Opiate agonists and antagonists modulate taste perception in opiate-maintained and recently detoxified subjects.

J Psychopharmacol. 2013 Jan 29;
Green A, Kaul A, O’Shea J, Sharma E, Bennett L, Mullings EL, Munafò MR, Nutt DJ, Melichar JK, Donaldson LF

Heroin addicts consume large quantities of refined sugars. This study investigated the effect of opiate use and antagonism on sweet taste in opiate-maintained drug users and detoxified former chronic opiate users, using a within-subject design.Seven opiate users received methadone and seven buprenorphine maintenance. Six detoxified subjects received naltrexone. Sucrose recognition thresholds and measurements of pleasantness and intensity were determined before and four hours after 1) a single dose of methadone or buprenorphine or 2) naltrexone. Control data were taken from a cohort of healthy volunteers including smokers.All measures of sweet and salt taste perception were significantly greater in opiate users and recently detoxified subjects compared to control subjects, with the exception of sweet pleasantness, which returned to control level after detoxification. Acute methadone administration reduced salt thresholds and unpleasantness to control levels. Increased sweet thresholds and salt unpleasantness in detoxified subjects were reversed by acute opioid antagonism, returning to control levels. These results suggest that opiate use and antagonism alters taste perception. Some of the alterations reverse on detoxification (sweet pleasantness), and others can be reversed by opioid antagonism (sweet threshold, salt unpleasantness). Changes in taste perception may underlie altered consumption of refined sugars in opiate users.
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[Effectiveness of intervention services provided by social workers in methadone maintenance treatment clinics].

Zhonghua Yu Fang Yi Xue Za Zhi. 2012 Nov; 46(11): 999-1003
Gu J, Zhao YT, Zhong Y, Xu CJ, Pan WL, Fan LR, Xu HF, Wang M

To investigate the effectiveness of psychosocial services provided by social workers in reducing dropout rate and increasing treatment dosage in methadone maintenance treatment (MMT) users.From May in 2009 to April in 2010, 300 MMT users were recruited from three MMT clinics in Guangzhou, and were randomly allocated into the intervention group and the control groups. The control group (152 cases) received standard MMT services while the intervention group (148 cases) received additional services provided by social workers. Methadone dosage, dropout rate, perceptions toward MMT etc. were compared between the two groups.The 1-month dropout rate of the control and intervention groups were 19.7% (30/152) and 6.8% (10/148) (P < 0.05) respectively; the 6-month dropout rate of the control and intervention groups were 75.5% (115/152) and 50.7% (75/148) (P < 0.05) respectively. The intervention group had higher average treatment dosage than the control group ((56.0 ± 21.2) vs (64.4 ± 23.1) ml/d, (58.0 ± 24.0) vs (66.1 ± 26.6) ml/d, P < 0.05). At 1-month and 6-month, the intervention group had higher scores of MMT-related perception ((1.26 ± 0.68) vs (1.84 ± 0.95), (1.55 ± 0.83) vs (2.44 ± 1.23), P < 0.05), self-efficacy of maintenance ((3.68 ± 1.33) vs (4.20 ± 1.05), (3.80 ± 1.38) vs (4.43 ± 0.79), P < 0.05) and satisfaction toward MMT((4.08 ± 0.54) vs (4.15 ± 0.60), (4.01 ± 0.67) vs (4.31 ± 0.64), P < 0.05) as compared to the control group. The reverse was true for the score of negative experiences ((1.05 ± 0.86) vs (0.96 ± 0.92), (1.46 ± 0.87) vs (1.11 ± 1.07), P < 0.05).The psychosocial interventions provided by social workers were effective in reducing dropout rate, increasing treatment dosage and improving cognitions of MMT users. HubMed – Methadone

[Characteristics and associated factors of long-term retention for methadone maintenance treatment patients].

Zhonghua Yu Fang Yi Xue Za Zhi. 2012 Nov; 46(11): 995-8
Cao XB, Wu ZY, Rou KM, Pang L, Luo W, Wang CH, Yin WY, Li JH,

To describe the characteristics and factors associated with long-term retention for methadone maintenance treatment (MMT) patients.This study was conducted in eight MMT clinics located in Sichuan, Yunnan, Guangxi, Guizhou and Zhejiang provinces. Five hundred and thirty-nine MMT patients who enrolled in MMT clinics in 2004 and retained in treatment by June 2010 were selected as study subjects. Chi-square tests were used to compare the demographics and drug abuse history at enrollment and treatment characteristics during the follow-up period between continuous treatment patients and discontinuous treatment patients.Of the 539 patients, 110 (20.4%) were continuous treatment patients whereas 429 (79.6%) were discontinuous treatment patients. Of these 429 discontinuous treatment patients, 84.1% (361/429) had 2-4 treatment episodes whereas 15.9% (68/429) had 5 or more episodes during follow-up period. When continuous treatment patients were compared with discontinuous treatment patients, living with family members or friends (88.2% (97/110), 78.5% (337/429)), age of first drug use under 25 (61.8% (68/110), 71.3% (306/429)), low urine morphine positive test results (67.3% (74/110), 38.2% (164/429)) and living within 5 kilometers of the MMT clinic (72.7% (80/110), 61.3% (263/429)) were positively associated with higher possibility of continuous treat retention (P < 0.05). Demographics and drug abuse characteristics at enrollment, including gender, age, employment status, family relationship, injection, needle sharing, criminal behavior, contacts with drug users, MMT daily dosage and family members receiving MMT were not significantly associated with treatment retention (P > 0.05).Illicit drug use during the treatment and longer distance travelling to MMT clinic might have negative impact on patients’ continuous treatment retention. Mobile MMT vehicles and expanded MMT service sites could be introduced to improve compliance of treatment retention of MMT patients.
HubMed – Methadone

When grammars collide: Harm reduction, drug detention and the challenges of international policy reform efforts in Vietnam.

Glob Public Health. 2013 Jan 30;
Edington C, Bayer R

Abstract Throughout the 1990s, a dramatic rise in HIV prevalence rates among drug users in Vietnam attracted the attention of international observers concerned about the prospect of a more generalised epidemic. Vietnam subsequently became the target of extensive funding and advocacy which sought to introduce needle exchange and methadone in a country where drug use was considered a ‘social evil’, and drug users were subjected to what international observers viewed as draconian incarceration measures. What were the goals of proponents of harm reduction when they came to Vietnam? How did they perceive the state of prevailing approaches to drug users in the context of the Vietnamese HIV epidemic? How did they understand the strategic challenges they faced and the dilemmas they had to confront? Based on in-depth interviews with international harm reduction proponents working in Vietnam, this paper explores the encounter of two grammars of harm reduction, one based on broadly accepted international approaches, the other rooted in Vietnam’s own history and politics. From this encounter a set of policies and practices characterised by needle exchange and methadone maintenance emerged, as well as an extensive network of closed centres where tens of thousands of drug users are currently detained.
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