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Specka M, Kröckert T, Trilling M, Bonnet U, Schifano F, Scherbaum N. Opiate maintenance patients' attitudes and self-reported adherence to protective measures against SARS-CoV-2 infections. Front Psychiatry 2023; 14:1254053. [PMID: 37779618 PMCID: PMC10539610 DOI: 10.3389/fpsyt.2023.1254053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background During the COVID-19 pandemic we assessed to which extent patients in opioid maintenance treatment (OMT) adhere to official recommendations regarding preventive intervention strategies against COVID-19. Methods Patients enrolled in two OMT clinics in Germany were interviewed applying a standardized questionnaire, which covered socio-demographic information, recent psychotropic substance use, recent social activities, the history of SARS-CoV-2 infection, attitudes toward official protection recommendations, and levels of adherence to these suggestions. Current mental and medical diagnoses were retrieved from medical files. In subjects without known infection and without vaccination, blood samples were tested for the identification of anti-SARS-CoV-2-S-antibodies. Interviews were performed between the end of May and the end of September 2021. Results Patients' (n = 155) average age was 47 years; 74% were males. In addition to the opiate dependence, in nearly 80% of cases another medical disorder was recorded. The range of medical factors that predispose for severe COVID-19 outcomes were present in 39% of patients; 18% of the sample refused to be vaccinated. Nearly all patients reported having carried out a range of activities outside their residence during the week prior to the interviews, including visits of treatment facilities (86.5%; 95% confidence interval [80.2%; 91.0%]) or meeting with friends (64.5% [65.7-71.6%]). Despite the fact that only about 47.1% [39.2%; 55%] felt well informed about measures against infection, adherence to COVID-19 countermeasures was generally high: 83.9% [77.3; 88.8%] claimed to have worn face masks always/nearly always; social distancing was performed always/nearly always by 58.7% [50.8%; 66.2%]; and hand hygiene was conducted by 64.5% [56.7%; 71.6%] of participants. None out of n = 25 tests from unvaccinated subjects was positive for anti-SARS-CoV-2-S-antibodies. Psychiatric comorbidity and educational degree were not statistically significantly associated with attitudes and compliance, except that patients with lower education felt relatively worse informed. Conclusion Self-reported adherence to recommended non-therapeutic intervention strategies and vaccination rates were similar to the German general population. Provision of more health-related information tailored to OMT patients appears necessary.
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Affiliation(s)
- Michael Specka
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Tobias Kröckert
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Mirko Trilling
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Udo Bonnet
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
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Martin E, Maher H, McKeon G, Patterson S, Blake J, Chen KY. Long-acting injectable buprenorphine for opioid use disorder: A systematic review of impact of use on social determinants of health. J Subst Abuse Treat 2022; 139:108776. [DOI: 10.1016/j.jsat.2022.108776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Kiburi SK, Mwangi J, Maina G. Exploring the experiences of clients receiving opioid use disorder treatment at a methadone clinic in Kenya: a qualitative study. Addict Sci Clin Pract 2022; 17:71. [PMID: 36510246 PMCID: PMC9742652 DOI: 10.1186/s13722-022-00352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Assessing the experiences of individuals on methadone treatment is essential to help evaluate the treatment program's effectiveness. This study aimed to explore the experiences of patients receiving methadone treatment at a clinic in Nairobi, Kenya. METHOD This study employed an exploratory qualitative study design. Through purposive sampling, participants were enrolled from individuals attending a methadone clinic for at least 2 years. Semi-structured individual interviews were used to collect data on substance use and experience before methadone treatment and experiences after starting methadone treatment, including benefits and challenges. Interviews were transcribed, and NVIVO 12 software was used to code the data using the preidentified analytical framework. Thematic analyses were utilized to identify cross-cutting themes between these two data sets. Seventeen participants were enrolled. RESULTS Seventeen participants were enrolled comprising 70% males, with age range from 23 to 49 years and more than half had secondary education. The interview data analysis identified four themes, namely: (a) the impact of opioid use before starting treatment which included adverse effects on health, legal problems and family dysfunction; (b) learning about methadone treatment whereby the majority were referred from community linkage programs, family and friends; (c) experiences with care at the methadone treatment clinic which included benefits such as improved health, family reintegration and stigma reduction; and (d) barriers to optimal methadone treatment such as financial constraints. CONCLUSION The findings of this study show that clients started methadone treatment due to the devastating impact of opioid use disorder on their lives. Methadone treatment allowed them to regain their lives from the adverse effects of opioid use disorder. Additionally, challenges such as financial constraints while accessing treatment were reported. These findings can help inform policies to improve the impact of methadone treatment.
