A. Kuldija

Opiate addiction recovery: New treatment with buprenorphine and naloxone (suboxone) helps bring families together in Bosnia and Herzegovina

Background The centre for medical prevention of opiate addiction established, as a part of the Tuzla University Clinical Centres Department of Psychiatry, is a result of several years of cooperation between the Tuzla department of psychiatry and the centre for addiction of the University Hospital in Orebro, Sweden. By working together, the scientists have developed the Tuzla model for opiate addiction in 2009, a first ever project of such kind in Bosnia and Herzegovina. Objectives To describe principles of organization and results of six years working period with buprenorphine+naloxone program. Method Authors described principles of organization and results of six years working period of the centre for medical prevention of opiate addiction in Tuzla. Results Once a patient is admitted to the center, a family member or a close friend signs a statement, committing to ensure that the patient will take the prescribed medicine regularly and always sticks around, from the very first psychiatric interview until the treatment finalization. This program helps create a bond between the addict and another person, which makes it different from other treatment programs which usually tend to isolate addicts in institutions. Another difference is that instead of methadone, patients receive another drug that has shown much better results–buprenorphine+naloxone (Suboxone ® ). Currently, the centre has about 160 patients who come for regular treatment and check-ups. Since the centre was established, over 260 patients were successfully treated. Conclusion The program helps families to rebuild their homes and relationships torn-apart by addictions, through rehabilitation, re-socialization and reintegration.

EPA-0904 – Integrative complex personalized treatment of dual diagnoses of opiate drug addict person who is treated with maintenance substitution opiate therapy with buprenorphine/naloxone (suboxone)- case report

Opiate addiction is very often complicated with different clinical problems which are not visible because of complex clinical problems because of opiate dependency. We present a male drug addict aged of 31 year, married, he is a father of two kids, unemployed who has a complex history of trauma exposure during the war in Bosnia-Herzegovina. He survived several life threatened dangerous events with age of twelve. He started to misuse marijuana with 15 years; he started with heroin addiction with 20 years when he worked in Croatia. As intravenous drug user he became hepatitis C infected. He returned from Croatia and started to live in small village in Bosnia-Herzegovina in very difficult conditions. After induced in maintenance substitution opiate therapy with Buprenorphine/Naloxone (Suboxone), he appeared with symtoms of posttraumatic stress disorder (PTSD), he had seizures Grand mal, so we did complex clinical investigation. We found both side brain cortex reduction, and EEG positive finding. With Suboxone we introduced and Sodium-Valproate, SSRI and Clozapine because of heavy night mares. Despite complex psychopharmacotherapy his recovery was questionable. We introduced him in the Interferon treatment of Hepatitis C infection, but because of lack of money he quitted it after incomplete treatment three month after beginning. Because of increased chronic insomnia he was hospitalized for integrative complex personalized treatment. After working through of his trauma experiences in individual EMDR psychotherapy and after telling his severe trauma experiences in the group therapy of war veterans he recovered and dismissed to continue treatment as an outpatient.

EPA-0908 – Successful treatment with interferon therapy of hepatitis c positive opiate addicts who are in substitution maintenance therapy with buprenorphine/naloxone (suboxone®)

Hepatitis C is highly infected disease with long period of failure to recognize it, what leads to chronic liver damage and lower chances for complete cure if detected late. Intravenous (IV) opiate users are not aware when be infected from virus carriers using the same non-sterile equipment so they pass the infection to other IV drug users. By implementation of substitution treatment of opiate addicts with Buprenorphine/Naloxone (Suboxone) at the Department of Psychiatry in Tuzla on 27 July 2009 year, we made the obligatory serological tests for hepatitis B and C and HIV, as well as laboratory findings with liver function parameter analysis as a condition for starting substitution therapy. In this way we discovered 50/195 opiate addicts hepatitis C positive. Although faced with danger of the final result if not treated in time, addicts when became aware that they were hepatitis C positive, they avoid further needed procedures leading to the inclusion of specific therapy with pegylated interferon. In this paper, the authors presented the procedure of multidisciplinary approach of treatment of hepatitis C positive opiate addicts despite their resistances they do not occur on the continuation of the procedure detecting HCV genotypes, and the inclusion of specific therapy for the treatment of hepatitis C in the clinics for infectious or internal diseases. At the end, the authors present eleven clinical vignettes of successful treatment of hepatitis C in opiate addicts realized with multidisciplinary team. All of the treated individuals, after finished interferon treatment appeared hepatitis C negative.

