Treatment Of Opiate Dependence Research Articles

An efficient LC-QTOF-mass spectrometry method for monitoring nal-trexone compliance in urine of opioid-dependent subjects.

Naltrexone (NTX) is an orally effective opiate antagonist used in maintenance treatment for opiate dependence. Its utility is limited by the patient's noncompliance. The study aimed to develop an efficient method for the detection of NTX in urine by LC-QTOF-mass spectrometry (MS) and its application to NTX compliance in opioid-dependent subjects. Sample preparation included a dilution step and direct injection to LC-QTOF-MS. Chromatographic separation was achieved with a C-18 column using a mixture of mobile phase 0.1 percent formic acid in water and 0.1 percent formic acid in 95 percent methanol. The calibration curve was linear in the range 1-100 ng/mL with a correlation coefficient higher than 0.996. Precision and accuracy were acceptable, and the recovery efficiency range was 80-85 percent. The current LC-QTOF-MS method is simple, precise, sensitive, and can be used for monitoring NTX compliance among opioid-dependent subjects in a clinical setting.

Sexual health in female under treatment for opiate dependence using diacetylmorphine

Sexual health is a key element to the well-being and quality of life of individuals. However, it is rarely incorporated into care delivery for women with an addictive condition. Female with severe dependence to opiate have their medical and social conditions improved by diacetylmorphine treatment. Which allows them to escape situations of high-risk of sexual violence. However, this pharmacotherapy can also induce adverse effects on the sexual sphere. This paper describes the relevance of integrating psycho-socio-sexological counselling into the care provision for the opiate dependence. The counselling should be oriented to respond to the specific relational and sexual issues faced by these female patients and empowering them on their lives and in recovering a better quality of life.

Self-Schema, Attachment Style, and Treatment Outcome of Patients in an Opiate Maintenance Treatment Unit.

The aim of this study was to explore self-schemas and attachment style among patients in a methadone or buprenorphine maintenance treatment program of opiate dependence, in relation to treatment outcome (relapse in substance use). The study included 84 patients (21 women and 63 men) in a psychiatric clinic in Malmö, Sweden, providing maintenance treatment of opiate dependence. Three self-report instruments were employed, Young Schema Questionnaire Short version (YSQ-S) and Young Parenting Inventory (YPI) for studying self-schemas and Experiences in Close Relationships–Relationship Structures questionnaire (ECR-RS) for studying attachment style. Demographical data and relapse in substance abuse were registered. The study demonstrated, unsurprisingly, that an insecure attachment style was more common in the group of patients compared to available general population reference data. Significant correlations were found between attachment style and core beliefs about the self (self-schemas). Memories of parenting experiences from childhood (YPI) showed correlations with ongoing self-schemas (YSQ-S). Treatment outcome, defined as relapses in substance abuse, was associated to a minor degree with self-schemas but showed no correlation with attachment style. Patients who did not work or study had more maladaptive self-schemas and insecure attachment style, and a higher incidence of relapse in abuse than patients who were working or studying.

A service evaluation of the use and outcomes of inpatient detoxification for the treatment of alcohol and opiate dependence within a community addictions service

