Methadone Substitution Treatment Research Articles

HEPATITIS B, HEPATITIS C AND HIV AMONG DRUG USERS IN METHADONE MAINTENANCE TREATMENT: PREVALENCE, DOSES, TREATMENT COMPLIANCE

TheUsersofopioidsubstances,especiallyinjectingdrugs,areathighriskofinfection with blood- borne viruses,such as hepatitis B,C and human immunodeficiency virus, due to the sharing of needles and injection equipment. Methadone substitution treatment is approven device in the risk reduction strategy of hepatitis B,C and HIV infection.The aim of this studyis to determine: the socio-demographic and medical psychiatric characteristics of patients with hepatitis B,C and HIV under methadone,the prevalence of hepatitis C,B and HIV,the dose of methadone and compliance with treatment in this population. Materials and methods: This is a retrospective descriptive study of patients admitted to the center of addictology at the hospital Ar-razi of Sale in Morocco , specifically in methadone unit. Results: The prevalence of hepatitis C, B and HIV were respectively 80%, 13% and 4% in patients with positive serology, the average dose of methadone was higher than the dose of all patients enrolled in the methadone program. 80% of patients under methadone with positive serology to HCV, HBV and HIV had a polyconsumption of psychoactive substances (cannabis, cocaine, alcohol, benzodiazepine). 72% of our patients with hepatitis C received treatment for their infection while all the patients with HIV were put on antiretroviral drugs with good therapeutic compliance. Conclusion:Methadone substitution therapy has proven to be a successful strategy to reduce the risk of HIV, HCV and HBV infection in opioid-dependent patients. However, the adjustment of methadone doses and systematic screening for HIV, HCV and HBV is essential in this vulnerable population.

GC-MS Analysis of Methadone and EDDP in Addicted Patients under Methadone Substitution Treatment: Comparison of Urine and Plasma as Biological Samples

(1) Background: Methadone, along with buprenorphine, is the most commonly used drug for the treatment of opioid dependence. This study aimed to analyze methadone and its major metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenyl pyrrolidine (EDDP), in the urine and plasma of opiate addicts. The study group consisted of drug users voluntarily admitted to the detoxification center C.E.T.T.T. "St. Stelian" of Bucharest. Secondly, the study aimed to identify whether urine or plasma provides better results for the proposed method. (2) Methods: A GC-MS method, using an internal standard (diphenylamine) in the FULL-SCAN and SIM modes of operation and using the m/z = 72 ion for methadone and the m/z = 277 ion for EDDP, combined with a liquid-liquid extraction procedure was performed. (3) Results: The applied procedure allows the detection and quantification of methadone in both urine and plasma samples. EDDP was identified in patients with higher levels of methadone. Higher levels of methadone were detected in urine than in plasma samples. (4) Conclusions: This procedure can be used in clinical laboratories for the rapid determination of methadone levels in urine rather than in plasma. The procedure can be applied for the monitoring of methadone substitution treatment.

Assessment of the Quality of Services Offered to Heroin Users Under Methadone by the Dakar Center for Integrated Addiction Care (CEPIAD)

Drug addiction is a major public health problem in Senegal. One of the responses has been the establishment of a Center for Integrated Addiction Care in Dakar (CEPIAD). The objective of this study is to evaluate the quality of services offered to heroin users under methadone substitution treatment. This is a descriptive cross-sectional study based on a systematic sampling of one hundred (100) heroin users under methadone substitution treatment who had given their consent. Individual interviews were conducted with patients regularly followed at the center from December 16, 2016 to February 17, 2017. Data were entered and analyzed using Epi-info and Excel software. There was a male predominance with 92 males and 8 females (sex ratio of 11.5). The average age was 48.8 years with a standard deviation of 9.7. The vast majority of respondents were Senegalese (99%), with 78% living in the city and 22% in the suburbs of Dakar. The vast majority were single, divorced or widowed (61%). The level of education was relatively high; 11% had a university level, 47% a high school level, 31% an elementary school level, and only 1 person had no schooling. Among the respondents, 39 were unemployed, 1 was a housewife, 5 were retired; the other 55 had an income-generating activity, including 42 in the informal sector. All of the respondents were satisfied and had access to risk reduction materials for sexually transmitted infections (RDR). The 80 respondents participate regularly in social activities such as talks, community meals, etc. The other 20 do not have the time to participate. Methadone is delivered from 9:00 a.m. to 1:00 p.m. on weekdays. Only 57 respondents were satisfied with the schedule. The 28% of heroin addicts said they were very satisfied with the methadone program and 70 were moderately satisfied and asked for the possibility of taking a week's supply. The single use of the cups reserved for the oral administration of methadone was requested by 2% of patients. Heroin addicts are generally satisfied, but it is necessary to insist on awareness raising, information and withdrawal. It is important to extend CEPIAD's activities to other regions and, above all, to help heroin addicts get a socioprofessional reintegration.

