Clonidine Abuse in a Methadone-Maintained, Clonazepam-Abusing Patient.
Clonidine Abuse in a Methadone-Maintained, Clonazepam-Abusing Patient.
J Addict Med. 2013 Mar 20;
Schindler EA, Tirado-Morales DJ, Kushon D
Opiate-Dependent Patients on a Waiting List for Methadone Maintenance Treatment Are at High Risk for Mortality Until Treatment Entry.
J Addict Med. 2013 Mar 20;
Peles E, Schreiber S, Adelson M
OBJECTIVES:: In 2002, our methadone maintenance treatment (MMT) clinic reached full capacity and admission to treatment was delayed for >1 year. In order to evaluate possible impact of the waiting list on mortality risk of the registered patients, we compared survival after the first 2 years, and long-term survival since registration between admitted and not admitted to our MMT (or other treatment facilities) and to those who admitted immediately, before the establishment of the waiting list in 2002. METHODS:: A total of 608 patients registered between 2002 and 2009. Their vital statistics were obtained from the Israeli National Registry (October 2010). RESULTS:: Of the total 608, 366 registrants (60.2%) were admitted to any treatment (194 [53%] to our MMT, 162 [44.3%] to other MMTs and 10 [2.7%] to other facilities) and 242 (39.8%) were not admitted anywhere. Nonadmission to treatment when it became available was due to inability to contact the patient (116, 47.9%), self-reported drug discontinuation (44, 18.2%), refusal to follow regulations (39, 16.1%), imprisonment (27, 11.2%), violent behavior (1, 0.4%), death (13, 5.4%), and other (2, 0.8%). The mortality rate (available among 583) during the 2 years on the waiting list was higher (5.0/100 person years) for the 225 nonadmitted applicants than for the 358 admitted (0.42/100 person years, P < 0.0005) and those who were admitted with no delay before 2002 (2.1/100 person years). The long-term survival between those 3 groups did not differ significantly. CONCLUSIONS:: Opiate addicts are at high risk for mortality during prolonged waiting periods for admission to MMT, indicating an urgent need for immediate expansion of MMT availability. HubMed – Methadone
[Management of opioid maintenance treatments when analgesic treatments are required.]
Presse Med. 2013 Mar 18;
Laprevote V, Geoffroy PA, Rolland B, Leheup BF, Di Patrizio P, Cottencin O, Schwan R
Opioid maintenance treatments (OMT) reduce illicit opiate use and its associated risks. They are often prescribed on a long-term basis. Physiological changes induced by long-term OMT may cause hyperalgesia and cross-tolerance to opioid agonists, which suggests that the dosage of analgesic treatment should be modified in cases of acute pain, especially when an opioid-based analgesia is required. When treatment with analgesics is necessary, OMT must be maintained, except in exceptional cases. If a split-dosing schedule is temporarily employed during OMT, the daily dosage should not be increased for analgesic purposes. Analgesic treatment must be managed differently in case of treatment with buprenorphine or methadone. With buprenorphine, non-opioid analgesics should be introduced first, if possible. If this strategy is inefficient or contraindicated, a temporary or definitive switch to methadone should be considered. In the case of methadone-based OMT, opioid analgesics should be added directly and the dosage should be adapted according to the level of pain reported by the patient.
HubMed – Methadone
Italy’s electronic health record system for opioid agonist treatment.
J Subst Abuse Treat. 2013 Mar 18;
Serpelloni G, Gomma M, Genetti B, Zermiani M, Rimondo C, Mollica R, Gryczynski J, O’Grady KE, Schwartz RP
Electronic health record systems (EHRs) play an increasingly important role in opioid agonist treatment. In Italy, an EHR called the Multi Functional Platform (MFP) is in use in 150 opioid-agonist treatment facilities in 8 of Italy’s 23 regions. This report describes MFP and presents 2010 data from 65 sites that treated 8145 patients, of whom 72.3% were treated with methadone and 27.7% with buprenorphine. Patients treated with buprenorphine compared to methadone were more likely to be male (p<.01) and younger (p<.001). Methadone compared to buprenorphine patients had a higher percentage of opioid-positive urine tests (p<.001) and longer mean length of stay (p=.004). MFP has been implemented widely in Italy and has been able to track patient outcomes across treatment facilities. In the future, this EHR system can be used for performance improvement initiatives. HubMed – Methadone
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