Reliability and Validity of Addiction Severity Index in Drug Users with Methadone Maintenance Treatment in Guizhou Province, China

Objective To evaluate the reliability and validity of the Chinese version of addiction severity index （ASI）-5th version （ASI-C-5）, in illegal drug users receiving methadone maintenance treatment （MMT） in China. Methods One hundred and eighty-six heroin addicts （144 men and 42 women） receivihg MMT at three clinics in Guizhou province, southwest China, were recmited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability. Results Cronbach＇s alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores （CSs） of ASI-C-5 were satisfactory （r=0.38-0.97）. Based on item analysis and expert＇s suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts＇ self-rating anxiety scale （SAS） and self-rating depression scale （SDS） （r=0.59 and 0.45） except for social support rating scale （SSRS）. Conclusions ASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.

Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children

AIM To describe our institutional experience with conversion from intravenous(IV) fentanyl infusion directly to enteral methadone and occurrence of withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation and analgesia.METHODS With Institutional Review Board approval,we retrospectively studied consecutively admitted invasively mechanically ventilated children(0-18 years) sedated with IV fentanyl infusion > 5 d and subsequently converted directly to enteral methadone.Data were obtained onsubject demographics,illness severity,daily IV fentanyl and enteral methadone dosing,time to complete conversion,withdrawal scores(WAT-1),pain scores,and need for rescue opioids.Patients were classified as rapid conversion group(RCG) if completely converted ≤ 48 h and slow conversion group(SCG) if completely converted in > 48 h.Primary outcome was difference in WAT-1 scores at 7 d.Secondary outcomes included differences in overall pain scores,and differences in daily rescue opioids.RESULTS Compared to SCG(n = 21),RCG(n = 21) had lower median WAT-1 scores at 7 d(2.5 vs 5,P = 0.027).Additionally,RCG had lower overall median pain scores(3 vs 6,P = 0.007),and required less median daily rescue opioids(3 vs 12,P = 0.003) than SCG.The starting daily median methadone dose was 2.3 times the daily median fentanyl dose in the RCG,compared to 1.1 times in the SCG(P = 0.049).CONCLUSION We observed wide variation in conversion from IV fentanyl infusion directly to enteral methadone and variability in withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation.In those children who converted successfully from IV fentanyl infusion to enteral methadone within a period of 48 h,a methadone:fentanyl dose conversion ratio of approximately 2.5:1 was associated with less withdrawal and reduced need for rescue opioids.

Effects of Methadone Exposure during Development on Avian Brain and Blood Cells

Maintenance with methadone is standard treatment for opioid-addicted patients, including pregnant women. Cellular effects of methadone exposure during development are investigated by using an avian model, which is free of confounding maternal variables. In the first study, which explored dose by duration interactions, methadone was administered at one of two doses (0.458 mg/kg or 1.75 mg/kg) for one of three durations of exposure: late in development (Incubation Days 12 to 19), middle to late (Days 9 to 19), or early to late (Days 5 to 19). In the second study, 1.00 mg/kg of methadone was administered from days 8 to 18 and compared with controls (0.00 mg/kg). Brain tissue and blood samples were harvested for all dose conditions from the two studies. Increased methadone exposure was associated with subependymal anomalies, subependymal hemorrhaging, edema, monocytic infiltration, an increase in disintegrating red blood cells, an increase in white blood cells, and a decrease in neurons. Significant differences in variance for cell counts by condition were observed. Exposed specimens had significantly more thrombocytes (t = - 2.66, p < 0.05). The anomalies suggest that methadone exposure may be harmful to develop organisms at the cellular level.