AimsThe 2012 Health and Social Care Act transferred Addictions commissioning from the NHS to local authorities, leading to cuts of up to 30-50% of budgets and having the greatest impact on inpatient detox services. In a system with such limited capacity, effectively triaging access to detox services and optimising the efficacy of each detox has become increasingly important. NICE offers limited guidelines to assist with making these decisions, focused on assessing the severity of dependence and risk, but provides little detail on specific predictors of success. Our aim is to evaluate the nature of cases referred for inpatient alcohol or opiate detox and their treatment outcomes. This will help develop our understanding of the factors which influence achieving abstinence, and inform future decision-making regarding suitability for inpatient detox and post-detox planning. Conclusions will form part of a review of the local alcohol care pathway guidelines.MethodA retrospective case note review of all inpatient detox admissions between April 2019-March 2020 (n = 113 patients) is being undertaken. Our data collection tool extracts quantitative and qualitative data based on criteria from Alcohol use disorders (NICE, 2017), Opiate detoxification (NICE, 2019) and local pathway guidelines.ResultPreliminary analysis of data from November 2019–March 2020 (43 patients) showed that a clearly documented rationale for inpatient detox was recorded in 95% of cases. 100% of cases had a recorded AUDIT score, whilst SADQ scores were recorded in 50% of cases. 33% of cases were admitted to rehab post detox, and 19% were prescribed anti-craving medication. Abstinence at one year was confirmed in 21% of cases. 28% of clients received a second detox within one year. The rationale for inpatient detoxes in this population is to be reported.ConclusionPreliminary data may highlight an opportunity to improve pre detox decision-making and post detox care, with confirmed abstinence in only 21% of clients at one year after detox. The low proportion of completed SADQ scores before accessing detox could offer an opportunity to improve client assessment, and the small proportion of clients prescribed anti-craving medication highlights an area of post detox care which could also be improved. The main limitation of this study is the lack of linked analysis of outcome to specific predictors, which is something that could be explored in future. It would also be valuable to gain survey data on the experience of accessing detox from a service user perspective.

Office-Based Buprenorphine Treatment: Identifying Factors That Promote Retention in Opioid-Dependent Patients.

Opiate addiction is a serious global health issue that profoundly impacts the welfare of populations around the world. Opioid addiction affects an estimated 1.9 million individuals in the United States alone, stimulating a rise in treatment options such as medication-assisted treatment with buprenorphine. When combined with counseling and relapse prevention groups, medication-assisted treatment has proven to be an effective office-based opioid treatment for opiate dependence. Office-based opioid treatment has broadened access to treatment of opioid dependence, has decreased the risk for overdose, and is effective for reducing cravings and opioid use at proper dosing levels. However, treatment retention and relapse remain significant challenges. The purpose of this study was to identify characteristics predictive of retention in treatment time of opioid-dependent individuals receiving office-based buprenorphine treatment. The records of individuals enrolled in a public health office buprenorphine clinic (n = 350) were analyzed to determine retention time in treatment and whether retention time varied by selected individual variables. Participants in the study had a cumulative predicted retention time on buprenorphine of 65% at 30 days, 35% at 6 months, 25% at 12 months, and 18% at 18 months.

Advantages and Disadvantages of Methadone among Children and Adults: A Systematic Review and Meta-Analysis

Background: Today, an increasing trend to methadone as an alternative maintenance treatment for opiate dependence in adults is observed; children for both intentional and accidental reasons are exposed to serious and fetal effects of methadone. We aimed to investigate effects of methadone on children and sexual functioning among adults in Iranian population. Materials and Methods: An extensive search was done in databases of Medline, EMBASE, Scopus, Cochrane, and Web of Science until August 2018. Two independent researchers screened articles, and categorized them based on the evaluated outcomes and overall effect size was presented. After excluding the duplicated, irrelevant and low-quality articles, eligible ones were enrolled in the meta-analysis. Finally, pooled effect size was presented as standardized mean difference (SMD) or pooled prevalence with 95% confidence interval (95% CI). Results: Methadone was found to be more effective than morphine on neonatal abstinence syndrome. The first four most common symptoms of methadone poisoning were loss of consciousness (81%), sleepiness (72%), meiotic pupils (76%), vomiting (56%), and Apnea (48%). The overall prevalence rate of sexual disorders and erectile dysfunction was 66.3% and 77.5%, respectively. The subjects in methadone group were over 2.5-fold more likely to use condom during intercourse (p<0.001). The methadone therapy could lead to a significant reduction in orgasm functioning (p<0.001), and a significant improvement in libido (p=0.001). The methadone maintenance treatment (MMT) significantly resulted in decreased orgasm function and improved libido in males. Conclusion: Evidence suggests a positive impact of methadone maintenance treatment on risky sexual behaviors. Regarding the methadone poisoning effect on children, people should be informed by health care providers about serious and fetal effects on children.