Hepatitis C treatment uptake among patients who have received methadone substitution treatment in the Republic of Georgia

ObjectivesThere is a dearth of research on hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWIDs) and receive methadone substitution treatment (MST) in Eastern Europe and Central Asia countries. This study contributed to addressing that gap. We examined and identified factors that may affect HCV treatment uptake among PWID who received MST in the Republic of Georgia. Study designThe design of the study is retrospective cohort study. MethodsWe conducted HCV care cascade analysis by matching the data from the web-based national hepatitis C program registry (ELIM C) and the MST treatment database between January 1, 2015, and December 31, 2018. Using the World Health Organization's (WHO) Consensus HCV cascade of care (CoC) global instrument, we assessed the progress made toward the country's 2020 and WHO's 2030 hepatitis C elimination targets for the subpopulation of MST patients. ResultsOverall, 10,498 individuals have been dispensed methadone during the study period. A total of 6828 MST beneficiaries had HCV screening, of whom 5843 (85.6%) tested positive; 5476 (93.7%) were tested for HCV viremia, and 5275 (96.3%) were confirmed with chronic HCV infection. More than 75% (n = 4000) of HCV-infected MST patients initiated HCV treatment, and 3772 (94.3%) completed the treatment. Of those eligible for sustained virologic response assessment, 71.0% (2641/3715) were evaluated, and the reported cure rate was 96.1% (2537). The study found the odds of patients starting HCV treatment differed by the type of facility they were screened at and whether they were registered as PWID at the screening sites. The patients screened at centers with integrated HCV treatment services had higher treatment uptake rates than those screened at other centers. ConclusionsAs the cumulative HCV treatment uptake and cure rates among MST patients with HCV infection are high (75.8% and 96.1%, respectively), the MST patients might become the first microelimination target population in which hepatitis C elimination will be achieved in Georgia. The study found the type of screening facility and whether MST patients registered themselves as PWID or not had significant effects on MST patients starting HCV treatment. At the same time, the study did not find gender and age to be significant predictors of MST patients starting HCV treatment. MST patients used different types of health facilities to get screened for HIV. Many of them did not register themselves as PWID when screened for HIV. The existence of only a few harm reduction sites with integrated HCV treatment services, a high level of stigma, and the criminalization of drug use might have incentivized MST patients to self-navigate across the HCV care continuum with the rest of the population. The implementation of focused, harm reduction, integrated HCV treatment with good peer and professional adherence support at treatment sites could help reach the hepatitis C elimination goals among MST patients.

SAT318 - HCV care cascade of PWID enrolled in methadone substitution treatment program in Georgia - is this the first group of population in which hepatitis C will be eliminated in Georgia?

SAT318 - HCV care cascade of PWID enrolled in methadone substitution treatment program in Georgia - is this the first group of population in which hepatitis C will be eliminated in Georgia?

NPS and the methadone queue: Spillages of space and time

BackgroundBetween 2008 and 2013, powder-stimulants sold by ‘head shops’ as novel psychoactive substances (NPS) or ‘legal highs’ have displaced heroin among groups of injecting substance users in Bucharest, Romania. Rising HIV-infection rates and other medical or social harms have been reported to follow this trend. MethodsThe study builds on two sets of original (N=30) and existing (N=20) interview data and on observations collected mainly at the site of a methadone substitution treatment facility. ResultsBy disentangling the space–time continuum of the methadone queue, this paper argues that injecting drug users’ (IDUs) passage from opiates to amphetamine-type stimulants (ATS) can be understood as ‘spillages’ of space and time. IDUs thus ‘spill’ out of the disciplinary flows of methadone treatment in two ways. The first is that of space and materiality. Drawing on actor-network theory (ANT), ATS/NPS appear embedded in reconfigured practices and rituals of injecting use. Such spillages see the pleasure-seeking self being fluidised in forming connections with, or spilling into, nonhuman actants such as substances, settings or objects. The second dimension of spilling is that of time. In this sense, heroin use is a ‘cryogenic strategy’ of inhabiting history and facing the transition to the market society that Romanian opiate injectors spill out of, not able to appropriate choice and legitimate consumption. The phenomenological qualities of stimulants that seem to accelerate lived time and generalise desire thus present them with an opportunity to alleviate a form of what a post-communist moral imaginary of transition frames as debilitating nostalgia. ConclusionATS/NPS are revealed as fluid entities that do not only shape risk conditions but also alter shared meanings and contextual configurations of bodies, substances and disciplinary regimes in unpredictable ways.