Evaluation of the suicide risk factors among methadone maintenance treatment of opiate dependent individuals: A six month assessment

Background: Opiate abuse is a universal socio-medical problem and one of the most important risk factors for suicide, especially in accordance with other psychological disorders. This study designed to evaluate four important suicide risk factors in methadone maintenance therapy clinics within six months treatment. Method: In this cross-sectional study, a psychologist performed interviews with 82 patients who attended in methadone maintenance therapy (MMT) center of Hejazi and Ebnesina hospitals’ clinics, Mashhad, Iran. Five questionnaires including demographic characteristics, Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory (BDI) were completed at first visit and after six months treatment. Results: Eighty two individuals (68 male and 14 female) ranged between 20 to 44 years old (31.68 ± 4.93) abused mostly crystal (crystal heroein) (79.3%), opium (15.9%) then Shishe (methamphetamine) (4.9%). All studied characteristics of the patients decreased significantly after six month follow up (P 0.05), while BHS after MMT period decreased significantly in men (P = 0.028). Conclusion: The positive effect of methadone maintenance therapy on reduction of four important risk factors for suicide imply on another benefits of this treatment method and it is useful for reduction of suicide risk, among substance abusers.

Chronic methadone use,poor bowel visualization and failed colonoscopy:A preliminary study

AIM:To examine effects of chronic methadone usage on bowel visualization,preparation,and repeat colonoscopy.METHODS:In-patient colonoscopy reports from October,2004 to May,2009 for methadone dependent(MD) patients were retrospectively evaluated and compared to matched opioid naive controls(C).Strict criteria were applied to exclude patients with risk factors known to cause constipation or gastric dysmotility.Colonoscopy reports of all eligible patients were analyzed for degree of bowel visualization,assessment of bowel preparation(good,fair,or poor),and whether a repeat colonoscopy was required.Bowel visualization was scored on a 4 point scale based on multiple prior studies:excellent = 1,good = 2,fair = 3,or poor = 4.Analysis of variance(ANOVA) and Pearson χ 2 test were used for data analyses.Subgroup analysis included correlation between methadone dose and colonoscopy outcomes.All variables significantly differing between MD and C groups were included in both univariate and multivariate logistic regression analyses.P values were two sided,and < 0.05 were considered statistically significant.RESULTS:After applying exclusionary criteria,a total of 178 MD patients and 115 C patients underwent a colonoscopy during the designated study period.A total of 67 colonoscopy reports for MD patients and 72 for C were included for data analysis.Age and gender matched controls were randomly selected from this population to serve as controls in a numerically comparable group.The average age for MD patients was 52.2 ± 9.2 years(range:32-72 years) years compared to 54.6 ± 15.5 years(range:20-81 years) for C(P = 0.27).Sixty nine percent of patients in MD and 65% in C group were males(P = 0.67).When evaluating colonoscopy reports for bowel visualization,MD patients had significantly greater percentage of solid stool(i.e.,poor visualization) compared to C(40.3% vs 6.9%,P < 0.001).Poor bowel preparation(35.8% vs 9.7%,P < 0.001) and need for repeat colonoscopy(32.8% vs 12.5%,P = 0.004) were significantly higher in MD group compared to C,respectively.Under univariate analysis,factors significantly associated with MD group were presence of fecal particulate [odds ratio(OR),3.89,95% CI:1.33-11.36,P = 0.01] and solid stool(OR,13.5,95% CI:4.21-43.31,P < 0.001).Fair(OR,3.82,95% CI:1.63-8.96,P = 0.002) and poor(OR,8.10,95% CI:3.05-21.56,P < 0.001) assessment of bowel preparation were more likely to be associated with MD patients.Requirement for repeat colonoscopy was also significant higher in MD group(OR,3.42,95% CI:1.44-8.13,P = 0.01).In the multivariate analyses,the only variable independently associated with MD group was presence of solid stool(OR,7.77,95% CI:1.66-36.47,P = 0.01).Subgroup analysis demonstrated a general trend towards poorer bowel visualization with higher methadone dosage.ANOVA analysis demonstrated that mean methadone dose associated with presence of solid stool(poor visualization) was significantly higher compared to mean dosage for clean colon(excellent visualization,P = 0.02) or for those with liquid stool only(good visualization,P = 0.01).CONCLUSION:Methadone dependence is a risk factor for poor bowel visualization and leads to more repeat colonoscopies.More aggressive bowel preparation may be needed in MD patients.