An observational study assessing the pathways to care among treatment seeking users of natural opiates

Background: Natural opiate users constitute a large proportion of opioid dependent individuals in India, and enjoy socio-cultural sanction in certain parts of the country. However, no study has assessed the pathways to care among this population in India.Objective: To assess the pathways to care among treatment-seeking natural opiate dependent individuals.Method: This cross sectional, explorative study was conducted at a tertiary care drug treatment centre located in North India. A total of 125 male participants aged >18 years, seeking treatment for natural opiate dependence from our outpatient clinic were included. A semi-structured proforma and WHO mental health encounter form was applied to assess socio-demographic, treatment details and pathways to care.Results: The mean age was 46.17 (±11.98) years. Poppy husk (phukki/doda/posht) was the most common primary natural opiate used (84%). First point of treatment contact was addiction psychiatrist (n = 90; 72%) in majority. First time treatment seeking was either by self-referral (60.8%) or referral by relatives and friends (24.8%) with mean time lag of 18.63 years after the onset.Conclusion: Natural opiates dependent patients seek treatment late in the course of their illness, often directly from a tertiary addiction treatment centre. Barriers to seek treatment needs to be addressed.

How the Opioid Addiction Crisis Was Rendered ‘White’

The opioid crisis and its effect on suburban and rural white populations has focused attention on socioeconomic factors. Yet the fastest rising rate of opioid deaths is in African-American communities where the response to addiction has largely been punitive.

Risky Sexual Behavior Among Individuals Receiving Buprenorphine/Naloxone Opiate Dependency Treatment: HIV Prevention Trials Network (HPTN) 058.

Understanding the role of opiate dependency treatment in risky sexual behavior could help optimize interventions for people who inject drugs (PWID). We evaluated whether long-term medication-assisted treatment (LT-MAT) of opiate dependency with buprenorphine/naloxone influenced risky sexual behavior among HIV-uninfected PWID and identified predictors of risky sexual behavior. We used data from HPTN 058, a randomized controlled trial of LT-MAT vs. short-term medication-assisted treatment among PWID in China and Thailand. We evaluated associations between randomized opiate dependency treatment group and self-reported risky sexual behaviors within the past month: condomless sex with primary partner, condomless sex with nonprimary partner, multiple partners, and more than 3 sexual acts. We used generalized estimating equations to conduct intention-to-treat, as-treated, and exploratory analyses of these associations. Of 1250 participants included in the analysis, 92% were male, with median age of 34 years (interquartile range 28-39). At baseline, referring to the past month, 36% of participants reported condomless sex with primary partner, 4% reported condomless sex with nonprimary partner, 6% reported multiple sex partners, and 30% reported more than 3 sexual acts. Risky sexual behaviors did not differ significantly between treatment groups at any point. Significant predictors (P < 0.05) of condomless sex with nonprimary partner were history of incarceration and noninjection drug use. Number of needle-sharing partners, noninjection drug use, and higher income were predictors for multiple sexual partners. LT-MAT did not significantly modify risky sexual behavior among HIV-uninfected PWID. Interventions that reduce sexual risk should target PWID with history of incarceration, alcohol use, and needle sharing.

Treatment and Intervention for Opiate Dependence in the United Kingdom: Lessons from Triumph and Failure

