Methamphetamine dependence in methadone treatment services in Iran: the first literature review of a new health concern

The rising threat of illicit amphetamine-type stimulant use among methadone maintenance treatment patients in East Coast Malaysia: a retrospective observational study

Background: In recent years, amphetamine-type-stimulants (ATS) have been extensively misused in South-East Asia, inducing major problems among methadone-maintenance-treatment (MMT) patients.Objective: We examine ATS-misuse prevalence and its determinants among MMT patients in East-Coast-Malaysia.Methods: A retrospective-observational study was conducted on government-subsidized medication for opioid-use-disorder (MOUD) treatment clinics involving 292 MMT-patients (98% males) who were selected using a multilevel-proportional-stratified random sampling technique. Information obtained during the mandatory monitoring procedure from January 1 to December 31 2019, was utilized to determine ATS misuse prevalence from consecutive random urine drug screening. The determinants associated with its use, namely sociodemographics, social networks, comorbidities, and pharmacological assessments were analyzed via a logistic model.Results: Overall, 52.2% of the MMT-patients (95% CI: 0.42-0.54) had misused ATS at least once during their methadone treatment. These misusing patients were active smokers, hepatitis B and C seronegative, concurrently misused opioids, and had received suboptimum prescribed doses of methadone. Multiple logistic regression analysis demonstrated that the odds of misusing ATS during methadone treatment were 37 times higher among those who concurrently misused opioids (AOR: 37.60, 95% CI: 14.03-100.74) and 12 times higher among those who received suboptimal methadone doses (<60 mg/day) (AOR: 12.24, 95% CI: 5.58-25.43).Conclusion: This study demonstrated the significant prevalence of ATS misuse among MMT-patients in East-Coast-Malaysia, especially among patients who were prescribed suboptimal doses of methadone and/or demonstrated concomitant opioid-misuse. Stringent urine-monitoring is crucial to prevent diversion to ATS misuse. Nonetheless, to avoid negligence and improve physician engagement, the relevant authorities should immediately plan a comprehensive national-standard training module comprising support activities for professional methadone-prescribers.

Healthcare Contacts Regarding Circulatory Conditions among Swedish Patients in Opioid Substitution Treatment, with and without On-Site Primary Healthcare

Patients in Opioid Substitution Treatment (OST) have increased mortality and morbidity, with circulatory conditions suggested to be a contributing factor. Since OST patients tend to have unmet physical healthcare needs, a small-scale intervention providing on-site primary healthcare (PHC) in OST clinics was implemented in Malmö, Sweden in 2016. In this study, we assessed registered circulatory conditions and healthcare utilization in OST patients with and without use of on-site PHC. Patients from four OST clinics in Malmö, Sweden, were recruited to a survey study in 2017–2018. Medical records for the participants were retrieved for one year prior to study participation (n = 192), and examined for circulatory diagnoses, examinations and follow-ups. Patients with and without on-site PHC were compared through descriptive statistics and univariate analyses. Eighteen percent (n = 34) of the sample had 1≤ registered circulatory condition, and 6% (n = 12) attended any clinical physiology examination or follow-up, respectively. Among patients utilizing on-site PHC (n = 26), the numbers were 27% (n = 7) for circulatory diagnosis, 15% (n = 4) for examinations, and 12% (n = 3) for follow-up. OST patients seem underdiagnosed in regard to their circulatory health. On-site PHC might be a way to diagnose and treat circulatory conditions among OST patients, although further research is needed.

Association of PICK1 and BDNF variations with increased risk of methamphetamine dependence among Iranian population: a case-control study

BACKGROUND

Genetic factors play an important role in susceptibility to methamphetamine dependency. In this line, protein that interact with C-kinase-1 (PICK1) and brain-derived neurotrophic factor (BDNF) genes are linked to methamphetamine dependence (substance use disorder). Thus, in a case-control study, we investigated the association between polymorphisms of PICK1 and BDNF genes and methamphetamine dependence in an Iranian population.