Relationship between ABCB1 polymorphisms and serum methadone concentration in patients undergoing methadone maintenance therapy (MMT)

ABSTRACTBackground: Methadone is a substrate of the permeability glycoprotein (P-gp) efflux transporter, which is encoded by the ABCB1 (MDR1) gene. Large interindividual variability in serum methadone levels for therapeutic response has been reported. Genetic variations in ABCB1 gene may be responsible for the variability in observed methadone concentrations. Objective: This study investigated the associations of ABCB1 polymorphisms and serum methadone concentration over the 24-hour dosing interval in opioid-dependent patients on methadone maintenance therapy (MMT). Methods: One hundred and forty-eight male opioid-dependent patients receiving MMT were recruited. Genomic deoxyribonucleic acid (DNA) was extracted from whole blood and genotyped for ABCB1 polymorphisms [i.e. 1236C>T (dbSNP rs1128503), 2677G>T/A (dbSNP rs2032582), and 3435C>T (dbSNP rs1045642)] using the allelic discrimination real-time polymerase chain reaction (PCR). Blood samples were collected at 0, 0.5, 1, 2, 4, 8, 12, and 24 hours after the dose. Serum methadone concentrations were measured using the Methadone ELISA Kit. Results: Our results revealed an association of CGC/TTT diplotype (1236C>T, 2677G>T/A, and 3435C>T) with dose-adjusted serum methadone concentration over the 24-hour dosing interval. Patients with CGC/TTT diplotype had 32.9% higher dose-adjusted serum methadone concentration over the 24-hour dosing interval when compared with those without the diplotype [mean (SD) = 8.12 (0.84) and 6.11 (0.41) ng ml−1 mg−1, respectively; p = 0.033]. Conclusion: There was an association between the CGC/TTT diplotype of ABCB1 polymorphisms and serum methadone concentration over the 24-hour dosing interval among patients on MMT. Genotyping of ABCB1 among opioid-dependent patients on MMT may help individualize and optimize methadone substitution treatment.

Injecting drug use, sexual risk, HIV knowledge and harm reduction uptake in a large prison in Bali, Indonesia.

The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study.

To assess whether risk of death increases during periods of treatment transition, and investigate the impact of supervised methadone consumption on drug-related and all-cause mortality. National Irish cohort study. Primary care. A total of 6983 patients on a national methadone treatment register aged 16-65 years between 2004 and 2010. Drug-related (primary outcome) and all-cause (secondary outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of regular supervised methadone consumption. Crude drug-related mortality rates were 0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio 1.63 [95% confidence interval (CI) = 0.66-4.00]. Crude all-cause mortality rate per 100 person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio 3.64 (95% CI = 2.11-6.30). All-cause mortality off treatment was 6.36 (95% CI = 2.84-14.22) times higher in the first 2 weeks, 9.12 (95% CI = 3.17-26.28) times higher in weeks 3-4, compared with being 5 weeks or more in treatment. All-cause mortality was lower in those with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years) although, after adjustment, insufficient evidence exists to suggest that regular supervision is protective (mortality rate ratio = 1.23, 95% CI = 0.67-2.27). Among primary care patients undergoing methadone treatment, continuing in methadone treatment is associated with a reduced risk of death. Patients' risk of all-cause mortality increases following treatment cessation, and is highest in the initial 4-week period.

A comprehensive model of treatment participation in chronic disease allowed prediction of opioid substitution treatment participation in Zurich, 1992–2012

ObjectivesChronic diseases are often associated with cycling in and out of treatment. We used data of a large opioid substitution treatment case register to (1) identify associated factors and (2) integrate retention and readmission into a model of overall participation over subsequent treatment episodes of various groups. Study Design and SettingData of all 9,407 patients undergoing 26,545 methadone or buprenorphine substitution treatment episodes between 1992 and 2012 in the canton of Zurich, Switzerland, were analyzed. We used extended survival analysis to estimate the duration of, and time between, treatment episodes, with the number of episodes, gender, nationality, administration route, age at onset of first regular heroin use, and provider type as independent variables. A similar analysis was applied to estimate overall participation (the probability of being in treatment at a given day after first entry independent of current number of treatment episode) and to test for group differences. ResultsThe time between treatment episodes shortened with the increasing number of episodes. Retention slightly increased after the first episode and then shortened for later treatment episodes. Effect sizes were generally rather weak (odds ratio ≤1.47). Effects were usually equal for all episodes, and if changing, weakened for later episodes. ConclusionThe complex process of leaving and entering treatment as well as the daily probability of being in treatment independent of treatment episode can be predicted by comprehensible statistical models applied to patient-period data sets.