The history of opiate treatment in the United Kingdom (UK) since the early 1980s is a rich source of learning about the benefits and pitfalls of drug treatment policy. We present five possible lessons to be learnt about how factors outside the clinic, including government, charities and researchers can influence treatment and outcomes. First, do not let a crisis go to waste. The philosophical shift from abstinence to harm reduction in the 1980s, in response to an HIV outbreak in injecting users, facilitated expansion in addiction services and made a harm reduction approach more acceptable. Second, studies of drug-related deaths can lead to advances in care. By elucidating the pattern of mortality, and designing interventions to address the causes, researchers have improved patient safety in certain contexts, though significant investment in Scotland has not arrested rising mortality. Third, collection of longitudinal data and its use to inform clinical guidelines, as pursued from the mid-1990s, can form an enduring evidence base and shape policy, sometimes in unintended ways. Fourth, beware of the presentation of harm reduction and recovery as in conflict. At the least, this reduces patient choice, and at worst, it has caused some services to be redesigned in a manner that jeopardises patient safety. Fifth, the relationship between the third and state sectors must be carefully nurtured. In the UK, early collaboration has been replaced by competition, driven by changes in funding, to the detriment of service provision.

My Path to Psychiatry

Back to table of contents Previous article Why I Aspired to Be a PsychiatristFull AccessMy Path to PsychiatryJohn Krystal, M.D.John KrystalSearch for more papers by this author, M.D.Published Online:19 Oct 2017https://doi.org/10.1176/appi.pn.2017.10b1AbstractI feel lucky to be a psychiatrist. I came to this choice through a path in which I benefitted from incredible role models, mentors, colleagues, trainees, and patients who helped me grow as a person, doctor, and scientist.My first role model, and that of my brother Andrew (also a psychiatrist), was my father, Dr. Henry Krystal. He was a Holocaust survivor who turned experiences in the Nazi death camps into a psychiatric career focused on the problem of psychological trauma. Not only was his career inspiring, but he embodied traits and values—such as integrity, skepticism, curiosity, and humanism—that we aspired to emulate.In 1976, I entered the University of Chicago with only rough ideas about a career in medicine. There, Dr. Daniel X. Freedman was a charismatic psychiatric leader. I was interested in learning about addiction. Drs. Ed Senay, at Chicago, and Ed Khantzian, at Harvard, included me in activities at their methadone programs. I also interned with Dr. Martin Mitcheson at University College London, where I observed methadone, heroin, and even cocaine maintenance treatment. Seminal moments that shaped my career happened by accident. One epiphany came during a college biochemistry course with Dr. Earl Evans in which he discussed the discovery of endogenous opiates and opiate receptors, highlighting the work of Dr. Solomon Snyder and his colleagues. I realized that specific molecular mechanisms could be identified for addiction, and perhaps other psychiatric illnesses, and that there might be opportunities for transformative scientific discoveries. After that class, on the advice of Dr. Freedman, I contacted Dr. Richard Miller. I studied opiates and endorphins in his laboratory in my free time for the remainder of my college career. Another epiphany came in 1979, when Dr. Senay graciously brought me to the College on Problems of Drug Dependence meeting. There, I heard Dr. Mark Gold describe one of the first successes of translational neuroscience: the discovery of clonidine as a nonopiate treatment for opiate dependence. This work was a team effort at Yale University involving basic scientists, such as Drs. George Aghajanian and Eugene Redmond, and clinical investigators, such as Drs. Gold and Herbert Kleber. At that point, I wanted to go to Yale to join the hunt for molecular mechanisms of illness and novel treatments.I arrived at Yale for medical school in 1980 and I never left. Along the way, I had numerous influential mentors, particularly Drs. Dennis Charney, George Heninger, and Patricia Goldman-Rakic. Also, I have had wonderful colleagues and collaborators, whom I count among my most important influences and closest friends. I also have worked with enormously talented mentees, who forged successful independent careers. So far, my career has been more stimulating than I could have imagined. I focused my work on translational neuroscience and, with my colleagues, identified a promising new treatment, that is, the rapid antidepressant effects of ketamine. The opportunities to have an impact on mental illness through science are greater than ever. We are fortunate that despite some obvious challenges, this is the best time in the history of the field to pursue a career in academic psychiatry. ■John Krystal, M.D., is the Robert L. McNeil Jr. Professor of Translational Research and chair of the Department of Psychiatry at Yale University School of Medicine. He is also director of the NIAAA Center for the Translational Neuroscience of Alcoholism and director of the Clinical Neuroscience Division at the VA National Center for PTSD and serves on APA’s Council on Research. ISSUES NewArchived