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Affiliation(s)
- Sarah Kanana Kiburi
- grid.411192.e0000 0004 1756 6158Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya ,grid.16463.360000 0001 0723 4123Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Jackline Mwangi
- grid.9762.a0000 0000 8732 4964Department of Psychology, Kenyatta University, Nairobi, Kenya
| | - Geoffrey Maina
- grid.25152.310000 0001 2154 235XCollege of Nursing, Prince Albert Campus, University of Saskatchewan, Prince Albert, Canada
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Müller UJ, Ahrens M, Vasilevska V, Dobrowolny H, Schiltz K, Schlaaff K, Mawrin C, Frodl T, Bogerts B, Gos T, Truebner K, Bernstein HG, Steiner J. Reduced habenular volumes and neuron numbers in male heroin addicts: a post-mortem study. Eur Arch Psychiatry Clin Neurosci 2021; 271:835-845. [PMID: 33001272 DOI: 10.1007/s00406-020-01195-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022]
Abstract
The Habenula is increasingly being investigated in addiction. Reduced volumes of other relevant brain regions in addiction, such as nucleus accumbens, globus pallidus and hypothalamus have been reported. Reduced volumes of the habenula as well as reduced neuronal cell count in the habenula have also been reported in mood disorders and an overlap between mood disorders and addiction is clinically widely recognized. Thus, our aim was to investigate possible volume and neuronal cell count differences in heroin addicts compared to healthy controls. Volumes of the medial (MHB) and lateral habenula (LHB) in heroin addicts (n = 12) and healthy controls (n = 12) were assessed by morphometry of 20 µm serial whole brain sections. Total brain volume was larger in the heroin group (mean 1466.6 ± 58.5 cm3 vs. mean 1331.5 ± 98.8 cm3), possibly because the heroin group was about 15 years younger (p = 0.001). Despite larger mean whole brain volume, the mean relative volume of the MHB was smaller than in healthy non-addicted controls (6.94 ± 2.38 × 10-6 vs.10.64 ± 3.22 × 10-6; p = 0.004). A similar finding was observed regarding relative volumes of the LHB (46.62 ± 10.90 × 10-6 vs. 63.05 ± 16.42 × 10-6 p = 0.009). In parallel, neuronal cell numbers were reduced in the MHB of heroin-addicted subjects (395,966 ± 184,178 vs. 644,149 ± 131,140; p < 0.001). These findings were not significantly confounded by age and duration of autolysis. Our results provide further evidence for brain-structural deficits in heroin addiction.
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Affiliation(s)
- Ulf J Müller
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany.
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany.
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany.
| | - Moritz Ahrens
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
| | - Veronika Vasilevska
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
| | - Kolja Schiltz
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Department of Forensic Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Konstantin Schlaaff
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
| | - Christian Mawrin
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Bernhard Bogerts
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Salus Institute, Magdeburg, Germany
| | - Tomasz Gos
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Kurt Truebner
- Institute of Legal Medicine, University of Duisburg-Essen, Essen, Germany
| | - Hans-Gert Bernstein
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany
| | - Johann Steiner
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany.
- Translational Psychiatry Laboratory, University of Magdeburg, Magdeburg, Germany.
- Center for Behavioral Brain Sciences, Magdeburg, Germany.
