Alcoholism in MMT Patients

Alcohol use problem among patients in methadone maintenance treatment in Taiwan. J Subst Abuse Treat. 2011 Mar;40(2):142-9.

http://www.ncbi.nlm.nih.gov/pubmed/21036515

PARTICIPANTS:

Study population included 438 patients who underwent more than 6 months of MMT.

MEASUREMENTS:

Demographic and clinical characteristics were collected for each patient prior to treatment, and treatment-related variables were collected during treatment process. Hazardous drinking, alcohol abuse, and dependence were measured using a Chinese version of the Alcohol Use Disorders Identification Test (AUDIT) and by measuring breath alcohol concentration.

FINDINGS:

The prevalence rates of alcohol use problems, indicated by hazardous drinking are 31.4%. The protective predictors of alcohol use problems among MMT patients include an attendance rate of more than 90% (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.30-0.97) and being older than 36 years (OR = 0.48, 95% CI = 0.27-0.86), and alcohol drinking problem at intake of study is a risk factor (OR = 5.30, 95% CI = 2.87-9.76).

Quality of Life (QOL) in MMT Patients

Change in quality of life and its predictors in heroin users receiving methadone maintenance treatment in Taiwan: an 18-month follow-up study. Am J Drug Alcohol Abuse. 2012 May;38(3):213-9.

http://www.ncbi.nlm.nih.gov/pubmed/22352836

METHODS:

A total of 368 intravenous heroin users receiving MMT in southern Taiwan between 2007 and 2008 were interviewed using the Taiwan version of the Brief Version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF) at baseline and after 3, 6, 9, 12, 15, and 18 months of treatment. Demographic and substance-use characteristics, severity of heroin use, HIV serostatus, criminal record, and family function data were collected during baseline interviews. Data on methadone dosage at each follow-up point and the duration of retention in the MMT program were also collected.

RESULTS:

Improvement in QOL was rapid during the first 3 months after initiation of MMT and slowed beyond the 3-month point. A higher dosage of methadone predicted a better QOL. In addition, longer retention in the program may be associated with a better QOL.

HIV Infection Risk in MMT Patients

HIV Infection Risk among Injection Drug Users in a Methadone Maintenance Treatment Program, Taipei, Taiwan 2007-2010. Am J Drug Alcohol Abuse. 2012 Nov;38(6):544-50.

http://www.ncbi.nlm.nih.gov/pubmed/22783806

Methods: Data from intake interviews and HIV testing completed by IDUs upon admission to the Taipei City Hospital MMTP in 2007-2010 were included in this analysis. HIV testing was repeated semi-annually among maintained clients who were HIV-negative during MMTP admission.

Results: Of 1444 IDUs admitted, 85.9% were male, median age was 40 years, and mean years of injecting was 14.3 (range: 1-64). The prevalence of HIV, HCV, and HIV/HCV co-infection was 13.4%, 91.1%, and 13.2%, respectively. In multivariable analysis, HIV infection was associated with sharing syringes during the 6 months prior to admission (OR = 14.76, 95% CI 10.31-21.13), homelessness (OR = 6.46, 95% CI 1.49-28.00), and lifetime number of MMTP admissions (OR = 1.76, 95% CI 1.30-2.38) and times incarcerated (OR = 1.10, 95% CI 1.03-1.18). HIV seroincidence was 1.15/100 person-years at risk (95% CI .62-8.77/100 PY) among IDUs who were HIV-negative at first admission.

sexual dysfunction methadone

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 Aug;36(8):739-43. doi: 10.3969/j.issn.1672-7347.2011.08.007.

Sexual function of 612 male addicts treated by methadone.

Zhang Y, Wang P, Ma Z, Xu Z, Li Y.

alcohol gene fMRI

• rs3771863, rs3755459, and rs1106855 predicted BOLD activation in response to alcohol cues in those same reward and reinforcement brain areas, especially in the medial prefrontal cortex, striatum, and insula.
•  rs3771863 also predicted AD symptom count in the SAGE data set and BOLD activation in the mesocorticolimbic pathway response to alcohol cues.

