Opioid dependence.

Filed under: Methadone Detox

Clin Evid (Online). 2009; 2009:
O’Shea J, Law F, Melichar J

Dependence on opioids is a multifactorial condition involving genetic and psychosocial factors. There are three approaches to treating opioid dependence. Stabilisation is usually by opioid substitution treatments, and aims to ensure that the drug use becomes independent of mental state (such as craving and mood) and independent of circumstances (such as finance and physical location). The next stage is to withdraw (detox) from opioids. The final aim is relapse prevention. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for stabilisation (maintenance) in people with opioid dependence? What are the effects of drug treatments for withdrawal in people with opioid dependence? What are the effects of drug treatments for relapse prevention in people with opioid dependence? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.In this systematic review, we present information relating to the effectiveness and safety of the following interventions: buprenorphine; clonidine; lofexidine; methadone; naltrexone; and ultra-rapid withdrawal regimes.
HubMed – Methadone Detox

Health and human rights concerns of drug users in detention in Guangxi Province, China.

Filed under: Methadone Detox

PLoS Med. 2008 Dec 9; 5(12): e234
Cohen JE, Amon JJ

Although confinement in drug detoxification (“detox”) and re-education through labor (RTL) centers is the most common form of treatment for drug dependence in China, little has been published about the experience of drug users in such settings. We conducted an assessment of the impact of detention on drug users’ access to HIV prevention and treatment services and consequent threats to fundamental human rights protections.Chinese government HIV and anti-narcotics legislation and policy documents were reviewed, and in-depth and key informant interviews were conducted with 19 injection drug users (IDUs) and 20 government and nongovernmental organization officials in Nanning and Baise, Guangxi Province. Significant contradictions were found in HIV and antinarcotics policies, exemplified by the simultaneous expansion of community-based methadone maintenance therapy and the increasing number of drug users detained in detox and RTL center facilities. IDU study participants reported, on average, having used drugs for 14 y (range 8-23 y) and had been confined to detox four times (range one to eight times) and to RTL centers once (range zero to three times). IDUs expressed an intense fear of being recognized by the police and being detained, regardless of current drug use. Key informants and IDUs reported that routine HIV testing, without consent and without disclosure of the result, was the standard policy of detox and RTL center facilities, and that HIV-infected detainees were not routinely provided medical or drug dependency treatment, including antiretroviral therapy. IDUs received little or no information or means of HIV prevention, but reported numerous risk behaviors for HIV transmission while detained.Legal and policy review, and interviews with recently detained IDUs and key informants in Guangxi Province, China, found evidence of anti-narcotics policies and practices that appear to violate human rights and imperil drug users’ health.
HubMed – Methadone Detox

Factors associated with pretreatment and treatment dropouts among clients admitted to medical withdrawal management.

Filed under: Methadone Detox

J Addict Dis. 2007; 26(3): 77-85
Li X, Sun H, Purl A, Marsh DC, Anis AH

The aims of this study were to identify factors associated with pretreatment and treatment dropouts among individuals accessing an inpatient medical withdrawal management program (Vancouver Detox). Two thousand five hundred sixty-six unique clients, who were referred to Vancouver Detox over two-year period, were assessed. Demographic and drug related variables were analyzed as possible risk factors, and two multivariate logistic regression analyses were conducted. We found that being male, being aboriginal, having no children, no fixed address, alcohol as a preferred substance, and being on methadone maintenance treatment at referral were significantly associated with high pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having HCV infection, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on welfare check issue periods or weekends. These findings may help clinicians and decision-makers to initiate corresponding preventive measures to decrease unnecessary attritions and improve utilization of treatment resources.
HubMed – Methadone Detox

Opioid dependence.

Filed under: Methadone Detox

Clin Evid (Online). 2007; 2007:
O’Shea J, Law F, Melichar J

Dependence on opioids is a multifactorial condition involving genetic and psychosocial factors. There are three approaches to treating opioid dependence. Stabilisation is usually by opioid substitution treatments, and aims to ensure that the drug use becomes independent of mental state, such as craving and mood, and independent of circumstances, such as finance, and physical location. The next stage is to withdraw (detox) from opioids. The final aim is relapse prevention. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for stabilisation (maintenance) in people with opioid dependence? What are the effects of drug treatments for withdrawal in people with opioid dependence? What are the effects of drug treatments for relapse prevention in people with opioid dependence? We searched: Medline, Embase, The Cochrane Library and other important databases up to June 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.In this systematic review we present information relating to the effectiveness and safety of the following interventions: buprenorphine, clonidine, lofexidine, methadone, naltrexone, and ultra-rapid withdrawal.
HubMed – Methadone Detox

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