Opioid Dependence Syndrome Research Articles

Slow-release oral morphine as a maintenance agent in opioid dependence syndrome: an exploratory study from India

Aim: Slow-release oral morphine (SROM) as agonist maintenance agent was introduced recently in India while buprenorphine is available for the past two decades. In this study, the drug use and psychosocial status of opioid-dependent patients who were maintained on buprenorphine and subsequently shifted to SROM were assessed.Design: This is an observational study.Procedure: This study was carried out in a community-based drug treatment clinic in New Delhi. Thirty-nine opioid-dependent males maintained on sublingual buprenorphine (for at least 1 month) were included in this study. Due to difficulty in buprenorphine procurement for some period, 34 patients were shifted to SROM after informed consent. Assessments were made prior to the switch-over and after 4 weeks of stabilisation on SROM.Results: All patients initiated on SROM continued to remain in the treatment during the 4-week period. The low scores on measures of opioid withdrawal symptoms, craving and high scores on quality of life observed while on buprenorphine continued even after 4 weeks of SROM treatment. Patients on SROM reported mild adverse effects.Conclusion: SROM is as effective as buprenorphine in controlling withdrawal, craving and quality of life on short-term follow-up.

Impact of Self-Reported Life Events on the Profile of Opioid Dependence Syndrome

Aim: The aim of this work was to investigate the impact of life events on the profile of opioid dependent patients. Method: Recruitment was achieved through outpatient drug treatment clinic in Birmingham, UK, and data were collected through semistructured interviews. One-hundred and twenty subjects with opioid dependence syndrome were interviewed, and 100 controls of non-drug-using family members and friends. Result: The mean age of the opioid group was 33.3 years, SD = 8.8. The majority individuals of the sample were White British (80.8%), unemployed (69.2%), and male (75%). The mean severity of dependence as measured by two scales indicated severe level of dependence according to the authors of each scale. The mean number of traumatic events for the opioid dependence group was 4.8, SD = 3.57 vs. 3.55; SD = 3.65 in control group with significant difference (t = 2.56, df = 218, p = .01). Significant predictors of severe opioid dependency were age of second exposure to events, change of residence, break-up with boy/girlfriend, and conflict with father. Conclusion: The data presented indicate that a significant group of opioid dependent patients experience adverse life events in both childhood and adulthood. It is by attending to and addressing these issues that health care workers can alleviate ongoing distress and promote confidence.

Why do we need to control alcohol use through legislative measures? A south east asia perspective?

Background:Even though prevalence of alcohol use in the world is very high, it has not been brought under legal control in several countries, contrary to other controlled substances like opium, cocaine, cannabis, and so on.Aim:To demonstrate the similarities in both alcohol and opioid dependence by comparing and contrasting the course of clinical dependence for both substances.Patients and Methods:Consecutively admitted patients during the period August 2005 to May 2006, in the Center for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, with ICD-10 (DCR) diagnosis of alcohol dependence syndrome or opioid dependence syndrome were recruited for the study and administered the alcohol or other drug (opioid) section of SSAGA-II, respectively, and the data was entered in the corresponding tally sheet.Results:The total sample size was 150, of which 112 consented to participate. Eighty-one (72%) were alcohol-dependent and 31 (28%) were opioid-dependent. Mean ages of the patients of alcohol dependence for opioid dependence was 35.16 ± 10.2 compared to 26.09 ± 5.65. Mean age of onset of alcohol and opioid use were similar (18.72 ± 6.84 and 20.73 ± 3.93 years, respectively). Patterns of dependence were also similar for both substances, from the first criteria to dependence (0.49 years for alcohol versus 0.64 years for opioids), and from the appearance of the second criteria to dependence (0.24 years versus 0.28 years).Conclusion:This study recommends alcohol to be treated on par with opioids and calls for legislations for the control of alcohol, uniformly, across the world, as a public health policy, on the lines of the Framework Convention for Tobacco Control.

Clinical course of development of alcohol and opioid dependence: What are the implications in prevention?