Methadone Maintenance Treatment Program in Portuguese Community Pharmacies

MMT （Methadone maintenance treatment） is an effective way to treat opioid dependence. In Portugal, an MMT program has been available in pharmacies since January 1998, when a formal agreement was signed by the IDT, I.P. （Institute on Drugs and Drug Addiction）, the PPS （Portuguese Pharmaceutical Society）, and the ANF （National Association of Pharmacies）. In January 2004, the INFARMED （National Authority of Medicine and Health Products） became a partner of the program. The possibility of continuing the treatment at a community pharmacy was restricted to patients receiving a stabilized dose of methadone at IDT, I.P. treatment centers. Pharmacists joining the MMT were given mandatory training. Patients on the MMT program received daily doses of methadone solution under directly observed therapy, and were followed up by trained pharmacists. From January 1998 to January 2013, 3,090 patients underwent MMT in Portuguese community pharmacies. The delivery of MMT at community pharmacy level is feasible. This strategy improves access and adherence to methadone treatment, thus helping to reduce the use of illegal opioids. Community pharmacists fully demonstrated their ability to perform extended roles in public health and harm-reduction strategies. Interaction and close cooperation between the different health professionals and organizations involved were crucial to achieve adequate support to the patients.

医护-社工联动康复模式对美沙酮维持治疗患者心理状况的影响

目的 探究医护-社工联动康复模式对美沙酮维持治疗患者心理状况的影响。方法 纳入94例美沙酮维持治疗服务的患者,随机分为观察组(48例)和对照组(46例)。对观察组运用医护-社工联动康复模式进行个体化干预,对照组则运用常规美沙酮治疗服务模式进行干预。分别在干预前、干预3个月及6个月三个时间点对两组受试者的焦虑状态、抑郁状态及生活质量进行评估。结果 观察组受试者在接受医护-社工联动康复模式干预6个月后在抑郁状态和焦虑状态方面均较干预前显著改善,并且无论是BDI评分和BAI评分均显著低于对照组(P <0.05)。同时,观察组受试者中“有抑郁”的人数占比和“有焦虑”的人数占比均显著低于对照组(P <0.05)。干预6个月后,观察组受试者的生活质量评分(183.77±8.90)显著高于对照组(174.76±11.14)(P <0.01)。结论 医护-社工联动康复模式在改善美沙酮维持治疗患者的心理状态方面具有一定的优越性,值得被推广应用。

美沙酮按需转换法治疗癌痛的临床研究

目的:探讨美沙酮按需转换法(Ad libitum,AL)治疗癌痛的有效性和安全性。方法:选取南京大学医学院附属金陵医院疼痛科2022年11月至2023年9月全身大剂量使用阿片类药物疼痛控制不佳的癌痛病人31例,采用每次20 mg(间隔≥2 h)按需口服美沙酮转换,观察并记录美沙酮转换前、转换第1~7天和第14天病人平均疼痛数字分级评分法(numerical rating scale,NRS)评分;记录转换前、转换第1天、第3天及第7天不良反应;转换第1天至第5天补救次数;评估转换前和转换第7、14天病人生活质量(quality of life,QOL);评价并计算病人满意度和转换成功率(NRS评分降低50%,且无不能耐受的不良反应)。结果:与转换前相比,转换第1~7天及第14天病人平均NRS评分均降低(P<0.05),生活质量明显改善(P<0.001)。补救次数随滴定时间的延长而降低。病人均未出现不能耐受的药物不良反应,总体满意度为4.0(1.0),美沙酮转换成功率为93.5%。结论:全身大剂量阿片类药物使用病人,采用每次20 mg口服美沙酮按需转换效果确切、不良反应少,病人生活质量获得改善且满意度高,适合中国人群,可供临床参考。