1540 – Chronic multiple skin ulcers in an i.v. drug user (shooter's patch) disappeared after treatment with buprenorphine/naloxone (suboxone)

We present a case report of an individual with multiple chronic ulcers, which were cultivated and maintained for the administration of heroin. A 34 year old not married musician man lives with his widowed mother. His both parents finished secondary school. After father death they are living in very humble material conditions, below average financial monthly income. He was previously treated for heroin addiction in 2006 (five years ago), finished secondary school, not employed. Has no child. With 16 years he started with marijuana smoking. Nowadays he is IDU, and takes heroin every day, started with age of 18 years (16 years active heroin user). He started with IVU with 24 years (ten years ago). He used common accessories for intravenous heroin. He was HIV negative five days before he started maintenance substitution therapy of heroin dependency with buprenorohine/naloxone (Suboxone). The most modern medically assisted method of substitution treatment of opiate dependants with Buprenorphine/Naloxone (Suboxone) may improve quality of life (QoL) of treated opiate addicts and his/her skin damages caused with intravenous heroin misuse.

2018 – Problems in inducing interferon therapy of opiate addicts with hepatitis c who are in substitution maintainance therapy with buprenorphine/naloxone (suboxone)

Hepatitis C is highly infected disease with long period of failure to recognize it, what leads to chronic liver damage and lower chances for complete cure if detected late. Intravenous (IV) opiate users often pass the infection to other IV drug users, or themselves be infected from virus carriers using the same non-sterile equipment. By implementation of substitution treatment of opiate addicts with buprenorphine / naloxone (Suboxone) at the Department of Psychiatry in Tuzla on 27 July 2009. year, we made the obligatory serological tests for hepatitis B and C and HIV, as well as laboratory findings with liver function parameter analysis as a condition for starting substitution therapy. In this way we discovered 47/159 opiate addicts hepatitis C positive. Although faced with danger of the final result if not treated in time, addicts when become aware that they were hepatitis C positive, they avoid further needed procedures leading to the inclusion of specific therapy with pegylated interferon. In this paper, the authors present the problems that opiate addicts hepatitis C positive bring out as a reason they do not occur on the continuation of the procedure detecting HCV genotypes, and the inclusion of specific therapy for the treatment of hepatitis C in the clinics for infectious or internal diseases. At the end, the authors present efforts expert responsible for the treatment of hepatitis C in opiate addicts to organize a multidisciplinary team, in order to be coordinated Interferon therapy for each IV opiate addict positive for hepatitis C.

2081 – Treatment of opiate addicts with maintaining substitution method of buprenorphine/naloxone (suboxone) at the department of psychiatry, clinical center tuzla

At the Department of Psychiatry in Tuzla since 29th July 2009 began the treatment program for opiate addicts using buprenorphine/naloxone (Suboxone). The treatment program is organized in Social Psychiatry Unit of Department of Psychiatry as an outpatient program. As the area around Tuzla Canton has no specialized institution for the treatment of opiate addicts and addicts of other psychoactive substances, the process of treatment of these patients is performed as parallel with treatment of all other psychiatric patients and in the rooms of the Department that is primarily intended for the treatment of psychiatric patients. The trained team is engaged in this program, we developed our own, authentic model of treatment based on the latest doctrinal principles. Three years of experiences points to some advantages but also the disadvantages of treating these patients at the Department of Psychiatry. Comorbid psychiatric disorder is treating simultaneosly with drug dependency as chronic relapsing brain disease, because the drug addiction is often associated with other psychiatric disorders. Some addicts are more reluctant to come to treatment because of the stigma of a psychiatric institution. So far, the 158 drug addicts were introduced in the treatment of opiate dependency. This is to show the whole process of treatment of opiate addicts, patient selection, the introduction into the treatment, the course of treatment and the end of a guided contemporary doctrinal principles and postulates of the profession.