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Carolien K, Annika M. Affective decision-making in children prenatally exposed to opioids. Scand J Psychol 2021; 62:529-536. [PMID: 34037260 DOI: 10.1111/sjop.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
Although opioid maintenance therapy (OMT) is currently recommended for pregnant opioid-dependent women, potential effects on children's long-term development are still largely unknown. The current study assessed the long-term cognitive development of children born to women in OMT. Particularly, children's decision-making performance was assessed with a child-friendly version of the Iowa Gambling Task. Using a prospective longitudinal design, a cohort of children was followed from birth to middle childhood. Data were collected in Norway between 2005 and 2017. Participants included 41 children (aged 9-11 years), 20 of whom had histories of prenatal methadone or buprenorphine exposure. Background data were collected from personal interviews and medical records in 2005-2006. Children's affective decision-making was assessed in 2016-2017. Results showed no main effect of group on the net scores in the gambling task, F(1, 39) = 1.44, p = 0.24, η2 = 0.04, demonstrating no group differences in decision-making performance. A main effect of group was found on sensitivity to punishment, with children in the control group choosing the doors with the infrequent, but high punishment more often compared to children in the OMT group, F(1, 39) = 4.90, p = 0.03, η2 = 0.11. No main effect of group on decision-making speed was found, although results showed a significant interaction effect between group and gain, F(1, 8,194) = 4.09, p = 0.04, η2 = 0.001. Children prenatally exposed to opioids were found to have normal decision-making performance on an affective decision-making task and were able to consider future consequences when making decisions.
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Affiliation(s)
- Konijnenberg Carolien
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway.,Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Oslo, Norway
| | - Melinder Annika
- Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Oslo, Norway.,Child- and Adolescents Mental Health, Oslo University hospital, Oslo, Norway
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Carlsen SEL, Isaksen K, Fadnes LT, Lygren OJS, Åstrøm AN. Non-financial barriers in oral health care: a qualitative study of patients receiving opioid maintenance treatment and professionals' experiences. Subst Abuse Treat Prev Policy 2021; 16:44. [PMID: 34001202 PMCID: PMC8130131 DOI: 10.1186/s13011-021-00379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with substance use disorders often have poor oral health, which can negatively impact their quality of life. Since 2005, patients receiving opioid maintenance treatment (OMT) in Norway have been eligible for free oral health care services offered through public oral health clinics. Despite a large need for oral health services amongst patients in OMT, figures suggest that the use of these services is low amongst this patient group. It has been unclear which barriers that contribute to this. This qualitative study explores the underlying barriers to the use of oral health care services amongst patients in OMT, from the perspective of the patients as well as dental health care workers (DHW). METHODS Through a combination of focus group interviews and individual interviews, data were collected from 63 participants; 30 patients in OMT and 33 DHW. Thematic analysis identified key themes for the use (or not) of oral health care services amongst patients in OMT. RESULTS Both individual and structural barriers prevent OMT patients from using the free oral health care services offered to them. These barriers include struggling to attend appointments, anxiety and fear of dentists, discrepancies between patients' expectations and the services offered and perceived stigma. OMT patients' lack of information regarding their rights and access to oral health services was also a barrier, as was DHWs' lack of knowledge and information of the OMT system and what they can offer patients. CONCLUSIONS OMT patients face several barriers in accessing and using oral health care services. However, through a number of relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be increased.
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Affiliation(s)
| | - Katja Isaksen
- Oral Health Centre of Expertise in Western Norway, PO Box 7900, 5020, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction medicine, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
- Institute of Global health, University of Bergen, PO Box 7804, 5020, Bergen, Norway
| | - Ole Jørgen Scheie Lygren
- Department of Addiction medicine, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
| | - Anne Nordrehaug Åstrøm
- Department of clinical dentistry, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
- Oral Health Centre of Expertise in Western Norway, PO Box 7900, 5020, Bergen, Norway.