Methadone Substitution Treatment and Its Impact On Quality of Life Among Moroccan Patients

Substitution treatment of opiate addiction with methadone is the most effective way for the treatment of heroin addiction. The aim of this research is the evaluation of the improvement of somatic and socio-professional status of patients treated with methadone. The study is realized in medico-psychological center in Tangier, Morocco, with a sample of 101 patients under methadone. Questionnaire based mainly on the items of 'Addiction Severity Index” (ASI) is used. The results show that the somatic status (weight, sleep and appetite) of 49% of the patients was improved, and it was weakly improved among 27% of patients. However, this somatic status declined in 14% of patients and has been in fluctuation among 22% of patients. The evaluation of lifestyle shows an improvement of lifestyle; an increase of 10.9% of the item 'living with family” against a decrease of 19.8% of the item 'living alone/precariousness” are registered. Moreover, an increase of 69.56% and 112.5% of 'paid intermittent activity” and 'paid continuous activity” items respectively, against a decrease of 41.7% of joblessness patients. The preliminary results of this study present an interessant impact of substitution treatment by methadone on patients’ quality of life. However, the effectiveness of the treatment depends not only on the molecule used, but it depends strongly on diagnosis, skills and attitude of the psychotherapist and on the patient’s specific characteristics and the sociocultural context.

Drug-related deaths between 2002 and 2013 with accent to methadone and benzodiazepines

AimThe aim of the study is to assess the trends of overdose and drug related fatalities in the Republic of Macedonia during the 11 years. Material and methodsCross-sectional retrospective survey and reviewed of postmortem toxicological analyses which examined fatal poisonings with illegal drugs in years 2002–2013. Information about gender, age, drug consumption, reported years were analyzed. Narcotics were confirmed with toxicological semi quantitative fluorescence polarization immunoassay (FPIA) in urine (range 250–4000 ng/ml). ResultsTotal of 165 deaths were observed. Out of them 145 (87.9%) were male. There is statistical significant differences between male and female DRD due to age (Mann–Whitney U Test = 925, Z = −2626, p = 0.0087). For p < 0.05 there is significant differences between genders due to cause of overdose (Pearson Chi-square = 9743, df = 4, p = 0.0449). DRD among male were mainly because of overdose due to heroin in 80 (51.17%) cases followed by DRD due to combination of methadone and BZD in 25 (11.72%) cases. Out of all DRD cases 50 (30.3%) are related to polydrug use. For p < 0.01 there is a significant differences between analyzed age groups due to cause of overdose (Pearson Chi-square = 33,886, df = 12, p = 0.0007). ConclusionsDeath cause analysis reveals the difficulties in determining the role of substitution drugs, as many other factors may be involved. The findings also highlight the importance of further enhancing treatment interventions for benzodiazepine misuse among patients on methadone substitution treatment.

Assessment of family functioning in families of patients on methadone maintenance treatment

Addiction has multi-factorial etiopathogenesis. Morbidity risk factors include both individual and social factors. Social factors are considered to be very important, especially at the initial stage of taking the substance. Family and the social environment, with their behavior and social norms, are the primary psychosocial determinants. Family functioning has an impact on both the development and the maintenance of addictions, so it is an important research topic. The aim of this study was to determine if families of drug addicts who are on methadone maintenance treatment differ in the level of functionality from families without addiction problems. The study sample included 100 persons divided into two groups - clinical and control. The clinical group consisted of 50 persons - drug addicts who are on methadone maintenance treatment, whereas the control group consisted of 50 persons without addiction problems. FACES IV and General questionnaire were used as instruments for the control group, and POMPIDU questionnaire for the clinical group. The results show that the families of addicts who are in methadone substitution treatment program vary in the level of functionality compared to families in which there is no problem of addiction and in a way that the families of the control group are more functional. These results in our region confirmed earlier results on the connection between family dysfunction and substance abuse, which may have significant implications in the treatment and prevention programs of addictions.

