Paula Rosca

Improved Quality of Life, Clinical, and Psychosocial Outcomes Among Heroin-dependent Patients on Ambulatory Buprenorphine Maintenance

Aim: A prospective longitudinal design was employed to examine the effects of buprenorphine maintenance on quality of life (QOL), clinical, and psychosocial characteristics of heroin-dependent patients. Method: Between 2003 and 2005 data were collected on 259 patients attending the outpatient centers for treatment of drug addictions across Israel, of which 157 were reevaluated 16 weeks later and 105 reevaluated 32 weeks later using the Clinical Global Impression, Distress Scale for Adverse Symptoms, Quality of Life Enjoyment and Satisfaction Questionnaire, General Health Questionnaire, General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. Univariate and multivariate analyses were conducted to examine the association between the parameters and the cross-sectional and longitudinal predictions of the QOL outcomes. Results: The groups did not differ in baseline values and their post-treatment ratings revealed significant improvement on virtually all the scales. Perceived self-efficacy and social support from friends and significant others at baseline as well as their changes over time were the best predictors of the QOL in the short and long terms. The studys limitations are noted. Conclusions: The beneficial effects on the QOL were associated with improvement in the psychosocial parameters and a reduction in buprenorphine-related side effects and psychological distress. This study could stimulate research to compare the QOL related to buprenorphine and methadone treatment and serve as a basis on which a controlled study should be performed.

Mortality and causes of death among users of methadone maintenance treatment in Israel, 1999–2008

OBJECTIVES To determine all-cause and specific-causes mortality, in the years 1999-2008, among opioid-dependent users treated at methadone maintenance treatment (MMT) clinics in Israel and to compare the obtained results with data from relevant studies worldwide. METHOD The records of patients treated at MMT units were linked to the nationwide database of causes of death. Information about the Israeli general population from the Central Bureau of Statistics was used for comparison to match sex and age to the cohort under study. Crude mortality rates (CMRs) per 100 persons per year (PY) and standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated. RESULTS The overall CMR for MMT users was 1.49/100 PY (CI 1.40-1.59) and was not associated with gender, age at entering MMT, ethnicity, and immigrant status. The leading causes of mortality were sudden/undefined death (0.31/100 PY, CI 0.26-0.35), overdose (0.22/100 PY, CI 0.17-0.27), and cancer (0.15/100 PY, CI 0.12-0.18). The MMT users were 12.2 times more likely to die from all causes than people from the general population. Overall, our estimates were comparable with the figures pooled from relevant studies. CONCLUSIONS The results suggest that the excess mortality of MMT users is associated with an increased morbidity, which alone or in combination with service-related risks, lead to worse outcomes.

Methadone maintenance and cancer risk: An Israeli case registry study

OBJECTIVES This study explored cancer incidence rates in a large cohort of Israeli (Jewish and Arab) opioid-dependent individuals receiving methadone maintenance treatment (MMT), and how the incidences vary by ethnicity and sex. METHOD The record linkage between the Israel National Addiction Registry (INAR) and the Israel National Cancer Registry (INCR) was performed. Information about the Israeli general population from the Central Bureau of Statistics was used for comparison to match sex and year of birth to the cohort under study. Age standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated. RESULTS Though the SIR values for aggregated cancer sites for both men and women on MMT did not differ significantly from the corresponding figures in the general population (0.88, 95% CI 0.76-1.00, and 1.06, 95% CI 0.76-1.36, respectively), the risks were substantially increased for lung (1.97, 95% CI 1.13-2.82), larynx (3.62, 95% CI 1.11-6.13) and liver (6.8, 95% CI 1.76-11.83) cancers among Jewish men and for cervix uteri cancer among Jewish women (2.41, 95% CI 0.99-3.84). By contrast, the SIR values for colorectal cancer among Jewish men (0.46, 95% CI 0.09-0.82) and for breast cancer among Jewish women (0.36, 95% CI 0.00-0.71) were significantly lower than expected. CONCLUSIONS The results suggest that the increased and reduced site-specific cancer risks are counterbalanced, resulting in the absence of the expected excess cancer risk for the entire cohort. The reduced risks for colorectal and breast cancers suggest a protective effect of MMT, warranting further investigation.