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Schulte B, Lehmann K, Schmidt CS, Rühling E, Weber B, Schäfer I, Reimer J, Verthein U. Addiction Recovery Among Opioid-Dependent Patients Treated With Injectable Subcutaneous Depot Buprenorphine: Study Protocol of a Non-randomized Prospective Observational Study (ARIDE). Front Psychiatry 2020; 11:580863. [PMID: 33363483 PMCID: PMC7752950 DOI: 10.3389/fpsyt.2020.580863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Once-weekly or once-monthly injectable depot buprenorphine is a new opioid substitution treatment (OST) medication that provides clinically relevant plasma concentrations without daily peaks. Together with a high tolerability and acceptance reported by patients, the prolonged release of injectable depot buprenorphine might have beneficial implications on the patients' quality of life and social participation. The primary objective of this prospective non-interventional observational study is to evaluate the effects of subcutaneous injectable depot buprenorphine on the quality of life of patients in routine OST care in Germany. Secondary outcomes like illicit substance use, psychological distress, social participation and activity are assessed to provide an overall evaluation toward addiction recovery. Methods and Analysis: The present study is a non-randomized prospective observational study with a control group (treatment-as-usual). To ensure comparability between both patient groups, suitable control patients (n = 213) from the same OST unit will be matched pairwise to each patient treated with injectable depot buprenorphine (n = 213). Matching variables are gender, duration of OST, take-home prescription and psychosocial functioning (according to the Global Assessment of Functioning scale). Primary study endpoint is the difference of change in quality of life, assessed with the recently developed Opioid Substitution Treatment Quality of Life scale (OSTQOL), within the depot buprenorphine group between baseline and month 12. The primary analysis will be carried out according to the intention-to-treat principle (ITT) by comparing OSTQOL mean scores using dependent t-tests. For secondary analyses, group comparisons will be done by mixed model approaches with baseline OSTQOL score and the (pairwise) cluster term as covariates. Discussion: The study combines clinical, routine OST care data with relevant patient reported outcome data. The pairwise matching allows conclusions on effects of different OST medications. The study findings will provide new insights in the addiction recovery processes of OST patients treated with depot buprenorphine. Ethics and Dissemination: The study protocol has been approved by the Ethics Committee of the Hamburg Chamber of Physicians (Ärztekammer Hamburg) (reference number: PV7078). The study results will be disseminated through peer-reviewed publications and presentations on scientific conferences. Clinical Trial Registration: German Clinical Trials Register DRKS-ID: DRKS00020797.
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Affiliation(s)
- Bernd Schulte
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten Lehmann
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Sybille Schmidt
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elke Rühling
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Weber
- Praxiszentrum Friedrichsplatz, Competence Center for Addiction Medicine, Kassel, Germany
| | - Ingo Schäfer
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
| | - Uwe Verthein
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kraus L, Seitz NN, Schulte B, Cremer-Schaeffer P, Braun B, Verthein U, Pfeiffer-Gerschel T. Estimation of the Number of People With Opioid Addiction in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:137-143. [PMID: 30961791 DOI: 10.3238/arztebl.2019.0137] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/12/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Opioid addiction is one of the most common substance-related disorders worldwide, and morbidity and mortality due to opioid addiction place a heavy burden on society. Knowing the size of the population that is addicted to opioids is a prerequisite for the development and implementation of appropriate health-policy measures. METHODS Our estimate for Germany for 2016 is based on an enumeration of opioid-addicted persons who were entered in a registry of persons receiving substitution therapy, an enumeration of persons receiving outpatient and inpatient care for addiction without substitution therapy, an extrapolation to all addiction care facilities, and an estimation of the number of opioid-addicted persons who were not accounted for either in the substitution registry or in addiction care. RESULTS The overall estimate of the number of opioid-addicted persons in Germany in 2016 was 166 294 persons (lower and upper bounds: 164 794 and 167 794), including 123 988 men (122 968 to 125 007) and 42 307 women (41 826 to 42 787). The estimates for each German federal state per 1000 inhabitants ranged from 0.1 in Brandenburg to 3.0 in North Rhine-Westphalia and 5.5 in Bremen. The average value across Germany was 3.1 per 1000 inhabitants. CONCLUSION Comparisons with earlier estimates suggest that the number of persons addicted to opioids in Germany has hardly changed over the past 20 years. Despite methodological limitations, this estimate can be considered highly valid. Nearly all persons who are addicted to opioids are in contact with the addiction care system.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, München; Department for Public Health Sciences, Stockholm University, Stockholm, Sweden and Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy; German Federal Institute for Drugs and Medical Devices, Federal Opium Agency
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Sapp AJ, Hooten P. Working with families impacted by the opioid crisis: Education, best practices, and providing hope. Arch Psychiatr Nurs 2019; 33:3-8. [PMID: 31711590 DOI: 10.1016/j.apnu.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Aida J Sapp
- University of Mary Hardin-Baylor, Belton, TX, United States of America; Baylor Scott & White Health, Temple, TX, United States of America.