In India, it is estimated that 75 million people are alcohol users and nearly 3 million are opioid users.(1) Of these, there has been a noted prevalence of 19.78-21.4%(2) of alcohol use and 5% of alcohol dependence in Indian population.(3) The prevalence of opium use in India has also been increasing and it is now considered to be a ’party drug’ or ’relaxation drug’. Several studies have described the prevalence of opium abuse to be 1.51-2%(3,4) although a recent study notes it to be around 0.4%.(2) Yet, there is a concerning increase in the social acceptance of alcohol even for frequent self-induced intoxication and easier access to ’hard drugs’ like opioids is now responsible for driving adolescents toward substance use and a trend is being noted toward lower ages of onset of both alcohol and opioid use. Even though opium use is generally frowned upon, alcohol use is widely accepted. There is, therefore, an urgent need for reduction in the demand of drugs of addiction, both legal and illegal, which may otherwise lead to numerous health, family and societal consequences. One of the ways this can be made possible is by identifying and preventing the development of dependence in both alcohol and opioid users. This study is therefore aimed at: Studying the clinical course of development, in terms of ages, order of onset and duration of criteria of ICD-10 dependence, of both alcohol and opioid dependence. Comparing and contrasting the two substances to evaluate differences if any, to formulate a strategy for primary prevention. Materials and Methods Consecutively admitted patients of ≥18 years of age for treatment of dependence in the period of August 2005 to May 2006 in Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India with ICD-10 DCR(5) diagnosis of alcohol dependence syndrome or opioid dependence syndrome (made by a senior resident/senior consultant) and giving written informed consent were recruited for the study. Subjects with other co-morbid psychiatric disorders/substance dependence/general medical condition and with MMSE score <24 and were excluded from the study. All the subjects participated in the personal face to face interview after medically supervised withdrawal using alcohol or other drug (opioid) section of SSAGA-II(6) (revised in 1997) according to individual diagnosis of patient. The details of this instrument and the methods have been given in an earlier paper.(7) Since it was a retrospective recall study, questions were framed individually to trigger the recall with reasonable accuracy using anchor questions to memorable events, tagging the questions with specific examples and defining the technical terms.(8) All ratings were done by an investigator blind to the diagnosis and current status of the subjects. The data were statistically analyzed by means of T-test for descriptive variables and the Chi-squared test for categorical variables.

Co-morbid Post-traumatic Stress Disorder and Opioid Dependence Syndrome

Post-traumatic stress disorder (PTSD) is common among patients with opioid dependence syndrome. The aim of this study was to find the prevalence of PTSD in patients with opioid dependence and to examine the relationship of PTSD with the severity of dependence on opioids in patients attending an outpatient clinic for drug treatment services. An interview using the Maudsley Addiction Profile, the Severity of Dependence Scale, the Impact of Events Scale, and ICD-10 clinical criteria was conducted in a large urban center for addiction treatment in the central United Kingdom. Seventy patients with opioid dependence syndrome were interviewed. On interview, 30% of the patients met ICD-10 criteria for PTSD. Clinically significant levels of intrusive (45.7%) and avoidant (65.7%) symptoms were reported. Participants with PTSD reported higher perceived rate of childhood threat to life including sexual abuse, physical abuse, and witnessing physical fights between parents. In adulthood, the main traumatic events were physical injuries and rape. One-third of this sample of opioid-dependent patients receiving methadone treatment met criteria for a diagnosis of PTSD, with clinically significant self-reported symptoms of intrusion and avoidance. As in other samples, the co-morbidity of PTSD and opioid use is much more common and warrants further study in the area of etiology and management.

Can we prevent drug related deaths by training opioid users to recognise and manage overdoses?

BackgroundNaloxone has been evidenced widely as a means of reducing mortality resulting from opiate overdose, yet its distribution to drug users remains limited. However, it is drug users who are most likely to be available to administer naloxone at the scene and who have been shown to be willing and motivated to deliver this intervention. The current study builds on a national training evaluation in England by assessing 6-month outcome data collected primarily in one of the participating centres.MethodsSeventy patients with opioid dependence syndrome were trained in the recognition and management of overdoses in Birmingham (n = 66) and London (n = 4), and followed up six months after receiving naloxone. After successful completion of the training, participants received a supply of 400 micrograms of naloxone (in the form of a preloaded syringe) to take home. The study focused on whether participating users still had their naloxone, whether they retained the information, whether they had witnessed an overdose and whether they had naloxone available and were still willing to use it in the event of overdose.Results & DiscussionThe results were mixed - although the majority of drug users had retained the naloxone prescribed to them, and retention of knowledge was very strong in relation to overdose recognition and intervention, most participants did not carry the naloxone with them consistently and consequently it was generally not available if they witnessed an overdose. The paper discusses the reasons for the reluctance to carry naloxone and potential opportunities for how this might be overcome. Future issues around training and support around peer dissemination are also addressed.ConclusionOur findings confirm that training of drug users constitutes a valuable resource in the management of opiate overdoses and growth of peer interventions that may not otherwise be recognised or addressed. Obstacles have been identified at individual (transportability, stigma) and at a systems level (police involvement, prescription laws). Training individuals does not seem to be sufficient for these programmes to succeed and a coherent implementation model is necessary.

