Forced Withdrawal From Methadone Maintenance Therapy in Criminal Justice Settings: A Critical Treatment Barrier in the United States.
Forced withdrawal from methadone maintenance therapy in criminal justice settings: A critical treatment barrier in the United States.
J Subst Abuse Treat. 2013 Feb 21;
Fu JJ, Zaller ND, Yokell MA, Bazazi AR, Rich JD
The World Health Organization classifies methadone as an essential medicine, yet methadone maintenance therapy remains widely unavailable in criminal justice settings throughout the United States. Methadone maintenance therapy is often terminated at the time of incarceration, with inmates forced to withdraw from this evidence-based therapy. We assessed whether these forced withdrawal policies deter opioid-dependent individuals in the community from engaging methadone maintenance therapy in two states that routinely force inmates to withdraw from methadone (N=205). Nearly half of all participants reported that concern regarding forced methadone withdrawal during incarceration deterred them engaging methadone maintenance therapy in the community. Participants in the state where more severe methadone withdrawal procedures are used during incarceration were more likely to report concern regarding forced withdrawal as a treatment deterrent. Methadone withdrawal policies in the criminal justice system may be a broader treatment deterrent for opioid-dependent individuals than previously realized. Redressing this treatment barrier is both a health and human rights imperative.
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Measurement of respiratory system compliance and respiratory system resistance in healthy dogs undergoing general anaesthesia for elective orthopaedic procedures.
Vet Anaesth Analg. 2013 Feb 23;
Bradbrook CA, Clark L, Dugdale AH, Burford J, Mosing M
Objective? The aim of this study was to investigate normal values for the dynamic compliance of the respiratory system (Crs) and respiratory system resistance (Rrs) in mechanically ventilated anaesthetized dogs. Study design? Prospective clinical study. Animals? Forty healthy dogs undergoing elective orthopaedic surgery. Body weight was (mean?±?SD) 26.8?±?10.7?kg (range: 1.9-45.0?kg), age 4.7?± 2.9?years (range: 0.1-10.6?years). Methods? Dogs were premedicated with acepromazine and methadone administered intramuscularly and anaesthesia induced with propofol intravenously. After endotracheal intubation the dog’s lungs were connected to an appropriate breathing system depending on body weight and isoflurane in oxygen administered for maintenance of anaesthesia. The lungs were ventilated mechanically with variables set to maintain normocapnia (end-tidal carbon dioxide concentration 4.7-6.0?kPa). Peak inspiratory pressure, Crs, Rrs, tidal volume, respiratory rate and positive end-expiratory pressure were recorded at 5, 30, 60, 90 and 120?minutes after start of mechanical ventilation. Cardiovascular variables were recorded at time of collection of respiratory data. Results? General additive modeling revealed the following relationships: Crs?=?[0.895?×?body weight (kg)]?+?8.845 and Rrs?=?[-0.0966?×?body weight (kg)]?+?6.965. Body weight and endotracheal tube diameter were associated with Crs (p?HubMed – Methadone
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