美沙酮维持治疗对海洛因依赖者大脑度中心性影响的静息态fMRI研究

目的探索美沙酮维持治疗(methadone maintenance treatment,MMT)对海洛因依赖(heroin dependence,HD)患者大脑拓扑特性度中心性(degree centrality,DC)的影响及其与心理行为学的相关性。材料与方法回顾性分析2016年1月至2017年12月于西安市灞桥区美沙酮门诊招募的41名正在接受MMT的HD患者,采集静息态功能磁共振成像(functional magnetic resonance imaging,fMRI)数据,评估稽延性戒断症状与渴求评分,纵向随访一年。对影像数据进行DC分析,并采用配对样本t检验进行纵向比较,差异脑区与心理学指标进行相关分析。结果HD患者入组时与MMT一年后稽延性戒断症状评分差异存在统计学意义(Z=3.004,P=0.003),渴求评分差异无统计学意义(Z=0.872,P=0.383)。与基线相比,HD患者经过MMT一年后,双侧丘脑、尾状核、壳核与左侧苍白球的DC降低;右侧舌回与距状回的DC值升高(Gaussian random field校正,单体素水平P<0.001,团块体素水平P<0.01,团块体素>95)。双侧尾状核及左侧苍白球DC值与戒断症状呈负相关性(r=-0.417,P=0.030;r=-0.392,P=0.043;r=-0.383,P=0.049),双侧壳核及左侧苍白球DC值的变化量与渴求的变化量呈正相关性(r=0.410,P=0.008;r=0.332,P=0.034;r=0.395,P=0.011)。结论美沙酮可能通过降低HD患者纹状体在成瘾奖赏脑网络中的中心性,从而调节HD患者戒毒后的稽延性戒断症状与心理渴求;同时可能抑制了冲动性,增强了视觉核心脑区的活动。该研究结果可以为美沙酮对HD患者治疗的神经机制提供影像学依据。

Cardiovascular Risk of Opioids: A Real-World Study Based on FAERS

Objective:This research utilizes the FAERS for data mining to identify heart-related side effects caused by opioids,ensuring the safe use of these medications.Methods:Data from 79 quarters(Q12004 to Q32023)involving adverse event(AE)reports for opioids like morphine and oxycodone was reviewed.We applied the MedDRA system to categorize events and used statistical tools,ROR and BCPNN,for signal detection.These findings were cross-checked with drug labels and SIDER 4.1 for accuracy.Identified risks were then categorized by severity using DME and IME classifications.Results:Analysis of adverse events(AEs)for the five examined drugs(35359,14367,144441,10592,and 28848)identified 33,6,12,37,and 34 cardiovascular AEs,and 16,5,7,25,and 21 instances of important medical events(IMEs)respectively.Each drug was linked to cases of cardiac and cardiopulmonary arrest.The cardiovascular AEs varied widely in occurrence and severity,with methadone notably presenting diverse and potent risks,including sudden cardiac death as a distinct medical event(DME).A comparison with SIDER 4.1 showed 11 opioid-related cardiovascular AEs in line with our findings.Standardized MedDRA Queries(SMQs)confirmed these results,indicating stronger signals for methadone and tramadol,while morphine,hydromorphone,and oxycodone exhibited fewer and weaker signals.Conclusion:The study revealed numerous heart-related adverse effects(AEs)not listed on drug labels and identified new AE patterns.Recognizing these differences in AE profiles and risks across different opioids is crucial for safer prescription practices to minimize cardiac complications.