Family Burden in Opioid Dependence Syndrome in Tertiary Care Centre

This is a cross-sectional, hospital based study conducted in De-Addiction centre under department of psychiatry, AIIMS, New Delhi, India. Patients and their spouses fulfilling inclusion criteria were enrolled in the study after taking informed consent. A diagnosis of Opioid Dependence Syndrome (ODS) was made based on ICD-10 criteria and the assessment of severity of ODS was determined by Addiction Severity Index (Hindi version). Subsequently the family burden, perceived by spouses was assessed using Family Burden Interview Schedule (FBIS). Most of the subjects were from urban or semi-urban areas, mostly from around the service facility. The maximum number of subjects was of age group 31-40 years with majority of having below high school level education. Both subjective and objective family burden was perceived as "severe" by subjects' spouses. The relationship between spouses' perceived burden and socio-demographic variables including duration of substance abuse were not correlated. Hence it was found that opioid dependent subjects cause considerable amount of distress to their care providers.

Opioid dependence and pregnancy

The management of opioid dependence during pregnancy has received considerable attention over the past three decades. Recent peer-reviewed literature in the fields of pregnancy and opioid dependence and neonatal abstinence syndrome has been evaluated and discussed. Pregnant opioid-dependent women must be carefully managed to minimize harm to the fetus; therefore, standardized care for maternal health is required. In a multidisciplinary care system opioid maintenance therapy is the recommended treatment approach during pregnancy. Equivalent attention must be given to the treatment of neonatal abstinence syndrome, which occurs in 55-94% of neonates after intrauterine opioid exposure with a 60% likelihood of requiring treatment; heterogeneous rating scales as well as heterogeneous treatment approaches are often responsible for extended hospital stays. Interpretation of available literature is confounded by several methodological flaws. In general, there is still a lack of evidence-based study designs for pharmacological treatment of these patients as well as neonatal abstinence syndrome.

Long-term outcome of in-patients with substance use disorders: A study from North India

Background:Research into substance use disorders (SUD) has been unable to unequivocally demonstrate effectiveness of treatment modalities.Aims:The aim of the study was to study the long-term outcome after in-patient treatment in a cohort of patients admitted for SUD in a deaddiction unit of a hospital in North India.Materials and Methods:The case notes of all in-patients with a primary diagnosis of alcohol and/or opioid dependence syndrome (F10.24 and F11.24) in the calendar year 2006 were examined. All patients without any physical or mental comorbidity other than comorbid SUD were included in the study. They were contacted telephonically or their case notes examined in September, 2007. Status regarding abstinence or relapse was determined and data was analyzed.Independent samples t-test and chi-square test were used for determining significance of difference between continuous and categorical variables respectively. Kaplan-Meier analysis was applied to find the survival times of different groups with the duration to relapse as variable of interest. Log rank test was applied to find the significance of differences in various groups. Cox's Regression analysis was applied to find the hazard ratio.Results and Conclusions:Data for 59.22% of patients included in the study were available for analysis. Mean survival time was 36.35 weeks (28.74-43.95, 95% CI) for patients across different groups, 36.71 weeks (26.24-47.18, 95% CI) for the alcohol group, 34.00 weeks (8.37-59.36, 95% CI) for natural opioids group, 37.53 weeks (26.33-48.73, 95% CI) for semi/synthetic opioids group and 17.00 weeks (3.39-30.60, 95% CI) for the mixed group. Kaplan-Meier analysis revealed that those who were following-up at time of evaluation had significantly longer durations to relapse. Deaddiction services should stress on keeping patients on follow-up as a means to better outcomes.

Why is alcohol excluded and opium included in NDPS act, 1985?

