Nor Hidayah Abu Bakar

Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy

BackgroundMethadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.MethodsSubjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.ResultsSixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.ConclusionsWe concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.

Role of oxidative stress in opiate withdrawal and dependence: Exploring the potential use of honey.

Opiate dependence and withdrawal is a worldwide public health problem and give a significant burden to society. In exploring the problems of opiate dependence and withdrawal, oxidative stress in thought to be involved in the mechanism of the development of dependence and tolerance to morphine. Therefore, there is possibility that antioxidant has the role to reduce the oxidative stress leading to the opiate dependence and withdrawal. In this mini review we describe the evidence of relationship between oxidative stress and opiate dependence. We also describe the evidence of honey which has been claimed to have high antioxidant properties and the promising potential to reduce oxidative stress in opiates dependence and tolerance individuals.

Phoenix dactylifera linn as a potential novel anti-oxidant in treating major opioid toxicity.

The use of opioids has gain popularity in the field of medicine especially in treating chronic terminally ill patients. Unfortunately, several adverse effects in relation to its use have been reported. Literature search on the adversity of opioids in treating pain, its paradoxical hyperalgesic effects and susceptibility to addiction were conducted using Pubmed, Embase and Google Scholar without species limitation. This brief article focuses on the corresponding neuro protective, hepato protective, anti-inflammatory, ulcero protective and nephron protective functions of (Phoenix dactylifera L) to elaborate on evidences, mechanisms, modulatory and pharmacological significance to counteract adverse effects of opioid treatment and provide insight on the underlying mechanisms of addiction.

High Frequency of CYP3A4*1B among Opiate Dependent Patients in Malaysia

The sharing of injection needles among drug user is a leading cause for the spread of HIV/AIDS. Malaysia introduced methadone as a management of heroin dependents to reduce HIV spread. Methadone has variable pharmacokinetics and CYP3A4 has been implicated in its metabolism. The objective of this study therefore was to determine if polymorphisms exist with CYP3A4 among opiate users in Malaysia. This study was approved by Ethics Committees at University of Malaya and Universiti Sains Malaysia. Control subjects comprised blood donors, students and residents of a village. Opiate-dependents were from methadone clinics and drop-in centers. They signed a written-informed consent to participate and gave blood for DNA CYP3A4 genotyping. DNA was extracted using QIAgen DNA mini kit. A nested two-step allele specific PCR method was developed to detect CYP3A4*1B, CYP3A4*3, CYP3A4*4, CYP3A4*5, CYP3A4*6, CYP3A4*7, CYP3A4*8, CYP3A4*9, CYP3A4*10, CYP3A4*11, CYP3A4*12, CYP3A4*13, CYP3A4*14, CYP3A4*15 and CYP3A4*16. Normal controls comprised Malays, Chinese and Indians but opiate-dependent subjects were majority Malay males. Control subjects all carried the wild-type gene. Mutant CYP3A4*1B allele was found in 2.17% of opiate-dependent subjects. Our results revealed that CYP3A4 was not polymorphic among Malaysian Malays, Chinese and Indians who were not opiate-dependent. To date, we are not aware of any study to associate CYP3A4 polymorphism and heroin addiction. It is conceivable that altered CYP3A4 function may contribute towards addiction liabilities in subsets of individuals. We conclude that CYP3A4 is polymorphic among heroin-dependent individuals. The mutation, CYP3A4*1B is not silent. This may have implications on heroin addiction liability as well as on dose requirements for MMT and HAART.

