Respiratory failure caused by a suspicious white powder: a case report of intentional methadone poisoning in an infant.

Filed under: Methadone Detox

Pediatr Emerg Care. 2012 Sep; 28(9): 918-20
Siew LT, Auerbach M, Baum CR, Pavlovic L, Leventhal JM

ABSTRACT: Methadone exposures in children have increased as the drug has gained more prevalence in the treatment of adult narcotic dependency. Previous literature concerning pediatric methadone ingestion has focused primarily on unintentional ingestions. We describe a 2-month-old male infant presenting with respiratory failure from suspected intentional methadone administration. The infant was born to a mother with narcotic dependency and at birth was treated for neonatal abstinence syndrome. After discharge for neonatal abstinence syndrome treatment, the infant continued to be fussy and persistently irritable. We believe the infant was intentionally given methadone at home by his mother for these symptoms. It is important for pediatric providers to be vigilant of households with methadone present. Family-centered education on prevention of methadone ingestion (eg, safe storage) and anticipatory guidance on the signs, symptoms, and treatment of toxicity are key.
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Association between harm reduction intervention uptake and recent hepatitis C infection among people who inject drugs attending sites that provide sterile injecting equipment in Scotland.

Filed under: Methadone Detox

Int J Drug Policy. 2012 Aug 31;
Allen EJ, Palmateer NE, Hutchinson SJ, Cameron S, Goldberg DJ, Taylor A

BACKGROUND: Prevalence of the hepatitis C virus (HCV) among people who inject drugs (PWID) in Scotland is high. The Scottish Government has invested significantly in harm reduction interventions with the goal of reducing HCV transmission among PWID. In evaluating the effectiveness of interventions, estimates of HCV incidence are essential. METHODS: During 2008-2009, PWID were recruited from services providing sterile injecting equipment across mainland Scotland, completed an interviewer-administered questionnaire and provided a dried blood spot for anonymous anti-HCV and HCV-RNA testing. Recent infections were defined as anti-HCV negative and HCV-RNA positive. Logistic regression was undertaken to examine associations between recent HCV infection and self-reported uptake of methadone maintenance therapy (MMT) and injection equipment. RESULTS: Fifty-four percent (1367/2555) of participants were anti-HCV positive. We detected 24 recent HCV infections, yielding incidence rate estimates ranging from 10.8 to 21.9 per 100 person-years. After adjustment for confounders, those with high needle/syringe coverage had reduced odds of recent infection (adjusted odds ratio [AOR] 0.32, 95% CI 0.10-1.00, p=0.050). In the Greater Glasgow & Clyde region only, we observed a reduced odds of recent infection among those currently receiving MMT, relative to those on MMT in the last six months but not currently (AOR 0.04, 95% CI 0.001-1.07, p=0.055). The effect of combined uptake of MMT and high needle/syringe coverage was only significant in unadjusted analyses (OR 0.34, 95% CI 0.12-0.97, p=0.043; AOR 0.48, 95% CI 0.16-1.48, p=0.203). CONCLUSION: We report the first large-scale, national application of a novel method designed to determine incidence of HCV among PWID using a cross-sectional design. Subsequent sweeps of this survey will increase statistical power and allow us to gauge the impact of preventive interventions.
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Effect of dexmedetomidine vs. acepromazine-methadone premedication on limb to lung circulation time in dogs.

Filed under: Methadone Detox

Vet J. 2012 Aug 29;
Rocchi A, Ambrisko TD, Moens Y

The study compared limb-to-lung circulation times (CT) in dogs under general anaesthesia after premedication with dexmedetomidine (DEX) or acepromazine-methadone (ACE-M). Healthy male and female dogs (n=20) were randomly assigned to receive acepromazine 0.04mg/kg and methadone 0.2mg/kg intramuscularly (IM), or DEX 0.01mg/kg IM. Anesthesia was induced with propofol and maintained with isoflurane at similar concentration in both groups. Mechanical ventilation was started immediately (20breaths/min; inspiratory to expiratory ratio 1:2) and tidal volume was adjusted to achieve an end-tidal CO(2) concentration (PE’CO(2)) of between 3.9 and 5.3kPa. Ten minutes later arterial blood gas was analyzed and baseline data recorded for 3 minutes. A single dose of sodium bicarbonate 0,5mEq/kg was administered intravenously over 10 s starting with inspiration. Limb-to-lung CT was defined as the time interval between the start of bicarbonate injection and the recording of the highest PE’CO(2). Following bicarbonate administration, PE’CO2 increased, and then rapidly decreased to baseline in both groups. CT was shorter in the ACE-M group (20±2.3 vs. 27±5.1s). Bodyweight was higher in the ACE-M group (30.6±3.9 vs. 23.3±6.8kg). Mean arterial blood pressure was higher in the DEX group (92±9 vs. 73±7mmHg) but premedication with DEX significantly prolonged CT compared to premedication with ACE-M.
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Who prescribes buprenorphine for rural patients? The impact of specialty, location and practice type in Washington State.

Filed under: Methadone Detox

J Subst Abuse Treat. 2012 Aug 29;
Kvamme E, Catlin M, Banta-Green C, Roll J, Rosenblatt R

We determined the specialty, geographic location, practice type and treatment capacity of waivered clinicians in Washington State. We utilized the April 2011 Drug Enforcement Agency roster of all waivered buprenorphine prescribers and cross-referenced the data with information from the American Medical Association and online resources. Waivered physicians, as compared to Washington State physicians overall, are more likely to be primary care providers, be older, less likely to be younger than 35years, and more likely to be female. Isolated rural areas have the lowest provider to population ratios. Ten counties lack either a buprenorphine provider or a methadone clinic. In rural areas, waivered physicians work predominately in federally-subsidized safety-net settings, which underscores the need for continued governmental support of primary care and mental health in these settings.
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Susan Dalgety: Going green is killing us

Filed under: Methadone Detox

The Centre for Policy Studies think-tank has called the methadone programme “nationalised drug dealing”. It suggests that real recovery will only come from residential detox and abstinence-based rehabilitation, as does the National Treatment Agency for …
Read more on Scotsman

Addiction treatment centre opens downtown

Filed under: Methadone Detox

It will provide assessments and treatment, as well as referrals for detox and rehabilitation, Paula Langdon, nurse manager and addictions specialist, told The Mirror. Despite rumours floating around to the … “Are we a methadone clinic? I think that …
Read more on The Barrie Advance

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