丁丙诺啡舌下含片用于海洛因依赖者脱毒治疗临床评价

目的 :评价丁丙诺啡舌下含片对海洛因依赖者脱毒的效果及不良反应。方法 :采用多中心随机双盲双模拟对照试验及无对照开放试验设计。对照试验选择 2 39例中度海洛因依赖者 ,按照 1:1:2的比例随机分入丁丙诺啡10d组、丁丙诺啡 14d组和美沙酮 14d组。另外 4 9例重度海洛因依赖者使用丁丙诺啡进行 10 - 14d脱毒治疗 ,进行开放观察。结果 :丁丙诺啡舌下含片控制戒断症状总分和主要戒断症状评分与美沙酮比较差异无显著性 (P >0 .0 5 )。焦虑量表评分丁丙诺啡组与美沙酮组比较差异也无显著性 (P >0 .0 5 )。用药前 3d丁丙诺啡单次用量最大可达 6mg ,日剂量最大为 18mg。不良反应较少 ,主要为便秘。停药后无明显戒断症状。结论

美沙酮维持合并心理、家庭干预治疗效果研究

目的:研究美沙酮维持治疗+心理、家庭干预对海洛因依赖者的治疗效果、生活质量的影响,并对维持治疗的剂量及不良反应发生情况进行初步探索。方法:将90例海洛因依赖者分为美沙酮+心理、家庭干预(A组,30例)、心理、家庭干预(B组,30例)和对照(C组,30例)3组。比较组间治疗保持率的差异及美沙酮+心理、家庭干预组生活质量的变化情况。结果:3组比较,美沙酮+心理、家庭干预组治疗保持率高(P<0.001);生活质量也显著提高(P<0.05)。维持剂量20-70 mg.d-1。结论:美沙酮+心理、家庭干预对提高海洛因依赖者治疗保持率效果显著,生活质量改善明显,不良反应轻微。美沙酮维持治疗的剂量应根据具体情况做到个体化,并足量给药。

江苏省美沙酮门诊在治病人药物滥用情况分析

目的:调查美沙酮门诊在治病人海洛因偷吸和多药滥用情况,为美沙酮门诊药物滥用预防和干预工作提供基础数据支持。方法:随机抽取江苏省3个美沙酮社区药物维持治疗门诊点,每个门诊按美沙酮服药剂量分层抽取150例正在治疗的海洛因成瘾者,现场问卷调查病人一般情况和多药滥用情况,采集的病人尿液分别做5种滥用物质检测。结果:449例在治病人中8.5%(38例)的病人曾经退出过治疗,23.8%(107例)的病人自我报告最近1个月偷吸过海洛因。尿检显示美沙酮门诊治疗病人多药滥用比例达到36.3%(163例),尿检结果中吗啡阳性率最高,为23.4%(105例);安定类为15.4%(69例);苯丙胺类为9.4%(42例);吗啡、苯丙胺类和安定类尿检阳性病人中分别有80.0%(84例)、14.3%(6例)和52.2%(36例)主动报告使用相关物质。结论:美沙酮门诊病人中有多种药物滥用和偷吸海洛因现象;门诊发现新型毒品尤其是甲基苯丙胺使用者。建议门诊加强对维持病人偷吸毒品的危害教育。

南昌市美沙酮维持治疗门诊海洛因依赖者心理健康调查分析

目的了解南昌市美沙酮维持治疗门诊内的海洛因依赖者的心理健康状况,为开展心理治疗提供科学依据。方法采用预先制订的问卷收集海洛因依赖者的人口学数据;SCL-90症状自评量表测定海洛因依赖者的心理症状;海洛因依赖者SCL-90评分与常模比较采用t检验。结果269例海洛因依赖者中男性为主,占76.2%;心理障碍主要表现为抑郁、躯体化和焦虑。结论南昌市美沙酮门诊内的海洛因依赖者均不同程度存在心理问题,门诊必须开展心理治疗促进吸毒者心理康复。

二氢埃托啡对吗啡依赖大鼠和猴的实验治疗

二氢埃托啡(DHE)能明显缓解吗啡依赖大鼠和猴用纳洛酮(Nal)催促或停用吗啡后出现的戒断症状,DHE对吗啡依赖猴替代治疗的疗效与美沙酮(Met)相当,经9d替代治疗,Met替代组动物Nal催促后仍出现一定的戒断症状,而DHE替代组动物未见戒断症状.