Comparisons of Alcohol and Drug Dependence in Terms of Attachments and Clinical Issues

ABSTRACTBackground: Alcohol and drug dependencies are associated with different social stigmas, and some studies suggest they might exhibit different clinical presentations. Further, the treatments for each vary considerably. Alcohol versus drug use problems were compared in terms of attachment patterns and related clinical treatment issues in two interlocking studies using converging logic and designs. Methods: In Study 1, alcohol versus drug dependence was defined in terms of a known groups design. Patients from an inpatient alcohol treatment center, patients receiving treatment for opiate dependence in a methadone maintenance clinic, and controls were compared on the 29 scales of the Attachment and Clinical Issues Questionnaire (ACIQ). Study 2 sampled a substantially different population (491 university students) and used different operational definitions of substance use problems, relying on screening instruments. Results: Study 1 found that, although the drug and alcohol dependent patients differed substantially from the controls, they did not differ from one another on any of the 29 ACIQ scales measuring attachments and clinical issues. Study 2 converged on the known groups design of Study 1, showing convergent and concurrent rather than discriminate evidence for the alcohol and drug dependence screening instruments. Conclusion: Alcohol and drug dependencies were not found to differ significantly in terms of attachments or clinical issues. These studies aimed to provide clearer and more empirically grounded guidance to the clinician and researcher.

Shall we Screen for Cardio-Metabolic Risks in Methadone and Buprenorphine Treatment for Opiate Dependence?

Recent evidence suggests that buprenorphine, the partial opiate receptor agonist, exhibits equal efficacy as methadone in reducing withdrawal and craving for opiates in opioid dependence. Very few studies examine the benefits of screening for combined cardiovascular and metabolic risk factors in methadone and buprenorphine maintenance options for opioid dependence. We explore the feasibility whether outcome maybe improved through developing cardio-metabolic screening strategy in treatment facilities for opioid addiction.

An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence.

AimsTo determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost‐effective use of health‐care resources.DesignA probabilistic cost‐effectiveness analysis was conducted, using a decision‐tree to estimate the short‐term clinical and health‐care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long‐term clinical consequences and costs associated with hepatitis B infection.Settings and participantsData on attendance to vaccination from a UK cluster randomized trial.InterventionTwo contingency management options were examined in the trial: fixed versus escalating schedule financial incentives.MeasurementLife‐time health‐care costs and quality‐adjusted life years discounted at 3.5% annually; incremental cost‐effectiveness ratios.FindingsThe resulting estimate for the incremental life‐time health‐care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = –£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8–30). The probabilistic incremental cost per quality adjusted life‐year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297–7172), with an 89% probability of being considered cost‐effective at a threshold of £20 000 per quality‐adjusted life years gained (97.60% at £30 000).ConclusionsUsing financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost‐effective use of health‐care resources in the UK as long as the incidence remains above 1.2%.

Influence of Psychiatric and Personality Disorders on Smoking Cessation Among Individuals in Opiate Dependence Treatment

