In utero drug and alcohol exposure in infants born to mothers prescribed maintenance methadone.

Arch Dis Child Fetal Neonatal Ed. 2013 Jul 8;
McGlone L, Mactier H, Hassan H, Cooper G

To describe the prevalence of in utero alcohol and illicit drug exposure in infants born to mothers prescribed methadone in pregnancy, and to compare the accuracy of maternal interview with infant toxicology.Urine and meconium samples were collected from 56 infants born to mothers prescribed methadone during pregnancy and a confidential interview conducted soon after delivery. Samples were screened for drugs of misuse and meconium samples analysed for the presence of fatty acid ethyl esters (FAEEs) to detect prenatal alcohol exposure.91% of infants had been exposed to illicit drugs in utero, including opiates (73%), benzodiazepines (70%) and cannabinoids (59%). 47% of infants had elevated FAEEs. Meconium was more sensitive at detecting in utero drug exposure than urine toxicology (p<0.01 for opiates, benzodiazepines, cannabinoids) or maternal interview (p=0.03 for opiates, p<0.01 for cannabinoids).The majority of infants born to mothers prescribed methadone during pregnancy are exposed to polysubstance misuse, and almost one-half additionally exposed to excess alcohol. HubMed – Methadone

A Randomized Controlled Trial of the Community-Friendly Health Recovery Program (CHRP) Among High-Risk Drug Users in Treatment.

AIDS Behav. 2013 Jul 9;
Copenhaver MM, Lee IC, Baldwin P

Existing evidence-based HIV risk reduction interventions have not been designed for implementation within clinical settings, such as methadone maintenance programs, where many high-risk drug users seek treatment services. We therefore systematically developed an adapted, significantly shortened, version of a comprehensive evidence-based intervention called the Community-friendly Health Recovery Program (CHRP) which has demonstrated preliminary evidence of efficacy in a feasibility/acceptability study already published. In a randomized controlled trial reported here, we tested the efficacy of the CHRP intervention among high-risk drug users newly enrolled in drug treatment at an inner-city methadone maintenance program. The CHRP intervention produced improvements in drug risk reduction knowledge as well as demonstrated sex- and drug-risk reduction skills. Support was found for the IMB model of health behavior change. Implications for future intervention research and practice are considered.
HubMed – Methadone

Expansion of a PBPK Model to Predict Disposition in Pregnant Women of Drugs Cleared via Multiple CYP Enzymes, Including CYP2B6, CYP2C9 and CYP2C19.

Br J Clin Pharmacol. 2013 Jul 9;
Ke AB, Nallani SC, Zhao P, Rostami-Hodjegan A, Unadkat JD

Conducting PK studies in pregnant women is challenging. Therefore, we asked if a physiologically-based pharmacokinetic (PBPK) model could be used to predict the disposition in pregnant women of drugs cleared by multiple CYP enzymes.We expanded and verified our previously published pregnancy PBPK model by incorporating hepatic CYP2B6 induction (based on in vitro data), CYP2C9 induction (based on phenytoin PK), and CYP2C19 suppression (based on proguanil PK), into the model. This model accounted for gestational age-dependent changes in maternal physiology and hepatic CYP3A, CYP1A2 and CYP2D6 activity. For verification, the pregnancy-related changes in the disposition of methadone (cleared by CYP2B6, 3A and 2C19), and glyburide (cleared by CYP3A, 2C9 and 2C19) were predicted.Predicted mean postpartum to second trimester (PP:T2 ) ratios of methadone AUC, Cmax and Cmin were 1.9, 1.7 and 2.0, vs. observed values 2.0, 2.0 and 2.6, respectively (Pond et al.,1985). Predicted mean postpartum to third trimester (PP:T3 ) ratios of methadone AUC, Cmax and Cmin were 2.1, 2.0 and 2.4, vs. observed values 1.7, 1.7 and 1.8, respectively. Predicted PP:T3 ratios of glyburide AUC, Cmax and Cmin were 2.6, 2.2 and 7.0, vs. observed values 2.1, 2.2 and 3.2, respectively (Hebert et al., 2009).Our PBPK model integrating prior physiological knowledge, in vitro and in vivo data, allowed successful prediction of methadone and glyburide disposition during pregnancy. We propose this expanded PBPK model can be used to evaluate different dosing scenarios, during pregnancy, of drugs cleared by single or multiple CYP enzymes.
HubMed – Methadone

Willingness to pay for methadone maintenance treatment in Vietnamese epicentres of injection-drug-driven HIV infection.

Bull World Health Organ. 2013 Jul 1; 91(7): 475-82
Tran BX

Willingness to pay for methadone maintenance treatment (MMT) in three Vietnamese epicentres of injection-drug-driven human immunodeficiency virus (HIV) infection was assessed.A convenience sample of 1016 patients receiving HIV treatment in seven clinics was enrolled during 2012. Contingent valuation was used to assess willingness to pay. Interviewers reviewed adverse consequences of injection drug use and the benefits of MMT. Interviewers then described the government’s plan to scale up MMT and the financial barriers to scale-up. Willingness to pay was assessed using double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay.A total of 548 non-drug-users and 468 injection drug users were enrolled; 988 were willing to pay for MMT. Monthly mean willingness to pay among non-drug-users, 347 drug users not receiving MMT and 121 drug users receiving MMT was 10.7 United States dollars [US$ ] (35.7% of treatment costs), US$ 21.1 (70.3%) and US$ 26.2 (87.3%), respectively (mean: US$ 15.9; 95% confidence interval, CI: 13.6-18.1). Fifty per cent of drug users were willing to pay 50% of MMT costs. Residence in households with low monthly per capita income and poor health status predicted willingness to pay less among drug users; educational level, employment status, health status and current antiretroviral therapy receipt predicted willingness to pay less among non-drug-users.Willingness to pay for MMT was very high, supporting implementation of a co-payment programme.
HubMed – Methadone

Love London Canada 2013 – I hope you enjoy watching this film as much as we enjoyed creating it! Naturally this film does not encompass ALL of what our beautiful city has to offer. An…

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