Effect of Zamzam Water Alone or In Combination with Methadone on Animal Withdrawal Symptoms in Morphine Dependent Rats

Prolong activation of Mu-Opioid receptor will causes adaptation to the downstream system of opioid. This adaptation is believed to be a key factor for tolerance and opioid dependence. This study aimed to investigate the potential of Zamzam water, healing nature water that reported to have high concentration of mineral on alleviating the morphine withdrawal symptoms of morphine-dependent rat. In this experimental study, 50 male Sprague Dawley rats (250-300 g) were randomly divided into five groups of 10 (normal group, untreated group, methadone treated group, Zamzam water treated group, and co-treatment methadone and Zamzam water group). The morphine dependence model was obtained through intraperitoneal (i.p.) injection of morphine (50-75 mg/kg) at increasing doses for 30 days. Morphine dependent rats then were treated with methadone, Zamzam water and co-treatment methadone and Zamzam water for 30 days, respectively. Spontaneous withdrawal symptoms (diarrhea, wet dog shake, body writhing, jumping, teeth chattering) were observed on day one, seven, fourteen, twenty one and thirty of withdrawal. Next, the obtained data were analyzed using SPSS v.11 software, and one way ANOVA followed by Tukey’s post statistical tests The data obtained from this animal behaviour observation indicates that the co-treatment methadone and Zamzam water significantly attenuated the spontaneous withdrawal symptoms (diarrhea, wet dog shake) of morphine-dependent rat compared to other groups’ (P < 0.05). This is probably due to the capability of methadone and mineral especially sodium in Zamzam water to prevent downregulation of MOR-1 after chronic morphine administration. We have concluded that co-treatment of methadone and Zamzam water significantly attenuates the spontaneous morphine withdrawal symptoms; Diarrhea and wet dog shake among rats.

Analgesic effect of honey bioactive compounds and its role in reducing morphine tolerance

Honey has been used as a supplement nutrient in human for centuries. It exerts antibacterial, anticancer, antiinflammatory properties as well as analgesic activity. But not many studies have been done to analyse effect of honey on morphine tolerance. Hence, this review is targeting on analgesic effect of honey bioactive compounds and their potential in morphine tolerance study.

Melioidosis in acute cholangitis of diabetic patient: a forgotten diagnosis

Melioidosis presents with a wide range of clinical presentations, which include severe community-acquired pneumonia, septicemia, central nervous system infection, and less severe soft tissue infection. Hence, its diagnosis depends heavily on the clinical microbiology laboratory for culture. In this case report, we describe an atypical presentation of melioidosis in a 52-year-old man who had fever, right upper-abdominal pain, and jaundice for 15 days. Melioidosis caused by Burkholderia pseudomallei was subsequently diagnosed from blood culture. As a primary care physician, high suspicion index is of great importance. High suspicion index of melioidosis in a high-risk group patient, such as the patient with diabetes mellitus and diabetic foot, is crucial in view of atypical presentations of pseudomonas sepsis. A correct combination of antibiotic administration in the early phase of therapy will determine its successful outcome.

Variability of Plasma Methadone Concentration in Opiate Dependent Receiving Methadone: A Personalised Approach Towards Optimizing Dose

1. Introduction 1.1 Methadone and methadone maintenance therapy (MMT): An overview Methadone acts on the opioid receptors and produces many of the same effects of morphine and heroin. In the treatment of opioid dependence, methadone has cross-tolerance with other opioid, including heroin and morphine and a long duration of effect. Higher doses of methadone can block the euphoric effects of heroin, morphine, and similar drugs. As a result, properly dosed methadone patients can reduce or stop altogether their use of these substances. Methadone is a misunderstood drug and ignorance about it is common. Even professionals, physicians and pharmacists who are supposed to be the “guardians” of MMT receive very little training about the very medication that they are responsible for. To compound the issue, addiction is mostly viewed not as a disease and its care is frequently relegated to the lay public, at least until very recently. In Malaysia, addiction has solely been under the charge of “Agensi Anti Dadah Kebangsaan” (AADK), an agency that has mainly adopted a criminal approach to addiction. However, this has recently changed in Malaysia. Addiction is now recognized as a medical illness, under the purview of the medical professionals. Nevertheless, many in the medical profession only have a rudimentary understanding of addiction. Most physicians, pharmacists and nurses receive very little training about addiction and much less regarding methadone. Thus, generally, both medical and other caregivers have very limited knowledge about addiction and much less about methadone. They have generally been taught to approach addiction as a character disorder and administer methadone as a substitute.