ABSTRACTObjective: We aimed to evaluate how psychiatric and personality disorders influence smoking cessation goals and attempts among people with opiate dependence who smoke. This information could aid the development of more effective cessation interventions for these individuals. Methods: Participants (N = 116) were recruited from two methadone clinics, completed the Millon Clinical Multiaxial Inventory-III, and were asked about their smoking behavior and quitting goals. We used the Least Absolute Shrinkage and Selection Operator (LASSO) method, a technique commonly used for studies with small sample sizes and large number of predictors, to develop models predicting having a smoking cessation goal, among those currently smoking daily, and ever making a quit attempt, among those who ever smoked. Results: Almost all participants reported ever smoking (n = 115, 99%); 70% (n = 80) had made a serious quit attempt in the past; 89% (n = 103) reported current daily smoking; and 59% (n = 61) had a goal of quitting smoking and staying off cigarettes. Almost all (n = 112, 97%) had clinically significant characteristics of a psychiatric or personality disorder. White race, anxiety, and a negativistic personality facet (expressively resentful) were negative predictors of having a cessation goal. Overall, narcissistic personality pattern and a dependent personality facet (interpersonally submissive) were positive predictors of having a cessation goal. Somatoform disorder, overall borderline personality pattern, and a depressive personality facet (cognitively fatalistic) were negative predictors of ever making a quit attempt. Individual histrionic (gregarious self-image), antisocial (acting out mechanism), paranoid (expressively defensive), and sadistic (pernicious representations) personality disorder facets were positive predictors of ever making a quit attempt. Each model provided good discrimination for having a smoking cessation goal or not (C-statistic of .76, 95% CI [0.66, 0.85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI [0.70, 0.88]). Conclusions: Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking.

Torsades-de-Pointes Predisposing Risk Factors (TdPPRFs) in a cohort of patients maintained on high dose methadone – a clinical safety caseload analysis

IntroductionMethadone, a long-acting opioid agonist commonly used in the treatment of opiate dependence, has been reported to cause QTc interval prolongation, increasing the risk of a fatal cardiac arrhythmia – Torsades-de-Pointes (TdP). This effect seems to be attributable to methadone's inhibitory effect on the cardiac “hERG”-K+ ion channel and is dose-dependent. There is a lack of consensus regarding when to perform an ECG for patients on methadone.ObjectivesIdentifying other TdPPRFs in a cohort of patients receiving ≥ 85 mg (high dose) methadone daily to inform local clinical safety guidelines.MethodsOur outpatient caseload was filtered to select opiate-dependent patients receiving more than 85 mg methadone daily. Primary care summaries and laboratory results databases were analysed for the presence of other TdPPRFs: female sex a documented history of ECG abnormalities, electrolyte imbalance, liver or renal failure, and concomitant use of other QT prolonging medication or stimulants.ResultsFourteen opiate-dependent patients (10.29% of patients on methadone) were maintained on ≥ 85 mg methadone daily. Gender distribution was F:M = 1:1.8; 64% misused illicit stimulants; 57% were prescribed other QTc prolonging medication and 29% had a documented history of liver/renal failure or electrolyte imbalance. Only 14% had previous ECGs documented in primary care summaries. Of patients on high dose methadone, 85.7% had at least one TdPPRFs present and 64.3% had at least two.ConclusionsThese results demonstrate an increased rate of TdPPRFs in this patient group and highlight the importance of ECG monitoring which ideally should be offered to patients receiving even lower doses of methadone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Predictors of quality of life in opiate-dependent individuals undergoing methadone maintenance treatment

IntroductionQuality of Life (QoL) is an important outcome variable in Methadone Maintenance Treatment (MMT) for opiate dependence. Previous research has focused on demographic variables, treatment features, drug use and physical and mental health as possible predictors of QoL in this condition but interest in genuinely psychological variables (skills and personal repertoires) has been lacking. Experiential Avoidance (EA), the tendency to behave in order to decrease some kind of internal distress, has a strong relationship to psychological disorders and holds promise as a potential predictor of QoL.ObjectivesTo identify predictors of QoL in clients undergoing MMT, taking into account psychological variables.AimsTo see if EA is related to QoL in clients undergoing MMT.MethodsUsing a cross-sectional design, information was gathered from 48 opiate-dependent individuals undergoing MMT. Variables included were QoL (IDUQOL), severity of drug use, social adjustment and physical and mental health (ASI-6), emotional distress (HAD) and EA (AAQ and its version for substance-abusing individuals, AAQ-SA). Mean-comparison tests and correlation tests were carried out, and several variables were entered into a stepwise multiple regression analysis.ResultsAnxiety and EA were the only variables which made it into the regression model, accounting for 41.9% of variance of QoL.ConclusionsContrary to previous research, the predictors of QoL were psychological. It is the first time that EA is related to QoL in this population. Interventions should explicitly target EA and anxiety. Additional research should make use of longitudinal designs and take into account further psychological variables (emotion regulation, coping).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Body Composition Changes Associated With Methadone Treatment.

