Claudio Castillo

Characteristics of Heroin Addicts Entering Methadone Maintenance Treatment: Quality of Life and Gender

Study objective. To provide information on MMP patients characteristics, particularly those related with Health Related Quality of Life (HRQoL) and gender. Design. Cross-sectional study. Data were collected on socio-demographic, toxicological variables, HIV risk behaviors, and HRQoL through the Nottingham Health Profile (NHP). Patients and setting. Over a 30-month period (1996–1999) Barcelonas Municipal Drug Care Centres recruited 586 patients. Main results. Mean age of patients was 31 years, 70% were males and 25% were HIV-infected. Rates of unemployment, criminal records and low educational level were high. Most poly-drug users used cocaine. NHP mean score was related with poly-drug use, educational level and HIV status. Consistent condom use was related with HIV status. Females’ route of administration was less likely to be injection, even though they were more frequently HIV-positive and manifested contemporary poorer general health. Conclusions. Patients QoL was poor. Nowadays harm reduction health strategies would need to face cocaine use, and sexual risk behaviors mainly among females and sexual partners.

Plasma methadone concentrations as an indicator of opioid withdrawal symptoms and heroin use in a methadone maintenance program

Plasma methadone concentrations and its main metabolite D,L-2-ethylidiene-1,5-dimethyl-3,5-diphenylpyrrolidine (EDDP) were determined in 93 patients under methadone maintenance treatment to assess their relationship with heroin use and opioid withdrawal symptoms. Neither plasma concentrations of methadone nor EDDP were significantly different when patients that used heroin in last 3 months were compared with those testing negative for this drug (methadone, 355 +/- 217 versus 369 +/- 216 ng/ml, t = 0.29, P = NS; EDDP, 49 +/- 28 versus 54 +/- 40 ng/ml, t = 0.51, P = NS). No correlation between opioid withdrawal scale scores and plasma concentrations of methadone (r = 0.02, P = NS) and EDDP (r = -0.14, P = NS) was found. Therapeutic drug monitoring during methadone maintenance seems to be useful for assessing compliance with treatment but not for predicting heroin use and subjective withdrawal symptoms.

Methadone maintenance treatment in Spain: the success of a harm reduction approach

PROBLEM During the 1980s, Spain had very strict laws limiting access to opioid agonist maintenance treatment (OAMT). Because of this, mortality among people who used illicit opioids and other illicit drugs was high. Spain was also the European country with the highest number of cases of acquired immunodeficiency syndrome transmitted through illicit drug injection. APPROACH The rapid spread of human immunodeficiency virus (HIV) infection among people using heroin led to a shift from a drug-free approach to the treatment of opioid dependence to one focused on harm reduction. A substantial change in legislation made it possible to meet public health needs and offer OAMT as part of harm reduction programmes in the public health system, including prisons. LOCAL SETTING Legislative changes were made throughout the country, although at a different pace in different regions. RELEVANT CHANGES Legal changes facilitated the expansion of OAMT, which has achieved a coverage of 60%. A parallel reduction in the annual incidence of HIV infection has been reported. Reductions in morbidity and mortality and improved health-related quality of life have been described in patients undergoing OAMT. LESSONS LEARNT The treatment of opioid dependence has been more heavily influenced by moral concepts and prejudices that hinder legislation and interfere with the implementation of OAMT than by scientific evidence. To fulfil public health needs, OAMT should be integrated in harm reduction programmes offered primarily in public facilities, including prisons. Longitudinal studies are needed to detect unmet needs and evaluate programme impact and suitability.

Medical Assessment in Drug Addicts: Reliability and Validity of the Cumulative Illness Rating Scale (Substance Abuse Version)

Objective: To adapt the Cumulative Illness Rating Scale for its use in substance abuse patients (CIRS-SA) and to assess the reliability, internal consistency, and validity of the instrument. Method: One-hundred outpatients of both sexes, 62 men and 38 women, with a mean (SD) age of 32.4 (7.9) years (range 19–57), all of them fulfilling the DSM-IV criteria for any substance abuse disorder. Internal consistency was calculated with Cronbach’s α coefficient. Test-retest and interrater reliability was assessed with the intraclass correlation coefficient and Wilcoxon z. Validity of the scale was assessed with Kendall’s τ correlation coefficient. Results: The final CIRS-SA version had a total of 13 items. Cronbach’s α coefficient was 0.57. All intraclass correlation coefficients were above 0.7, and some items showed exact coincidence. The stability of the CIRS-SA scale in a 1-month test re-test reassessment was demonstrated. The CIRS-SA score showed a significant correlation with all consultant scores. Conclusion: CIRS-SA is a reliable and valid instrument to assess and to determine systematically the physical condition of substance abusers in whom infections, particularly by the HIV, are highly prevalent.

Monitoring patterns of substance use in drug-dependent patients.

Drug-addicted patients (N = 435) admitted for treatment in different clinical settings were studied. Patients were classified according to their self-report of consumed drugs and to the results of urine screening tests. Of the patients, 77.8% were active consumers, 9.6% were included in a methadone maintenance program, and 12.6% were abstinent. In the active consumer patients, positive urine screening results surpassed by far the information provided in the self-reports. Most patients tested positive to several drugs, while only 8.7% tested negative to all screened drugs. These results indicate that the information provided by drug-dependent patients lacks reliability when an analytical screening method is used simultaneously.