METHODS

Total of 235 cases and 204 controls were recruited in a period between 2015 to 2018. The PICK1-rs713729, -rs2076369 and BDNF-rs6265 genotypes were determined via ARMS-PCR assay. Statistical analysis was performed, using SPSS 20.0, PHASE 2.1.1 program as well as SNP Analyzer 2.0.

RESULTS

In the present study, two polymorphisms including PICK1-rs713729 (OR 1.38 (CI 1.08-1.52; P-value 0.004) in multiplicative and dominant models, and PICK1-rs2076369 (OR 1.31 (CI 1.10-1.56; P-value 0.002) in multiplicative, dominant and co-dominant models were associated with the risk of methamphetamine abuse. Moreover, haplotype analysis showed a significant association of haplotype AG (OR 2.50 (CI 1.50-4.16; P-value 0.0002) in dominant, recessive and co-dominant models, and haplotype TT (OR 0.67 (CI 0.50-0.91; P-value 0.009) in dominant and co-dominant models with the risk of methamphetamine abuse. None of the polymorphisms in this study had a high level of linkage disequilibrium.

CONCLUSION

Our findings indicate that the PICK1 gene polymorphism might affect the risk of methamphetamine dependency in our population.

Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews

Introduction: Amphetamine-type stimulants (ATS) use is a global concern due to increased usage and the harm to physical, mental, and social well-being. The objective of this overview of systematic reviews is to summarise trial results of psychosocial interventions and describe their efficacy and safety. Methods: We searched seven bibliographic databases to November 2020 for systematic reviews examining ATS misuse treatment by psychosocial interventions. Given the apparent incompleteness of the included reviews, we undertook a supplemental meta-analysis of all eligible primary studies. Results: We included 11 systematic reviews of moderate to high quality and 39 primary studies which assessed the outcomes of psychosocial interventions on people who use ATS. The key findings include: (1) There were conflicting results about the effectiveness of psychosocial interventions among reviews, which may confuse decision-makers in selecting treatment. (2) In the supplemental meta-analysis, relative to usual care (only counselling or self-help materials), membership of a psychological intervention group was associated with an important reduction in drug usage [risk ratio (RR) 0.80, 95% CI: 0.75 to 0.85]. Patients in psychological interventions used injectables substantially less [odds ratio (OR) 0.35, 95% CI: 0.24 to 0.49]. The risk of unsafe sex in the psychosocial intervention group was lower than in the control group (RR 0.49, 95% CI: 0.34 to 0.71). The combination of therapies reduced 1.51 day using drugs in the preceding 30 days (95% CI: -2.36 to -0.67) compared to cognitive behavioural therapy intervention alone. (3) Compared to usual care, cognitive behavioural therapy was less likely to be retained at follow-up (RR 0.89, 95% CI: 0.82 to 0.97; high-quality evidence). However, the additional of contingency management strategy can make an important improvement upon retention (RR 1.42, 95%CI: 1.25 to 1.62). Authors' Conclusions: Integrated models are more effective than a single-treatment strategy. Comprehensive and sustained psychosocial interventions can help to reduce use of ATS and other drugs, risk behaviours and mental disorders, and significantly improve treatment adherence.

An alarming rise in the prevalence of deaths with methamphetamine involved in Tehran, Iran 2011-2018