Byline: Saddichha. Sahoo, N. Manjunatha, Baxi. Sinha, C.R.J. Khess The Problem Different forms of alcohol have been used in various human societies at least since the beginning of recorded history. As part of the contemporary dynamic of globalization, there has also been an increased use of drugs, which has now reached mammoth proportions. The use of both licit drugs such as alcohol and tobacco and illicit drugs such as cannabis, cocaine and opioids has been acknowledged to have multiple consequences to health, society and economy. According to estimates made by the World Health Report,[sup] [1] at least ten thousand million people throughout the world regularly use alcohol and about 13.5 million people use opioids. In India too, the problem is slowly increasing and it is estimated that 75 million people are alcohol users and nearly three million are opioid users, of which a majority require medical treatment and rehabilitation.[sup] [2] A number of other psychoactive substances are being added daily to the present list of psychotropic substances. The entire issue is complex and multifaceted requiring both health measures and efforts to control trafficking / smuggling and manufacture of these drugs. There is a need for the reduction in the demand of drugs of addiction, both legal and illegal, which may otherwise lead to numerous health, family and societal consequences. To combat this, the Government of India formulated the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985,[sup] [3] which provides the current framework for drug abuse control and sale in this country. Essentially, the Act deals with supply reduction activities of psychotropic substances namely, cannabis, cocaine and opium. However, the absence of alcohol in the list of psychotropic substances is surprising given the fact that mental health professionals consider alcohol to be a psychoactive substance leading to various social, legal, economic and medical complications ranging from gastritis to withdrawal seizures and delirium tremens.[sup] [4] The Reasons The reasons for not including alcohol in the NDPS Act are many, the important ones being (a) prevailing social acceptance even for frequent self-induced intoxication;[sup] [5] (b) the high revenues earned by the Government on the sale of alcoholic beverages; (c) prevalence of illicit and locally brewed undistilled forms of alcohol is very high in society and (d) there may be differences in the clinical course of alcohol dependence contrary to other drugs like opium which have been included in NDPS. The last reason is what can be corrected through systematic clinical studies, which have not been conducted until now. The Solution Our study We therefore aimed at evaluating the reasons for inclusion of opium and exclusion of alcohol from NDPS by comparing and contrasting the course of dependence for both substances. We recruited consecutively admitted patients of ≥18 years of age for treatment of dependence in our Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India with International Classification of Diseases-10-Diagnostic criteria for research (ICD-10-DCR) diagnosis of alcohol dependence syndrome or opioid dependence syndrome and obtained their written informed consent. We excluded other comorbid psychiatric disorders, substance dependence or general medical conditions requiring additional treatment. We administered the SSAGA-II[sup] [6] (Semi-Structured Assessment for the Genetics of Alcoholism-II) test to all our subjects after detoxification. SSAGA II is a poly-diagnostic instrument, which was designed to assess the physical, psychological and social manifestations (in other words, in terms of the criteria of ICD-10-DCR dependence). After the interview, data was transferred to the ICD-10 tally sheets of the respective alcohol or opioid sections of SSAGA-II. We considered the earliest age of any items of respective criteria of ICD-10-DCR dependence which was taken as the age of first onset of respective criteria of dependence. …

Effects of Craving Self-Report Measurement on Desire for Heroin in Opioid Dependent Individuals

This study aims to investigate whether the administration of questionnaires measuring subjective craving induces more craving for opiates compared to questionnaires measuring other subjective states. The study was conducted in 2000. The sample was composed of 53 patients that were treated as inpatients and outpatients for their opioid dependence syndrome. Participants were assigned randomly into four groups. Both a craving and negative affect condition were presented to each group. The administration of the Visual Analogue Scale (VAS) preceded and followed each condition. Findings of the present study show that the administration of questionnaires measuring instant as well as general craving does not have a distinctive effect on measures of unidimensional craving compared to a questionnaire focused on anxiety and depression states. Because of the small sample, the results should be interpreted cautiously.

Diretrizes para o tratamento de pacientes com síndrome de dependência de opióides no Brasil

There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medical use of codeine and opiate-containing syrups. However, opioid dependence syndrome shows a significant total impact on mortality and morbidity. Over the past 20 years, scientific progress has changed our understanding of the nature of opioid addiction and its various possible treatments. Addiction is a chronic illness treatable if the treatment is well-delivered and tailored to the needs of the particular patient. There is indeed an array of treatments that can effectively reduce drug use, help manage drug cravings, prevent relapses and restore people to productive social functioning. The treatment of drug addiction will be part of long-term, medical, psychological, and social perspectives. This guideline aims at providing guidance to psychiatrists and other mental health professionals who care for patients with opioid dependence syndrome. It comments on the somatic and psychosocial treatment that is used for such patients, and reviews scientific evidences and their strength. Also, the essential historical, epidemiological and neurobiological aspects of opioid dependence are reviewed.

The Early Diagnosis of Iatrogenic Opioid Dependence Syndrome

Abstract: The Opioid Dependence Syndrome is defined in terms of a pattern of opioid drug use which includes evidence of both physical and psychological dependence. While nearly all individuals receiving long‐term opioid analgesics for chronic pain will develop physical dependence on opioids, only a small proportion will develop the “pathological” Opioid Dependence Syndrome. Some possible attributes which may differentiate between those who are, and those who are not, likely to develop “pathological” opioid dependence are listed, as are the behaviour patterns which, if observed to develop in patients already receiving long‐term opioid analgesia, should raise one ‘s suspicions of its diagnosis. The problems of psychological dependence, such as maladaptive drug‐seeking behaviour, are discussed and the management of the opioid dependence syndrome, with special reference to those patients who have developed it iatrogenically, is outlined. An algorithm for the management of recurrent acute/chronic pain is proposed.

ASSESSMENT OF OPIOID DEPENDENCE

ABSTRACTDiagnostic criteria for opioid dependence is presented. Five methods are described to assess the presence and/or severity of the opioid dependence syndrome: Self‐report. Physical examination Toxicological analysis Observation of withdrawal symptoms Naloxone (Narcan) test. Problems in determining actual amounts of heroin in “street deals’ is also discussed. It is emphasised that assessment of heroin‐related problems in particular, requires a comprehensive lifestyle assessment in addition to the specific diagnosis of opioid dependence based largely on physical symptomatology as outlined in this paper.