| | - Phyllis Hooten
- Baylor Scott & White Health, Temple, TX, United States of America
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Müller UJ, Mawrin C, Frodl T, Dobrowolny H, Busse S, Bernstein HG, Bogerts B, Truebner K, Steiner J. Reduced volumes of the external and internal globus pallidus in male heroin addicts: a postmortem study. Eur Arch Psychiatry Clin Neurosci 2019; 269:317-324. [PMID: 30173319 DOI: 10.1007/s00406-018-0939-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/22/2018] [Indexed: 01/11/2023]
Abstract
Deep brain stimulation (DBS) of the globus pallidus internus was recently proposed as a potential new treatment target for opioid addiction. DBS requires computer-assisted-3D planning to implant the stimulation electrode precisely. As volumes of brain regions may differ in addiction compared to healthy controls, our aim was to investigate possible volume differences in addicts compared to healthy controls. Volumes of the globus pallidus externus (PE) and internus (PI) in heroin addicts (n = 14) and healthy controls (n = 12) were assessed using morphometry of serial whole-brain sections. Total brain volume was larger in the heroin group (mean 1479 ± 62 cm3 vs. mean 1352 ± 103 cm3), as the heroin group was more than 10 years younger (p = 0.001). Despite larger mean whole brain volume, the mean relative volume of the PE and PI was smaller in addicted subjects compared to healthy controls (PE 0.658 ± 0.183 × 10-3 vs. 0.901 ± 0.284 × 10-3; ANOVA F(1, 24) = 6.945, p = 0.014, η2 = 0.224; PI 0.253 ± 0.095 × 10-3 vs. 0.345 ± 0.107 × 10-3; ANOVA F(1, 24) = 5.374, p = 0.029, η2 = 0.183). These findings were not significantly confounded by age, duration of autolysis, and fixation time. Our results provide further evidence for structural and not only functional deficits of the globus pallidus in addiction. In the context of previous studies, our findings support the idea of shared pathophysiological processes between comorbid depression and impulsivity in opioid addiction.
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Affiliation(s)
- Ulf J Müller
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany. .,Center for Behavioral Brain Sciences, Magdeburg, Germany. .,Department of Psychiatry and Psychotherapy, Saarland University, 66421, Homburg, Germany.
| | - Christian Mawrin
- Center for Behavioral Brain Sciences, Magdeburg, Germany.,Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Stefan Busse
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany
| | - Hans-Gert Bernstein
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Bernhard Bogerts
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Kurt Truebner
- Institute of Legal Medicine, University of Duisburg-Essen, Essen, Germany
| | - Johann Steiner
- Department of Psychiatry and Psychotherapy, University of Magdeburg, 39120, Magdeburg, Germany. .,Center for Behavioral Brain Sciences, Magdeburg, Germany.
