Association of Nerve Growth Factor and Vascular Endothelial Growth Factor A with Psychometric Measurements of Opiate Dependence: Results of a Pilot Study in Patients Participating in a Structured Diamorphine Maintenance Program.

Filed under: Methadone Side Effects

Eur Addict Res. 2012 Apr 20; 18(5): 213-219
Heberlein A, Dürsteler-Macfarland KM, Frieling H, Gröschl M, Lenz B, Bönsch D, Kornhuber J, Wiesbeck GA, Bleich S, Hillemacher T

Preclinical study results suggest that neurotrophic peptides like nerve growth factor (NGF) and vascular endothelial growth factor A (VEGF-A) may be associated with symptoms of addictive behavior like withdrawal symptoms and rewarding effects. We investigated alterations in NGF and VEGF-A serum levels in opiate-dependent patients (25 male patients), who received diamorphine (DAM, heroin) treatment within a structured opiate maintenance program, and compared the results with the NGF and VEGF-A serum levels of healthy controls (23 male controls). NGF and VEGF-A serum levels were assessed before and after DAM administration twice a day (in the morning (16 h after last application – t1) and in the afternoon (7 h after last application – t3)) in order to detect a possible immediate or summative (in the afternoon) heroin effect on these two neuropeptides. Moreover, we investigated possible associations between the serum levels of these neurotrophic growth factors and psychometric dimensions of addictive behavior, e.g. craving, withdrawal, depression. Whereas there was no direct effect of DAM application on the serum levels of both neurotrophic growth factors neither in the morning nor in the afternoon, the NGF serum levels of the patient group were found to be significantly increased at all four time points of investigation compared with the healthy controls. In contrast, VEGF-A serum levels did not differ significantly in the patient and control groups. We found a significant positive association between the NGF serum levels and several items of the short opiate withdrawal scale as well as a negative association between self-reported mood (measured by visual analogue scale) and mood before heroin application (in the morning as in the afternoon). Moreover, we found a significant positive association between the NGF serum levels (t1 and t3) and the self-reported craving for methadone. In contrast, we found a negative association between the VEGF-A serum levels and avoidance, anxiety, suicide intentions of the SCL-90 as well as a positive association between the VEGF-A serum levels and the subscales of the heroin craving questionnaire measuring the rewarding effects of heroin. In conclusion, the results of this pilot study show that there might be an association between symptoms of opiate dependence and withdrawal and serum levels of VEGF-A and NGF.
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The influence of living along the U.S.-Mexico border on unintentional drug overdose death, New Mexico (USA), 2005-2009.

Filed under: Methadone Side Effects

Drug Alcohol Depend. 2012 Apr 16;
Shah NG, Lathrop SL, Flores JE, Landen MG

BACKGROUND: The objective of this study was to characterize unintentional drug overdose death patterns among Hispanic ethnicity/sex strata by residence in New Mexico counties that border Mexico and non-border counties. METHODS: We analyzed medical examiner data for all unintentional drug overdose death in New Mexico during 2005-2009. Logistic and Poisson regression was used to examine the relationship of unintentional drug overdose death with border residence and demographics. Risk of overdose death was examined by the interactions of ethnicity, sex and border residence. RESULTS: During 2005-2009, the statewide drug overdose death rate was 17.6 per 100,000 (n=1812). Border decedents were more likely to have died from overdose of prescription opioids other than methadone (Schedule II, Adjusted Odds Ratio (aOR)=1.98; Schedule III/IV, aOR=1.56) but less likely to have died from heroin overdose (aOR=0.35), compared to non-border decedents. In population-based analyses, people living in border counties had lowest rates of overall overdose death and from illicit drugs, particularly heroin and cocaine. Hispanic males (adjusted incidence rate ratio [aRR]=2.41), Hispanic females (aRR=1.77) and non-Hispanic males (aRR=1.37) from non-border counties had higher risk of drug overdose death than their counterparts from border counties. Border residence had no effect on risk of drug overdose death among non-Hispanic females. CONCLUSIONS: Residents in border counties incurred a protective effect for drug overdose death, most pronounced among Hispanics. There is a component of overdose death risk for which border residence is a proxy, likely an array of cultural and healthcare-related factors.
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Availability of Services in Ontario Hospices and Hospitals Providing Inpatient Palliative Care.

Filed under: Methadone Side Effects

J Palliat Med. 2012 Apr 18;
Towns K, Dougherty E, Kevork N, Wiljer D, Seccareccia D, Rodin G, Le LW, Zimmermann C

Abstract Purpose: Most Canadians die in inpatient settings. Our aim was to determine the availability of medical services, programs, and care for common palliative procedures, in hospices, palliative care units (PCUs), and hospital medical wards (MWs) providing inpatient palliative care in Ontario, Canada. Methods: We identified facilities providing inpatient palliative care using the Ontario Hospital Association (OHA) and Hospice Association of Ontario (HAO) websites. An electronic survey was sent to the person responsible for palliative care at each facility. We compared services available among the three types of units, using Fisher’s exact and Kruskal-Wallis tests. Results: Of 128 surveys sent, 102 (80%) were completed and returned, from 58 MWs, 31 PCUs, and 13 hospices. MWs were the most common location of palliative care overall, particularly in rural areas. PCUs were most likely to provide care for common procedures (e.g., tracheostomy, nephrostomy; p<0.01); methadone for pain management (p<0.0001); and palliative radiation (p<0.01). MWs were most likely to offer intravenous chemotherapy and antibiotics (p<0.01). Transfusions were available in most PCUs and MWs, but only in one hospice (p<0.0001). Hospices were most likely to provide complementary therapies. Lack of financial support and human resources were the most frequent perceived barriers to providing quality palliative care. Conclusions: There is considerable variability of available services depending on the setting where inpatient palliative care is provided. Further financial support and resources are required to ensure consistent high quality of care in both urban and rural areas. Source

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