P01-47 - Medical assisted treatment of opioid dependence with suboxone method as prevention of social excluding young people

Introduction The most modern medically assisted method of substitution treatment of opiate dependants with Buprenorphine+Naloxone (Suboxone) has been implemented in Department of Psychiatry in Tuzla from 27 July 2009. Suboxone offers possibility for achievement of prompt and effective results of detoxification and weaning of opiates in outpatient treatment. Treated opiate dependants become “clear minded”, qualified for the all professional and social activities, what improves significantly quality of family and social relationship. With this, the treatment in the institutions can be avoided, therefore it prevents social excluding of treated individuals. Aim To present medical assisted treatment of opiate dependence with substitution medicament Suboxone in Bosnia and Herzegovina, with which we may prevent social excluding of young opiate dependants. Methodology With presentation of clinical vignettes, authors described how opiate dependants with social hazardous behavior avoided social excluding after they were included in the Suboxone maintenance treatment program. Results All exemplars described with clinical vignettes showed that opiate dependants previously had open doubts in efficacy of this particular treatment, and after only three days they surprised with positive effects of Suboxone. Also they are very satisfied with life quality during treatment. Family members of dependant person show satisfaction with achieved efficacy of Suboxone. Conclusion Medically assisted treatment of opiate dependence with Suboxone is implementing outpatient with involvement of close family members who are not drug dependant, it brings back “clear mind” to treated addicts, it does not stigmatize but it re-socialize and in that way it preventing social excluding of young opiate dependants.

P01-27 - Differences of patients with acute alcohol intoxication treated at the departments for psychiatry and internal medicine in Tuzla during 2009

Introduction Patients with Acute alcohol intoxication (F 10.0) are referred most often to psychiatry or internal departments. Aim To examine some epidemiological characteristics of patients with acute alcohol intoxication treated at the admission departments of Psychiatry and Internal Medicine in Tuzla during 2009 year. Methodology We selected from the admission protocols 91(1.8%) of 5 055 patients examined in Psychiatry, and 76(0.5%) of 14 460 patients examined in Internal Medicine admission, who were diagnosed with F 10.0 according to ICD-10. Observed variables were sex, age, treatment they received at the admission departments and the instructions given for further treatment. Results We found that Majority of them were males. Patients referred to the Psychiatry were somewhat older (43.2 years), than patients in the Internal Medicine (38.4 years). The most common referral to the Psychiatry was in March 14(13.4%), and November 11(12.1%), while in the Internal Medicine there were 9(14.28%) in November and 8(12.69%) in December. At Psychiatry, 29(31.86%) patients were hospitalized and 62(68.13%) continued with outpatient treatments. At Internal Medicine 40(52.6%) of 76 patients were detoxified, 30(39.47%) patients were referred to the Department for Psychiatry, while in-home treatment was offered to 40 patients (52.63%). Conclusion The prevalence of acute alcohol intoxication compared to other diagnoses is higher in the Psychiatry admission than in the Internal Medicine, males were more frequent patients, and patients referred to Psychiatry were somewhat older. The most frequent alcohol intoxication in Psychiatry was recorded in October and November, while in Internal Medicine it was in November and December.

P02-149 - Computerized tomography diagnoses amongst alcohol dependant male inpatients clinicaly treated

Objective To assess the frequency of silent brain infarcts and cerebral cortical atrophy in male alcohol dependant psychiatric patients in post war Bosnia and Herzegovina (BH). Methods We analyzed twenty male alcohol dependant patients who were treated in the Department of Psychiatry in University Clinical Centre Tuzla during one year period (July 2007-July 2008), and to whom Computerized Tomography (CT) scan of neuro-cranium were done, according to age, war engagement, brain trauma, employment, smoking and presence of silent strokes and cerebral cortical atrophy. The results were analyzed using descriptive statistics. Results Average age of the group of patients studied was 48.8±6.0 years, and 13/20 was hospitalized for the first time. Eleven of 20 were engaged as soldiers during the 1992-95 war in BH. Four of them were wounded and two of them had air-blast injury and head stroke without concussion. Fourteen of twenty were unemployed, and two of them were retired. Only one was admitted with alcoholic delirium. Eleven of twenty were cigarette smokers. Half of them had CT objectified silent stroke, and sixteen of twenty had generalized brain cortical atrophy. Brain cortical atrophy was significantly negatively associated with war engagement, while silent stroke were positively associated with age of patients. Conclusion Brain cortical atrophy and silent brain stroke are frequent findings in computerized tomography of the brain in psychiatric patients with alcohol dependency.