Methamphetamine is one of the most commonly abused illicit drugs in Iran. Despite this fact, there has been relatively little research on methamphetamine-associated deaths in Iran. The present study aimed to investigate the cause of death in methamphetamine positive cases based on forensic toxicology findings In this data base descriptive study, individuals with methamphetamine-associated deaths that were referred to the Legal Medicine Organization, Tehran, Iran (2011-2018) were assessed. Deaths including those from natural causes, toxicity, accident and suicides with positive forensic toxicology analyses for methamphetamine and its metabolite amphetamine in postmortem samples were investigated. All cases were examined to determine trends in methamphetamine-associated deaths, and in the manner and causes of deaths. During the eight year study there were 1389 methamphetamine-associated deaths. The mean age was 37.47±10.87 years, with a male/female ratio of 12.36:10. The methamphetamine-associated death rate increased significantly during the study period (2.05 vs. 21.93 per 10⁶ Tehran province populations). The most common cause of death was cardiac arrest due to stimulant abuse with supportive histologic findings of acute myocardial infarction, myocardial fiber hypertrophy, aortic dissection and perivascular fibrosis (25%). Opioids (methadone, tramadol and morphine), tricyclic antidepressants and benzodiazepines were frequently present in postmortem samples of study cases. Methamphetamine-associated deaths significantly contribute to illicit drug-associated deaths in Tehran and represent a substantial clinical and public health problem.

The therapeutic effects of methylphenidate and matrix-methylphenidate on addiction severity, craving, relapse and mental health in the methamphetamine use disorder

Background

Little evidence has examined the therapeutic effects of methylphenidate (MPH) and Matrix Model treatment on addiction severity, craving, relapse and mental health in people who use methamphetamine (PWUM). This study was conducted to determine the effects of MPH, Matrix Model treatment, and Matrix-MPH on addiction severity, craving, relapse and mental health in PWUM.

Methods

This clinical trial was conducted among 100 patients with METH users. Participants were randomly divided into four groups who received: 1) 22 sessions of 45-min, twice a week for Matrix Model treatment (n = 25); 2) MPH 10 mg/day in the first month, 7.5 mg/day in the second month and 5 mg/day in the third month (n = 25); 3) Matrix Model treatment combined with MPH (n = 25); 4) control group (n = 25) for 12 weeks. Addiction severity, craving, relapse and mental status were evaluated at baseline and end-of-trial.

Results

Matrix Model treatment combined with MPH significantly reduced MA craving (P < 0.001) and addiction severity (P < 0.001). In addition, Matrix Model treatment combined with MPH resulted in a significant increase of mental health (P = 0.001), compared with Matrix Model treatment, MPH, and control group. Also, negative METH urine test significantly increased in the Matrix Model treatment combined with MPH group compared with the other groups (P < 0.001).

Conclusions

In conclusion, Matrix Model treatment combined with MPH for 12 weeks had beneficial effects on addiction severity, craving, relapse, and mental health in PWUM, compared with Matrix Model treatment, MPH, and control group.

Trial registration

This study was retrospectively registered in the Iranian website (www.irct.ir) for clinical trials registration (http://www.irct.ir: IRCT20171105037245N1). Registration date: 9 December 2017.

Mental health and cognitive function responses to quetiapine in patients with methamphetamine abuse under methadone maintenance treatment

BACKGROUND

Patients with methamphetamine (MA) abuse under methadone maintenance treatment (MMT) are susceptible to several complications including cognitive disturbance and mental health disorder. This trial was designed to determine the impacts of quetiapine administration on cognitive function and mental health scale in patients with MA abuse under MMT.

METHODS

This study was carried out in 60 MA abusers under MMT. Patients were randomly allocated to receive either 100 mg quetiapine (n = 30) or control (n = 30) daily for 8 weeks. Cognitive function and mental health scale were taken at baseline and post-treatment to evaluate relevant variables.

RESULTS

Quetiapine significantly decreased depression (b -3.94; 95% CI, -7.73, -0.16; P = 0.04) and sleep disorder (b -2.18; 95% CI, -2.89, -1.47; P < 0.001). Also, quetiapine administration resulted in a significant reduction in Iowa Gambling Task (b -2.70; 95% CI, -4.69, -0.71; P = 0.009), and significant increases in Verbal Fluency Test (b 3.04; 95% CI, 1.24, 4.85; P = 0.001), Reverse Digit Span (b 2.80; 95% CI, 2.13, 3.47; P = 0.001) compared with the placebo.

CONCLUSION

Overall, taking 100 mg quetiapine daily for 8 weeks by patients MA abuse in MMT had favorable effects on some of cognitive functions and mental health parameters.