Background:Methadone is associated with a statistically significant increase in BMI in the first 2 years of treatment.Objectives:To evaluate the changes of body composition (bone mass, % fat, % muscle mass, % water, and basal metabolic rate) related to this increase.Patients and Methods:Changes in body composition were monitored, via bioelectrical impedance, in 29 patients in methadone treatment for opiate dependency (age 18 to 44, mean = 29.3, SD = 7.0, 13 men, 16 women).Results:Within one year from admission to treatment, a statistically significant (t-tests, P < 0.05) increase was noted in their body mass index (BMI), % of body fat, average body mass, and average basal metabolic rate, and relative decrease in their % of muscle mass and % of bone mass. Neither absolute bone mass nor muscle mass changed significantly.Conclusions:Physicians involved in care of methadone patients should recommend dietary and lifestyle changes to improve their overall health.

Buprenorphine Maintenance Treatment of Opiate Dependence: Correlations Between Prescriber Beliefs and Practices

ABSTRACTBackground: Despite the existence of evidence-based guidelines, different prescriber practices around buprenorphine maintenance treatment (BMT) of opiate dependence exist. Moreover, certain prescriber beliefs may influence their practice patterns. Objective: To understand community BMT practice patterns and discern their relationship to practitioner beliefs. Method: Survey of 30 local BMT prescribers about aspects of BMT, and analysis of correlations between practices and practitioner beliefs. Results: Practitioners generally followed standard treatment guidelines, though the most-common maintenances dosages of BMT (4–12 mg) were lower than recommended by some studies. Endorsement of belief in a “spiritual basis” of addiction correlated with lower average BMT doses and less frequent endorsement of the belief that BMT-treated patients are “in recovery.” Conclusions/Importance: These data suggest that relatively standardized, longer-term BMT of opiate dependence is accepted among the majority of surveyed prescribers, and certain provider beliefs about addiction may influence prescribing habits and attitudes. Future studies should: (1) assess these findings in larger samples; (2) examine how prescriber beliefs about addiction and BMT compare with those of other addiction treatment providers; and (3) ascertain whether individual prescriber beliefs influence patient outcomes.

Brain default mode network functional connectivity in polysubstance using emerging adults during opioid dependence treatment