四川省美沙酮维持治疗门诊现状调查

目的:了解四川省美沙酮维持治疗工作现状,分析存在的问题,推动全省美沙酮维持治疗工作的深入开展。方法:通过问卷调查、现场数据核实等形式了解各门诊运行情况。结果:截至2009年3月底,全省共设立38所美沙酮维持治疗门诊,累计入组病人17 161人,门诊所在地估计吸毒人数为46 420人,3月份门诊在治病人为8258例;所有门诊均提供了外展服务,有34所门诊建立了针对病人的激励机制;尿检阳性率为41.16%,脱失率为46.93%。结论:四川省美沙酮维持治疗工作发展迅速、成效显著,但存在治疗工作覆盖率低、病人脱失率高、多部门合作不力和部分门诊工作管理薄弱等问题。

美沙酮维持治疗者偷吸及保持状况调查

目的了解吸毒者美沙酮维持治疗期间的偷吸和保持情况,为艾滋病防治策略提供依据。方法于2007年5～10月,在江苏省无锡市美沙酮维持治疗门诊选取64名参加维持治疗的吸毒者进行有关偷吸、保持状况的个人深入访谈,采用社会学定性方法进行影响因素分析。结果71.8%的治疗者存在偷吸现象,其影响因素主要是戒断症状引起的对毒品的心理依赖以及对美沙酮疗效的怀疑;84.4%的治疗者能坚持服用美沙酮,主要是自身想戒掉毒瘾,也为了家庭和睦。结论美沙酮维持治疗患者在治疗期间普遍存在偷吸现象,直接影响治疗的真实效果。提高美沙酮维持治疗者的保持率和减少偷吸现象重点应加强宣传,并辅以心理干预。

美沙酮维持治疗海洛因依赖者的生命质量及其影响因素研究

目的了解参加美沙酮维持治疗的海洛因依赖者的生命质量及其影响因素。方法在四川省自贡市社区药物维持治疗中心抽取216名海洛因依赖者进行问卷调查,问卷包括WHOQOL-BREF及影响生命质量的相关因素的条目。结果美沙酮门诊治疗者的得分为13.14±2.79(生理领域),12.17±3.38(心理领域),12.20±3.17(社会关系领域),11.94±3.31(环境领域),12.06±3.73(总的生存质量与健康状况)。单因素分析显示,年龄越大,吸毒年限越长,没有工作,与家人关系越差,过去3个月被抓,性生活越少,服用过安定,对治疗没有信心,各领域生命质量越差(P<0.05)。治疗6～12个月的患者环境领域的生命质量高于治疗6个月以内者(P<0.01)。注射与其他方式混用的患者生理领域的生命质量低于单纯口吸者(P<0.05)。多元逐步回归分析结果表明,美沙酮门诊治疗者生命质量的影响因素包括年龄、吸毒年限、是否工作、与家人关系、性生活频率、过去3个月是否被抓、是否服用安定、治疗的信心。结论应根据治疗者不同的个体和家庭情况,采取相应的措施提高其生命质量。

影响美沙酮维持治疗依从性及相关因素的定性研究

目的:了解北京市社区美沙酮维持治疗(methadone maintenance treatment,MMT)脱失和保持的影响因素。方法:根据课题设计,于2007年12月-2008年9月,在北京市社区药物维持治疗门诊选择29名服药人员,对每位服药人员单独进行深入访谈,归纳总结服药人员脱失和保持的影响因素。结果:脱失的主要影响因素是:服药人员对美沙酮药物本身或/和MMT普遍存在不正确认知、服药期间偷吸毒品、缺乏必要的社会心理干预、个别服药人员缴费困难、存在服药不够便利的问题和公安部门的配合仍需提高等;有利于保持的因素是:家人支持、给药剂量合适、门诊工作人员的服务态度积极等。结论:加大MMT政策和相关知识的宣传力度,对MMT服药人员积极开展社会心理干预活动,针对北京市美沙酮维持治疗的薄弱环节采取有针对性的防治措施,降低脱失率。