal effects of methadone in conscious and in isoflurane anaesthetised dogs. Six mature dogs (28.0±3.8kg bodyweight) received intravenous (IV) methadone (1mg/kg) three times, once when conscious and twice during isoflurane anaesthesia (with a wash-out period of 1week). The vasopressin antagonist relcovaptan (0.1mg/kg IV) was administered before the methadone either during the first or second (selected randomly) isoflurane anaesthesia to evaluate the contribution of vasopressin to methadone-associated vasoconstriction. Cardiorespiratory data, plasma catecholamines and serum vasopressin were recorded before (baseline) and for 90min after methadone. Methadone induced dysphoria in all conscious dogs and significantly (P<0.05) increased mean arterial pressure (MAP), catecholamines, and vasopressin concentrations. During anaesthesia, in addition to significantly greater decreases in heart rate (HR) and cardiac index (CI) than during the conscious state, methadone induced apnoea and mechanical ventilation was necessary in all dogs. In anaesthetised animals, methadone administration significantly increased vasopressin concentrations and systemic vascular resistance index (SVRI), while MAP did not differ from baseline. Relcovaptan administration did not modify the increase in SVRI associated with methadone injection during anaesthesia. Increases in plasma catecholamines may account for the slight decreases in HR and CI seen after methadone administration in conscious dogs. In contrast, isoflurane enhanced the intensity of the cardiorespiratory changes induced by methadone. Vasoconstrictive responses associated with methadone did not appear to be induced by vasopressin. Source

Addicts Misusing Drug Treatments

Filed under: Methadone Treatment

Use of methadone is heavily restricted and the drug is commonly dispensed on-site at treatment centers in daily doses. But some doctors are now also prescribing methadone, which contains small amounts of opioids, to treat chronic problems like back …
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Methadone painkiller overdoses kill about 5000 patients a year, CDC warns

Filed under: Methadone Treatment

Methadone is also used to treat heroin addiction, but the CDC report focused only on the 4 million methadone prescriptions written annually for pain relief. “Methadone is riskier than other prescription painkillers,” CDC director Dr. Thomas Frieden …
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