Clonazepam as Agonist Substitution Treatment for Benzodiazepine Dependence: A Case Report.
Clonazepam as agonist substitution treatment for benzodiazepine dependence: a case report.
Case Rep Psychiatry. 2013; 2013: 367594
Maremmani AG, Rovai L, Rugani F, Bacciardi S, Pacini M, Dell’osso L, Maremmani I
Nowadays, the misuse of benzodiazepines (BZDs) is a cause for a serious concern among pharmacologically inexperienced patients, whether treated or untreated, that could lead to significant complications, including tolerance, dependence, and addiction. We present a case report in which an Italian patient affected by anxiety disorder and treated with BZDs presented a severe case of dependence on BZDs. We treated him according to an agonist substitution approach, switching from the abused BZD to a slow-onset, long-acting, high potency agonist (clonazepam), and looking at the methadone treatment model as paradigm. We decided to use clonazepam for its pharmacokinetic properties. The advantage of choosing a slow-onset, long-lasting BZD for the treatment of our patient was that it led us to a remarkable improvement in the clinical situation, including the cessation of craving, absence of withdrawal symptoms, reduced anxiety, improvements in social functioning, and a better cognition level.
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Postmortem blood and tissue concentrations of R- and S-enantiomers of methadone and its metabolite EDDP.
Forensic Sci Int. 2013 Feb 16;
Jantos R, Skopp G
Body fluids and tissues in 16 methadone (MTD)-associated fatalities were investigated to find out whether analysis of MTD and its metabolite 2-ethylidine-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) following enantioselective separation of both compounds may assist in the interpretation of MTD findings. Individual case histories were shortly described. R- and S-MTD as well as R- and S-EDDP concentrations were determined by chiral LC-MS/MS. In all cases under investigation total MTD was present in sufficient quantities to kill or to contribute to death; concentrations were highest in lungs (MTD) and kidneys (EDDP). It appears that both MTD and EDDP undergo postmortem redistribution. In three cases, only the pharmacologically active R-MTD isomer was present. R-MTD mainly contributing to the drug’s pharmacological effects, the enantiomeric ratio of MTD and EDDP may indicate whether MTD intoxication might have contributed to death or not. Further, it may be helpful to establish whether racemic MTD or enantiomerically pure R-MTD has been administered last, especially if R/S-ratios of MTD and EDDP significantly differ. It could be shown, that in vivo racemization occurs for neither MTD nor EDDP in any body fluid or tissue sample. Significantly higher MTD R/S-ratios in femoral and heart blood were present in individuals having participated in a MTD maintenance program. Overall, R/S-ratios of MTD and EDDP allow a more detailed interpretation of analytical results in MTD-associated deaths. Thus, determination of MTD and EDDP by enantioselective methods and calculation of their R/S-ratios should be favored.
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Trends in Opioid Agonist Therapy in the Veterans Health Administration: Is Supply Keeping up with Demand?
Am J Drug Alcohol Abuse. 2013 Mar; 39(2): 103-7
Oliva EM, Trafton JA, Harris AH, Gordon AJ
Background: Opioid agonist therapy (OAT) through addiction specialty clinic settings (clinic-based OAT) using methadone or buprenorphine or office-based settings using buprenorphine (office-based OAT) is an evidence-based treatment for opioid dependence. The low number of clinic-based OATs available to veterans (N = 53) presents a barrier to OAT access; thus, the expansion in office-based OAT has been encouraged. Objectives: To examine trends in office-based OAT utilization over time and whether availability of office-based OAT improved the proportion of veterans with opioid use disorders treated with OAT. Methods: We examined Veterans Health Administration (VHA) administrative data for evidence of buprenorphine prescribing and clinic-based OAT clinic stops from October 2003 through September 2010 [fiscal years (FY) 2004-2010]. Results: The number of patients receiving buprenorphine increased from 300 at 27 facilities in FY2004 to 6147 at 118 facilities in FY2010. During this time, the number of patients diagnosed with an opioid use disorder increased by 45%; however, the proportion of opioid use disorder patients receiving OAT remained relatively stable, ranging from 25% to 27%, Conclusions: Office-based OAT utilization and the number of opioid use disorder veterans treated with OAT are increasing at the same rate over time, suggesting that office-based OAT is being used to meet the growing need for OAT care. Although office-based OAT is increasingly being used within the VHA and may be one way the VHA is keeping up with the demand for OAT, more research is needed to understand how to engage a greater proportion of opioid use disorder patients in treatment.
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