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e181 Dynamic causal modeling in humans offers a novel approach to delineate prefrontal-striatal serotonergic drivers of impulsivity in rats Amanda E. Price1, Harshini Neelakantan1, Liangsuo Ma2, Joel L. Steinberg3, Scott D. Lane4, James M. Bjork3, P.A. Narayana5, Thomas Kosten6, Antoine Bechara7, Noelle C. Anastasio1,8, F. Gerard Moeller3,9, Kathryn A. Cunningham1,8 1 Ctr Addiction Res, University of Texas Medical Branch, Galveston, TX, United States 2 Dep Radiology, Virginia Commonwealth University, Richmond, VA, United States 3 Dep Psych, Virginia Commonwealth University, Richmond, VA, United States 4 Dep Psych & Behav Sci, University of Texas Health Science Center, Houston, TX, United States 5 Dep Diag & Intervent Img, University of Texas Health Science Center, Houston, TX, United States 6 Dep Psych, Baylor College of Medicine, Houston, TX, United States 7 Dep Psych, University of Southern California, Los Angeles, CA, United States 8 Dep Pharm, University of Texas Medical Branch, Galveston, TX, United States 9 Dep Pharm, Virginia Commonwealth University, Richmond, VA, United States Aims: The prefrontal-striatal network is a major driver of impulsivity and altered neurotransmission in this circuit may underlie heightened impulsivity in cocaine use disorder (CUD). Serotonin transmission through 5-HT2A receptors (5-HT2AR) and 5HT2CR governs prefrontal-striatal networks. This study employed fMRI based DCM to investigate prefrontal-striatal effective connectivity underlying impulsivity in CUD. We also aim to translate our human findings to rodentmodels to analyze themodulatory role of the 5-HT systemwithin the prefrontal-striatal network that drives impulsivity. Methods: Ten control and 13 CUD subjects underwent fMRI while performing Go/NoGo tasks with Easy and Hard NoGo difficulty. Connectivity was determined via DCM analyses. Results: There were no differences in overall performance (p=0.9) or modulation effects on Easy NoGo (p=0.4) between groups. Hard NoGo influenced right dorsoand ventrolateral prefrontal connectivity to left caudate in controls but left anterior cingulate connectivity to left caudate in CUD subjects (p<0.05). Conclusions: CUD subjects utilize different connectivity during impulsive responding to perform similarly to controls. Altered topdown control may be mediated by impaired 5-HT transmission at 5-HT2AR and 5-HT2CR. Ongoing studies are testing if 5-HT2AR:5HT2CR imbalance in the prefrontal-striatal circuit shifts effective connectivity governing impulsivity in CUD. Financial support: DA020087, DA033935, DA034131, DA033374. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.674 Brain default mode network functional connectivity in polysubstance using emerging adults during opioid dependence treatment Jenessa S. Price2, Marc L. Copersino2, Gordana Vitaliano3, Scott E. Lukas3, Roger Weiss1, Amy Janes2 1 Harvard Medical School, Belmont, MA, United States 2 McLean Hospital/Harvard Medical School, Belmont, MA, United States 3 Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, United States Aims: The default mode network (DMN) is an interconnected set of brain regions typically active at rest and during low cognitive demand conditions. Heroin-dependent adults show DMN connectivity abnormalities correlated with lifetime heroin use. Functional organization abnormalities are especially pertinent to younger substance-using persons who have ongoing neurodevelopment, higher risk of relapse and lower treatment completion rates. This study examined brain connectivity indices and associations with acute drug use in ten emerging adult patients (ages 18–27) in partial relapse prevention treatment for opioid dependence. Methods: Patients who met DSM-IV criteria for current opioid dependence and used opiates in the past month received restingstate functional magnetic resonance imaging (fMRI) scans within 24hours of admission. Potential participants were not excluded for other drug use or dependence; in most cases this included marihuana, sedatives and/or nicotine. Seven participants also met dependence criteria for at least one other substance. Imaging data wereanalyzedusingan independent componentsanalysis followed by dual regression to identify subject-specific spatial maps of the DMN. A non-parametric permutation testing method was used to correlate DMN with total days of any substance use in the past 30 days. Results: Increased drug use over the past 30 days was correlated with less connectivity between the DMN and insula, dorsal striatum and post central gyrus (cluster corrected Z=2.3, p<0.05, 5000 permutations). Conclusions: These findings provide evidence that polysubstance use is associated with functional adaptations in the DMN of emerging adults seeking treatment for opiate dependence. Further research is needed to delineate if these connectivity changes are related to recent detoxification. Financial support: T32 DA015036, K23 DA027045, K01 DA029645. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.675 Current drug scheduling reviews of synthetic cathinones by the U.S. drug enforcement administration Cassandra Prioleau, Srihari R. Tella, Michelle Walker, Sandy Ghozland, Li Fang, Jordan Trecki, Ambuja S. Bale, Artisha R. Polk, Daniel Willenbring, Liqun L. Wong, Terrence L. Boos Office of Diversion Control, Drug Enforcement Administration, Springfield, VA, United States Aims: In accordance with the Controlled Substances Act (CSA), DEA collects and reviews scientific, medical and other data for substances with abuse potential to evaluate them for possible control under the CSA. Numerous synthetic cathinones have become