Maree Jensen

Extended-release methylphenidate for treatment of amphetamine/methamphetamine dependence: a randomized, double-blind, placebo-controlled trial

AIMS To assess the efficacy of methylphenidate as a substitution therapy for amphetamine/methamphetamine dependence in Finland and New Zealand. DESIGN Parallel-group, double-blind, randomized placebo-controlled trial. SETTING Out-patient care. PARTICIPANTS Amphetamine-/methamphetamine-dependent, aged 16-65 years. MEASUREMENTS The primary outcome measure was presence/absence of amphetamine/methamphetamine in urine samples collected twice weekly. Secondary measures included treatment adherence, alterations in craving scores and self-reported use. Primary analysis was by intention-to-treat (ITT). The study drug, methylphenidate (as Concerta(®) ), was up-titrated over 2 weeks to a maximum dose of 54 mg daily and continued for a further 20 weeks. Doses were given under daily supervision at the clinics. FINDINGS Seventy-nine participants were randomized (40 methylphenidate; 39 placebo); 76 received allocated treatment and 27 completed the trial. ITT analysis (n = 78) showed no statistically significant difference in the percentage of positive urines between the methylphenidate and placebo arms (odds ratio: 0.95, 95% confidence interval: 0.83-1.08). However, there was a significant difference (P < 0.05) between the active and placebo arms in retention, the placebo arm displaying a significantly lower retention from 6 weeks that persisted until the end of the trial. CONCLUSIONS The trial failed to replicate earlier findings suggesting that methylphenidate was superior to placebo. The low retention rate confounded the ability to draw firm conclusions about efficacy. The higher retention rate was observed in the methylphenidate arm. Any replication of this work would need to consider alternatives to the rigid clinic attendance criteria, and consider an increased dose.

Neuropsychological performance of methadone-maintained opiate users

Methadone maintenance treatment (MMT) has been used to treat opiate dependence since the mid-1960s. Previous studies have investigated the effects of methadone on cognitive function however the findings have been inconsistent. Some report a complete absence of deficits while others report different types of cognitive impairment. Our research aimed to investigate the effects of MMT on cognitive function by comparing the performance of patients currently enrolled in MMT (n=32) with opiate-dependent subjects (n=17) and healthy control subjects (n=25) on a computerised neuropsychological test battery. Both the patients undertaking MMT and the opiate users showed less efficient interaction between visual searching and manually connecting digits and letters during the Switching of Attention Task than the healthy control subjects (F(2,64)=3.25, p=0.05), which indicates deficits in information processing. Nevertheless, the performance of the MMT group was similar to that of healthy control subjects in all other tasks, in contrast to the group of opiate users who performed poorly when compared to healthy control subjects during tests of attention (mean difference (MD)=2.8, 95% confidence interval (CI) (0.9–4.7), p=0.001) and executive function (MD=5.9, 95% CI (1.3–10.5), p=0.007). These findings suggest that cognitive function in patients undertaking MMT is improved compared to those dependent on illicit opiates.

Changes in resting EEG following methadone treatment in opiate addicts.

OBJECTIVE This study investigated the electrophysiological activity associated with methadone maintenance treatment (MMT). METHODS The resting EEG spectrum of beta (14.5-30 Hz), alpha (8-13 Hz), theta (4-7.5 Hz) and delta (1.5-3.5 Hz) rhythm were measured in 32 patients undertaking chronic MMT, 17 opiate users and 25 healthy volunteers. Differences in the EEG components of each group were evaluated using a repeated measures Analyses of Variance (ANOVA). Post-hoc comparisons were Bonferroni corrected. RESULTS Our results show that either patients undertaking MMT or active opiate users exhibited a significant increase in the power of beta and theta bands relative to healthy control subjects. However, the spectral power of patients undertaking MMT fell between that of current opiate users and healthy control subjects on many regional EEG measures. There was an inverse correlation between the power of beta or theta bands and cognitive performance. CONCLUSION The abnormal neural electrical activity present in those still using illicit opiates might be reduced following MMT. SIGNIFICANCE The present findings provide further support for MMT of opiate dependence and demonstrates potentially positive effects of substitution treatment on brain function.

Prevalence of cognitive enhancer use among New Zealand tertiary students.

INTRODUCTION AND AIMS Cognitive enhancers (CE) such as methylphenidate, amphetamines and modafinil are becoming more commonly used in non-medical situations. This study explored the prevalence and motivations for CE use in a New Zealand university. DESIGN AND METHODS Students from the Schools of Pharmacy, Nursing, Medicine, Law and Accounting at a university in New Zealand were invited to complete a paper-based questionnaire that elicited their views on the prevalence, reasons for use and attitudes towards use of CEs. Questionnaires were distributed at the end of a third-year lecture (August-October 2012). Reasons for use and attitudes towards use was measured using a 7-point Likert scale from strongly agree (1) to strongly disagree (7). Descriptive and prevalence statistics were calculated. Inferential statistics were generated to explore the overall associations between CE use and how the respondents had first learnt about CEs, and to investigate reasons for CE use. RESULTS The response fraction was 88.6 % (442/499) and the prevalence of CE use was 6.6% (95% confidence interval 4.5-9.0). Commonly cited reasons for use were to get high [M = 4.43, standard deviation (SD) 2.36], experimentation (M = 4.17, SD 2.36), increase alertness (M = 3.55, SD 2.48), to help concentrate (M = 3.48, SD 2.42), to help stay awake (M = 3.20, SD 2.33), to help study (M = 3.10, SD 2.47) and to concentrate better while studying (M = 3.00, SD 2.43). DISCUSSION AND CONCLUSIONS Use of CEs was uncommon in contrast to the prevalence reported in the USA. The reasons for use also varied depending on which CE was used. Students who use CEs have differing attitudes towards their acceptability, which warrants further research about how these attitudes influence their use and attitudes towards academic performance. [Ram S(S), Hussainy S, Henning M, Jensen M, Russell B. Prevalence of cognitive enhancer use among New Zealand tertiary students. Drug Alcohol Rev 2016;35:245-351].

An International Perspective on Pharmacy Student Selection Policies and Processes

Objective. To reflect on selection policies and procedures for programs at pharmacy schools that are members of an international alliance of universities (Universitas 21). Methods. A questionnaire on selection policies and procedures was distributed to admissions directors at participating schools. Results. Completed questionnaires were received from 7 schools in 6 countries. Although marked differences were noted in the programs in different countries, there were commonalities in the selection processes. There was an emphasis on previous academic performance, especially in science subjects. With one exception, all schools had some form of interview, with several having moved to multiple mini-interviews in recent years. Conclusion. The majority of pharmacy schools in this survey relied on traditional selection processes. While there was increasing use of multiple mini-interviews, the authors suggest that additional new approaches may be required in light of the changing nature of the profession.

Access to high-cost medicines in New Zealand

Abstract This chapter presents an overview of access pathways to high-cost medicines in New Zealand. It describes the avenues via the Pharmaceutical Management Agency’s (PHARMAC) access schemes and also avenues via non-PHARMAC mechanisms.