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Sarkar S, Lal R, Varshney M, Kumar S, Singh Balhara YP. Can Tramadol be Used for Maintenance Treatment of Opioid Dependence? Subst Use Misuse 2019; 54:506-513. [PMID: 30395757 DOI: 10.1080/10826084.2018.1521427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Certain limitations of the existing opioid substitution therapies necessitate exploration of other options for maintenance of patients with opioid dependence. This study aimed to present the experience of use of tramadol for long-term treatment of patients with opioid dependence. METHODS This was a cross-sectional interview-based observational study conducted in Uttar Pradesh state in India. Patients with opioid dependence who received oral tramadol treatment for a period of more than 6 months were recruited. Outcome was assessed in terms of self-reported abstinence on tramadol. RESULTS A total of 102 participants were recruited in the study, with a mean age of 41.3 years. All the participants were males. Abstinence to extraneous opioids was reported by 58.8% of the sample, and the median dose of tramadol at which abstinence was achieved was 350 mg/d. Those who reported to be taking natural opioids (raw opium or poppy husk) at the time of seeking treatment had higher rates of achieving abstinence. CONCLUSIONS Tramadol may be a possible option for the maintenance treatment among some opioid-dependent individuals. Further studies are required to establish its efficacy vis-à-vis other medications used in opioid substitution treatment.
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Affiliation(s)
- Siddharth Sarkar
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Rakesh Lal
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Mohit Varshney
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Saurabh Kumar
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Yatan Pal Singh Balhara
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
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Total hypothalamic volume is reduced in postmortem brains of male heroin addicts. Eur Arch Psychiatry Clin Neurosci 2018; 268:243-248. [PMID: 28534187 DOI: 10.1007/s00406-017-0809-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/17/2017] [Indexed: 01/26/2023]
Abstract
The hypothalamus is at the core of the stress responses systems of the brain. Most interestingly, even though changes of HPA-function have been observed in opiate addiction not much is known about structural changes of the hypothalamus. Volumes of hypothalamus in heroin addicts (n = 14) and healthy controls (n = 12) were assessed by using morphometry of serial whole-brain sections. Total brain volume was larger in the heroin group (mean 1478.85 ± 62.34 cm3 vs. mean 1352.38 ± 103.24 cm3), as the heroin group was more than 10 years younger (p = 0.001). Thus, diagnosis-related effects in the hypothalamus were assessed using the hypothalamus volume relative to whole brain volume showing reduced volumes of the hypothalamus in the heroin group (0.201 ± 0.074 × 10-3 vs. 0.267 ± 0.048 × 10-3; ANOVA: F(1,23) = 6.211, p = 0.020) with a strong hemispheric effect (left side: about 20% reduction 0.209 ± 0.080 × 10-3 vs. 0.264 ± 0.049 × 10-3; F = 4.109; p = 0.054; right side: about 27% reduction, 0.198 ± 0.069 × 10-3 vs. 0.271 ± 0.050 × 10-3; F = -8.800; p = 0.007). Our results provide further evidence for structural and not only functional deficits of the hypothalamus in addiction.
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Muller AE, Skurtveit S, Clausen T. Building abstinent networks is an important resource in improving quality of life. Drug Alcohol Depend 2017; 180:431-438. [PMID: 28988006 DOI: 10.1016/j.drugalcdep.2017.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
AIMS To investigate changes in social network and quality of life of a substance use disorder cohort as they progressed through treatment. DESIGN Multi-site, prospective, observational study of 338 adults entering substance use disorder treatment. SETTING Patients at 21 facilities across Norway contributed baseline data when they initiated treatment, and follow-up data was collected from them one year later. METHODS The cohort was divided into those who completed, dropped out, and remained in treatment one year after treatment initiation. For each treatment status group, general linear models with repeated measures analyzed global and social quality of life with the generic QOL10 instrument over time. The between-group factor was a change in social network variable from the EuropASI. FINDINGS Those who gained an abstinent network reported the largest quality of life improvements. Improvements were smallest or negligible for the socially isolated and those who were no longer in contact with the treatment system. CONCLUSIONS Developing an abstinent network is particularly important to improve the quality of life of those in substance use disorder treatment. Social isolation is a risk factor for impaired quality of life throughout the treatment course.
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Affiliation(s)
- Ashley Elizabeth Muller
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Heath, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
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