Interpersonal distances, coping strategies and psychopathology in patients with depression and schizophrenia

AIM To explore (1) intergroup differences in comfortable interpersonal distances (CIDs) and the use of coping strategies; (2) the association of these parameters with individual symptomatology; and (3) the interplay between CIDs and coping styles in patients with depression and schizophrenia. METHODS The parameters of interest were assessed by means of standardized questionnaires: CID and Coping Inventory for Stressful Situations. Psychopathology was evaluated with the Beck Depression Inventory and Positive and Negative Syndromes Scale. ANOVA, Pearsons correlations and multiple regression analyses were used to examine relationships among the variables. RESULTS Compared with controls, depressed patients were more distanced from family members, significant others and self-images, whereas patients with schizophrenia were less distanced from neutral and threat-related stimuli. Distancing from self-images was mostly associated with depression severity in depressed patients, whereas distancing from hostile and threat-related stimuli with the severity of psychotic and affective symptoms in patients with schizophrenia. Both patient groups used more emotion-oriented than task-oriented and avoidance-oriented coping strategies. Self-distancing among patients with schizophrenia was positively associated with the use of the social diversion coping, implying social support seeking. CONCLUSION Patients with depression and schizophrenia use different maladaptive emotion - regulation strategies to cope with their symptoms and related distress. Training in stress management might provide these patients with skills for more effective emotion regulation.

The Recent Legal Approach to New Psycho-Active Substances Regulationin Israel: Does it Work?

Background: New Psychoactive Substances (NPS), rapidly spreading on the global drug market have become a major concern in different Countries. The drug control systems did not allow a prompt and effective response to this phenomenon, due to the slow and complicated procedures to declare a substance dangerous and illegal. Aims: To briefly describe to legal background of drug control in Israel and illustrate the characteristics of the novel legislation. Method: The Authors summarize the legal approach to NPS control in Europe and in New Zealand, the first Country to opt for a pre-market approval regime for NPS, describing the legal alternative sad opted and describe the Israeli Law for the Fight against the Phenomenon of the Use of Dangerous Substances. Findings: The new legislation succeeded to close kiosks and retailers, marketing NPS to youth and young adults in the Country. The law is unique in that it includes both an urgent temporary declaration, whose violation is penal, banning a substance as dangerous with its inclusion after 12 months into the First Schedule of the Dangerous Drugs Ordinance, and the empowerment of the police forces to search, seize and destroy the dangerous substance, constituting an administrative procedure. The law is enforced using a novel, integrated model of enforcement, providing the cooperation of different control agencies, and avoiding to criminalize the consumers. Conclusions: The effectiveness of this legislation, although promising short-term results have been registered, has still to be ascertained and more time is needed in order to perform a scientific evaluation of its results but meanwhile its impact is already noticed in the Court decisions, which make a difference between NPS and other drugs such as Cannabis in the severity of the penalties.

Legal Representation is Associated with Psychiatric Readmissions

The legal representation at District Psychiatric Boards hearings of psychiatric inpatients committed under a Compulsory Admission Order is a very important but insufficiently studied issue. This study aimed 1) to review the prac- tice of legal representation in the western world and Israel, and 2) to test the hypothesis that the legal representation of compulsorily committed psychiatric patients at their discharge hearings is associated with their subsequent readmission. A random sample of 153 compulsorily committed patients discharged in 2003 was drawn from Israels National Psychiatric Case Register and their psychiatric readmission over the next two years was reviewed. The 109 patients who were dis- charged with legal representation (the index group) were compared with the 44 patients who were discharged without le- gal representation (the control group). Although the groups were comparable on all sociodemographic and background clinical characteristics the patients from the index group had significantly more readmissions and inpatient days over the follow-up period than the control group. The results suggest that the involvement of lawyers in the discharge process is associated with more readmissions and more inpatient time. The possible reasons for this and its implications are dis- cussed.