TACR1 Genotypes Predict fMRI Response to Alcohol Cues and Level of Alcohol Dependence.
Blaine S, Claus E, Harlaar N, Hutchison K.
Alcohol Clin Exp Res. 2012 Oct 18. doi: 10.1111/j.1530-0277.2012.01923.x. [Epub ahead of print]

publish on scientific journal

• we report results from a large-scale survey of the submission process, covering 923 scientific journals from the biological sciences in years 2006–2008.
•  Manuscript flows among journals revealed a modular submission network, with high-impact journals preferentially attracting submissions. 
• About 75% of published articles were submitted first to the journal that would publish them, and high-impact journals published proportionally more articles that had been resubmitted from another journal. 
• Submission history affected postpublication impact: Resubmissions from other journals received significantly more citations than first-intent submissions, and resubmissions between different journal communities received significantly fewer citations.

Flows of Research Manuscripts Among Scientific Journals Reveal Hidden Submission Patterns
Science DOI: 10.1126/science.1227833

cocaine evoked synaptic potentiation

• We find that cocaine potentiates excitatory transmission in D1-receptor-expressing medium-sized spiny neurons (D1R-MSNs) in mice via ERK signalling with a time course that parallels locomotor sensitization
•  Depotentiation of cortical nucleus accumbens inputs by optogenetic stimulation in vivo efficiently restored normal transmission and abolished cocaine-induced locomotor sensitization. 
• These findings establish synaptic potentiiation selectively in D1R-MSNs as a mechanism underlying a core component of addiction, probably by creating an imbalance between distinct populations of MSNs in the nucleus accumbens. 
• Our data also provide proof of principle that reversal of cocaine-evoke synaptic plasticity can treat behavioural alterations caused by addictive drugs and may inspire novel therapeutic approaches involving deep brain stimulation or transcranial magnetic stimulation.

Nature. 2011 Dec 7;481(7379):71-5. doi: 10.1038/nature10709.

Reversal of cocaine-evoked synaptic potentiation resets drug-induced adaptive behaviour.

Heroin hepatitis

•  Of the first 27 patients who initiated CGT, 42% achieved a sustained viral response.
•  87% (13/15) of genotype-1 infected patients treated with direct acting antiviral agent achieved an undetectable viral load at 24weeks.

Concurrent group treatment for hepatitis C: Implementation and outcomes in a methadone maintenance treatment program.

J Subst Abuse Treat. 2012 Oct 2. pii: S0740-5472(12)00142-0. doi: 10.1016/j.jsat.2012.08.007. [Epub ahead of print]

Drug abuse-related accidents

• During the study period, a total of 166 patients visited the EDs of one of the two study hospitals due to drug abuse-related accidents.
•  Opioids (41.1%) were the drugs most commonly abused by the patients, followed by benzodiazepines (32.1%).
• More than two-thirds of the patients (n=38, 67.9%) required hospitalization, and three patients died (5.4%).

Drug abuse-related accidents leading to emergency department visits at two medical centers.

J Chin Med Assoc. 2012 May;75(5):234-9. Epub 2012 Apr 28.

Why We Like to Drink

• Alcohol robustly activated striatal reward circuits while attenuating response to fearful stimuli in visual and limbic regions.
• Self-ratings of intoxication correlated with striatal activation, suggesting that activation in this area may contribute to subjective experience of pleasure and reward during intoxication.
• These results show that the acute pharmacological rewarding and anxiolytic effects of alcohol can be measured with fMRI.

Why We Like to Drink: A Functional Magnetic Resonance Imaging Study of the Rewarding and Anxiolytic Effects of Alcohol. The Journal of Neuroscience, April 30, 2008 • 28(18):4583– 4591 • 4583

Opioid itch

• μ-opioid receptor (MOR) isoform MOR1D is essential for morphine-induced scratching (MIS)

Unidirectional cross-activation of GRPR by MOR1D uncouples itch and analgesia induced by opioids.

Cell. 2011 Oct 14;147(2):447-58.

Memory retrieval-extinction heroin craving relapse

• In rats, daily retrieval of drug-associated memories 10 minutes or 1 hour but not 6 hours before extinction sessions attenuated drug-induced reinstatement, spontaneous recovery, and renewal of conditioned drug effects and drug seeking.

• In heroin addicts, retrieval of drug-associated memories 10 minutes before extinction sessions attenuated cue-induced heroin craving 1, 30, and 180 days later. The memory retrieval-extinction procedure is a promising nonpharmacological method for decreasing drug craving and relapse during abstinence.