Adverse drug reactions of antiretroviral therapy in patients receiving methadone substitution treatment

Aim of the studyThe aim of the study was to analyze the incidence of adverse effects of antiretroviral therapy in patients receiving concomitant therapy with methadone substitution. BackgroundWith the advances in research on anti-retroviral drugs, we now have regiments with different mechanisms of action that can be combined to give an effective therapy that lengthens the life of HIV-infected people into old age. It should be emphasized, however, that anti-retroviral drugs, as other pharmacologically active substances, are characterized by adverse effects (AEs), significantly changing the quality of life for patients, as well as predisposing to the development of comorbidities. Their appearance can be triggered by administration of other therapy at the same time such as methadone in heroin addicts. Materials and methodsThe survey was conducted among 60 people, 21 of respondents were participants of methadone program. ResultsBased on the survey we found that among patients receiving methadone, compared to patients treated only with antiretroviral drugs, more often the following symptoms occurred: loss of appetite, constipation, cough, rhinitis, insomnia, libido and decreased hemoglobin level. ConclusionA study found that co-administration of methadone may increase the incidence of adverse effects, which in turn has a significant impact on patient quality of life. This issue has not been fully explained and requires further studies in a larger group of patients.

A National Study of the Retention of Irish Opiate Users in Methadone Substitution Treatment

Background: Retention in treatment is a key indicator of methadone treatment success. The study aims to identify factors that are associated with retention. Objectives: To determine retention in treatment at 12 months for Irish opiate users in methadone substitution treatment and to indicate factors that increase the likelihood of retention. Methods: National cohort study of randomly selected opiate users commencing methadone treatment in 1999, 2001, and 2003 (n = 1269). Results: Sixty-one percent of patients attending methadone treatment remained in continuous treatment for more than 1 year. Retention in treatment at 12 months was associated with age, gender, facility type, and methadone dose. Age and gender were no longer significant when adjusted for other variables in the model. Those who attended a specialist site were twice as likely to leave methadone treatment within 12 months compared with those who attended a primary care physician. The most important predictor of retention in treatment was methadone dose. Those who received <60 mg of methadone were three times more likely to leave treatment. Conclusion: Retention in methadone treatment is high in Ireland in a variety of settings. The main factors influencing retention in methadone treatment was an adequate methadone dose and access to a range of treatment settings including from primary care physicians. Scientific Significance: Providing an adequate dose of methadone during treatment will increase the likelihood of treatment retention. Methadone treatment by the primary care physician is a successful method of retaining opioid users in treatment.

Tratamiento de sustitución con Metadona para la adicción a la Heroína: evaluación de un programa en Colombia

Assessment of a methadone substitution and maintenance treatment program in Colombia using the OTI (Opiate Treatment Index) instrument. Descriptive study with a 50-patient sample attended in the period 2007- 2008 for their heroin addiction. The OTI instrument was implemented to assess drug use, HIV risk-taking behavior, social functioning, criminality, health status and psychological functioning. Men accounted for 74% of the sample, women for 26%. Mean age was 22, with 64% in the 20-24 age group. Mean reported age at onset of heroin use was 18, with a range of 13-28. In 38% of the sample (19 patients) comorbidity with other mental disorders was found, 47% of these being personality disorders. Median reported current methadone dose was 40 mg/day, with a range of 15-80 mg/day. According to the OTI subscales, HIV risk-taking behavior was low-moderate, while social functioning, criminality and health status were low-risk. In the case of psychological adjustment, a low-moderate risk score was obtained for the 0-12 month treatment group, and a moderate risk score for the 12-24 and ≥ 24 month groups. Starting age for heroin use in this population is early . In general, the risk assessed in the OTI areas is low, possibly due to problematic heroin use being in its early stages in Colombia, but comorbidity with personality disorders is high.

