Health care service utilization and associated factors among heroin users in northern Taiwan.

Addict Behav. 2013 Jul 10; 38(11): 2635-2638
Chen YC, Chen CK, Lin SK, Chiang SC, Su LW, Wang LJ

Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2±8.3years) who entered two psychiatric hospitals (N=83) and a detention center (N=41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit.
HubMed – Methadone

White matter impairment in chronic heroin dependence: A quantitative DTI study.

Brain Res. 2013 Jul 26;
Li W, Li Q, Zhu J, Qin Y, Zheng Y, Chang H, Zhang D, Wang H, Wang L, Wang Y, Wang W

Exposure to addictive drugs has been associated with disrupted brain white matter integrity. A few studies have examined the white matter deficits in heroin users; however, the results were influenced by the use of substitution drugs such as methadone and buprenorphine. The present study assessed the alteration in white matter integrity and heroin-related neuropathology in heroin dependents who had not received any replacement therapy using quantitative diffusion tensor imaging (DTI). The study comprised 17 heroin-dependent (HD) subjects and 15 matched healthy controls (HC). Fractional anisotropy (FA) and eigenvalues (??,?||) of white matter in the whole brain were measured and compared using a voxel-based analysis. The correlation between DTI measurements in identified regions and history of heroin exposure was tested by partial correlation analysis. Compared with HCs, HD subjects displayed decreased FA in the bilateral frontal lobe sub-gyrus, cingulate gyrus, medial frontal gyrus, extra-nuclear, left temporal lobe sub-gyrus and right superior frontal gyrus. Among these regions, the HD group had significantly increased ?? in the bilateral frontal lobe sub-gyrus, cingulate gyrus and extra-nuclear relative to the HC group. There were no group differences in ?||. In addition, there were no significant correlations between duration of heroin use or accumulated dosage and FA or ?? values. In conclusion, chronic heroin-dependent subjects had widespread disruption of white matter structural connectivity located mainly in anterior and superior regions of the brain. Damage to myelin other than axons was the primary pathological feature in the brain of the heroin user.
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Sitting Time, But Not Level Of Physical Activity, Is Associated With Depression In Methadone-Maintained Smokers.

Ment Health Phys Act. 2013 Mar 1; 6(1): 43-48
Stein MD, Caviness CM, Anderson BJ, Abrantes A

Sedentary behavior has been linked to many physical and mental health disorders including heightened risk for depression. Methadone-maintained individuals are at increased risk for depression and have been shown to be physically active at lower rates than the general population.We assessed the relationship between sitting time, physical activity, and depression in a group of 315 methadone-maintained smokers.Mean participant age was 39.9 years of age, 49.5% were male, and 79.4% were non-Hispanic White. The mean time reported sitting each day was 320.4 minutes and the mean CES-D depression score was 12.0. After controlling for background characteristics, physical function, and physical activity, depression was significantly and positively related to sitting time.Interventions to decrease time spent sitting and increase physical activity could have important benefits for the mental health of methadone-maintained individuals. This population is often underserved and suffers disproportionately from limited physical and mental health functioning, making them an ideal population for low-cost interventions to reduce sitting time and/or increase physical activity to improve well-being.
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Evaluation of metabolite/drug ratios in blood and urine as a tool for confirmation of a reduced tolerance in methadone-related deaths in Denmark.

Drug Alcohol Depend. 2013 Jul 24;
Nielsen MK, Johansen SS, Linnet K

Methadone blood concentrations in fatal cases are highly variable and there is an appreciable overlap between therapeutic methadone concentrations and the concentrations detected in fatalities. As with other opioids, the background of these methadone-related deaths is unclear. The aim of this study was to investigate if short-time abstinence was contributing to the cause of death in methadone-related deaths by evaluation of the EDDP/methadone ratio in blood and urine.Samples of blood and urine were collected from 103 autopsy cases and analysed for the concentrations of methadone and its main metabolite EDDP. The cases were divided into three groups according to the cause of death: cases where methadone was the cause of death (N=67), cases where poly-drug poisoning including methadone was the cause of death (N=24) and cases where death were caused by other factors (N=12). Urine samples from 11 living persons receiving methadone were also included.In general, a substantial overlap of the methadone concentrations in blood and urine was seen between the groups. There was a tendency of lower median EDDP/methadone urinary ratios in the methadone poisoning group (median: 1.0), poly-drug poisoning group (median: 0.94) and in the fatalities not related to methadone (median: 1.1) compared to the living subjects in methadone treatment (median: 1.6), although the differences were not significant.It was not possible to reveal a possible abstinence period prior to death by using the EDDP/methadone ratio in blood and urine in methadone-related deaths.
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Estimating the proportion of prescription opioids that is consumed by people who inject drugs in Australia.

Drug Alcohol Rev. 2013 Jul 25;
Degenhardt L, Gilmour S, Shand F, Bruno R, Campbell G, Mattick RP, Larance B, Hall W

To estimate the contribution that people who inject drugs (PWID) make to population-level use of prescription opioids in Australia.Data on prescriptions of oxycodone, morphine and methadone tablets were obtained for New South Wales, Victoria, Tasmania and Queensland, and time series analyses used to characterise the trends from 2002 to 2010. Estimates of the number of PWID were combined with data on their levels, frequency and typical doses of morphine, methadone tablet (only prescribed in Australia for pain) and oxycodone from 2004 to 2010. Estimated consumption per 1000 PWID and per 1000 persons aged 20-69 years was contrasted and the proportion of total consumption accounted for by PWID estimated.Morphine prescribing declined; oxycodone prescribing increased. PWID had far higher rates of prescription opioid consumption (defined daily doses per 1000) than the general population. Tasmania had highest use of prescribed opioids. PWID contribution to morphine consumption in Tasmania increased to 28% (range 22-37%) in 2010; elsewhere, PWID contribution was lower (midpoints of 2-12%, 2010). Methadone tablet use was less elevated compared with the general population. With the exception of Tasmania, PWID were estimated to consume less than 5% of oxycodone.PWID use prescription opioids at high levels and can account for a significant proportion of consumption. Increased oxycodone prescribing in Australia has not been driven by PWID. Opioid substitution therapy and other effective treatments need to be more available and attractive to PWID. [Degenhardt L, Gilmour S, Shand F, Bruno R, Campbell G, Mattick RP, Larance B, Hall W. Estimating the proportion of prescription opioids that is consumed by people who inject drugs in Australia. Drug Alcohol Rev 2013].
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