A memory retrieval-extinction procedure to prevent drug craving and relapse. Science. 2012 Apr 13;336(6078):241-5.

Opiate gene

Kreek MJ.

Opiate addiction and cocaine addiction: underlying molecular neurobiology and genetics.

J Clin Invest. 2012 Oct 1;122(10):3387-93. doi: 10.1172/JCI60390. Epub 2012 Oct 1.

Methadone mortality Taiwan

Factors associated with mortality among heroin users after seeking treatment with

methadone: A population-based cohort study in Taiwan

• 1616 Taiwanese heroin users between October 2006 and December 2008, central Taiwan (National Taiwan University Hospital Yun-Lin Branch, St. Joseph's Hospital, China Medical University Beigang Hospital, and National Cheng Kung University Hospital Dou-Liou Branch),
• linkage with the National Death Certification Registry system
• Opiate Treatment Index (OTI),
• 26 (1.6%) people died, with an all-cause mortality rate per 100 person years of 3.42
• The primary cause of death  was
• accidents,
• suicide
• drug overdose
• Older age, HIV infection, psychiatric treatment history, and alcohol abuse/dependence were risk factors for all-cause mortality;
• remaining on MMT was protective for survival

Factors associated with mortality among heroin users after seeking treatment with methadone: A population-based cohort study in Taiwan. J Subst Abuse Treat. 2012 Sep 25. pii: S0740-5472(12)00138-9. doi: 10.1016/j.jsat.2012.08.003. [Epub ahead of print]


Charles Lung-Cheng Huang, M.D.a,b, Lee Chung-Wei, Master c
a Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
b Department of Nursing, Chung-Hwa University of Medical Technology, Tainan, Taiwan
c Department of Psychiatry, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

Heroin gene postmortem

Method: We evaluated singlenucleotide polymorphisms of key genes within these systems in three populations of opiate abusers and controls, totaling 489 individuals from Europe and the United States with postmortem tissue.
Conclusion: Genetically influenced interactions between glutamatergic and dopaminergic pathways in opiate abusers


Dopamine receptor D1 and postsynaptic density gene variants associate with opiate abuse and striatal expression levels. Molecular Psychiatry (2012), 1–6

Methadone and perinatal outcomes

  A total of 117 pregnant women on methadone maintenance treatment recruited between July 2009 and July 2010.
 Information on concomitant drug use was recorded with the Addiction Severity
Index. Perinatal outcomes included pre-term birth (<37 weeks’ gestation), small-for-gestational-age (<10th centile) and neonatal unit admission. NAS outcomes included: incidence of medically treated NAS, peak Finnegan score, cumulative dose of NAS treatment and duration of hospitalization. Findings Of the 114 liveborn infants 11 (9.6%) were born pre-term, 49 (42.9%) were small-for-gestational-age, 56 (49.1%) had a neonatal unit admission and 29 (25.4%)were treated medically for NAS. Neonates exposed to methadone-only had a shorter hospitalization than those exposed to methadone and concomitant drugs (median 5.0 days versus 6.0 days, P = 0.03). Neonates exposed to methadone doses 80 mg required higher cumulative doses of morphine treatment for NAS (median 13.2 mg versus 19.3 mg,P = 0.03).The incidence and duration of NAS did not differ between the two dosage groups.
 Conclusions The incidence and duration of the neonatal abstinence syndrome is not associated with maternal methadone dose, but maternal opiate, benzodiazepine or cocaine use is associated with longer neonatal hospitalization

Methadone and perinatal outcomes: a prospective cohort study. Addiction. 2012 Aug;107(8):1482-92. doi: 10.1111/j.1360-0443.2012.03844.x. Epub 2012 May 8.

Nucleus Accumbens Surgery for Addiction

  Our institute had performed this surgery in 272 patients with severe heroin addiction. The follow up study showed the 5 years non-relapse rate was 58% and the quality of life was significantly improved.

 

Nucleus Accumbens Surgery for Addiction. World Neurosurg. 2012 Oct 6. pii: S1878-8750(12)01106-0. doi: 10.1016/j.wneu.2012.10.007. [Epub ahead of print]