P-08 - Socio-demographic data of the clients in methadone substitution treatment and predictors of developing opiate addiction - a pilot study

From year to year, dependence of opiates is a big problem in society. The number of addicted patients is rapidly growing, also the number of deadly issues of overdose is in growing tendency. Most of the researches showed that among addicted to opiates, are number of people with mental disorders, fragile health, criminal past and unemployed. Methadone substitution treatment is an effective treatment which is harm reduce and is maintaining abstinence from opiates. The sample consisted of 50 patients on methadone substitution therapy in the Methadone center, Sombor. Subjects were tested with inventories which explore trait and state depression and anxiety, and trait of psychopathic deviation. The objectives of the research were: to collect socio-demographic data of patients on methadone substitution therapy. to make a pilot study by which the predictors of becoming addicted can be identified, based on instruments that measure anxiety, depression and psychopathic deviation The instruments: trait anxiety, state anxiety, state depression, trait depression, psychopathic deviation, POMPIDOU. The results confirmed the hypothesis that there is a connection between the first and the regular use of psychoactive substances (PAS). Psychopathic deviation proved to be a significant predictor of becoming dependent - the higher the score on psychopathic deviation scale was, the earlier the patient had become addicted. Hierarchical regression analysis found that PAQ (psychopathic deviation) score explains 18% of the variance of the dependent variable (regular use of PAS). Later borns had significantly higher scores on trait and state depression, compared to the first born.

P-30 - Clinical correlations HIV infection in patients maintaining substitution treatment with methadone

Opiate dependence is a significant risk factor for HIV infection. An assessment of differences between opiate addicts with and without HIV infection. 171 opiate dependent patients treated with methadone were asked about: length of dependence, age of onset of opiate dependence, dosage of methadone, effects of methadone on interviewed subjects and HIV infection. In our sample 72 (42%) subjects had HIV infection (HIV+) and 99 (58%) subjects had not HIV infection (HIV-). Comparison of 99 HIV (-) patients with 72 HIV (+) patients revealed that in HIV (+) group there were statistically significantly more women (40 vs. 25%), patients were older (39 vs. 36 years old), had longer length of dependence (22 vs. 16 years), had longer time of maintained methadone treatment (63 vs. 26 months). It was also found that HIV (+) patients had earlier age of onset of opiate dependence than the patients in HIV (-) group (18 vs. 19 years old, p = 0,058). Our research may suggest that HIV infection had correlation with the course of methadone substitution treatment of opiate dependence.

Outcome of heroin-dependent adolescents presenting for opiate substitution treatment

Because the outcome of methadone and buprenorphine substitution treatment in adolescents is unclear, we completed a retrospective cohort study of 100 consecutive heroin-dependent adolescents who sought these treatments over an 8-year recruitment period. The participants' average age was 16.6 years, and 54 were female. Half of the patient group remained in treatment for over 1 year. Among those still in treatment at 12 months, 39% demonstrated abstinence from heroin. The final route of departure from the treatment program was via planned detox for 22%, dropout for 32%, and imprisonment for 8%. The remaining 39% were transferred elsewhere for ongoing opiate substitution treatment after a median period of 23 months of treatment. Males were more likely to exit via imprisonment ( p < .05), but other outcomes were not predicted by gender. There were no deaths during treatment among these 100 patients who had a cumulative period of 129 person years at risk. Our findings suggest that this treatment delivers reductions in heroin use and that one fifth of patients will exit treatment following detox completion within a 1- to 2-year time frame.

Premature ejaculation and other sexual dysfunctions in opiate dependent men receiving methadone substitution treatment

Background A significant number of men with opiate misuse have sexual problems. Premature ejaculation (PE) occurs predominantly on discontinuation of the opiate but seems to persist in some cases. The aims of this study were to determine the rates of PE and other sexual dysfunctions in patients maintained on methadone; to determine the time of onset of PE in relation to onset of opiate misuse; and to look at the patients' perception of the effect of heroin and methadone on PE. Methods Sixty five men attending a tertiary referral clinic for methadone maintenance treatment were assessed cross-sectionally using a semi-structured questionnaire, clinical interview, review of clinical records and the International Index of Erectile Function (IIEF). Results Thirty eight (58.5%) subjects reported a “lifetime” history of PE. Twenty (30.76%) of them reported “current” history of PE. Eleven (16.9%) people reported that PE preceded opiate misuse. Twenty four (63.2%) felt that heroin helped their PE and 7 (18.4%) felt that heroin worsened it. Fourteen (36.8%) felt that methadone helped PE, while 10 (26.3%) felt methadone worsened PE. Only 2 out of 65 (3.07%) reported that they had been asked about their sex life by the addiction services. Conclusion Prevalence of “current” premature ejaculation was almost 3 times greater than reported in the general population. A significant number of patients perceived heroin to be beneficial on PE. Presence of sexual dysfunction could therefore be a risk factor for relapse into heroin misuse. Most clinicians avoid asking patients questions of a sexual nature. Nevertheless, managing sexual difficulties among patients with opiate misuse could be a significant step in relapse prevention.