A stereoselective HPLC method was developed to separate and quantify both enantiomers of methadone and its main metabolite EDDP in serum and urine. The method was used to establish that there is a relationship between the dose of methadone prescribed and its serum concentration as well as urine excretion of methadone and its metabolite enantiomers.The chiral alpha1-glycoprotein stationary phase was used for enantioseparation of (R)-methadone, (S)-methadone and (R)-EDDP (S)-EDDP. The enantiomers of methadone and EDDP were extracted from urine and serum by a simple solidphase procedure.The validated method was applied to the analysis of 31 serum and urine samples obtained from methadone-maintained outpatients (65% male, age 28.8+/-4; methadone dose 146+/-47 mg). A significant correlation (Pearson) r=0.67 (p<0.001) between methadone dose and serum concentration of (R)-methadone was found. Due to the large variation in results obtained from analysis of the subjects' urine specimens, no statistically significant relationship between methadone dose and urine excretion of methadone and EDDP enantiomers was established. The rate of R/S methadone (1.38 in serum, 2.43 in urine) and R/S EDDP (0.83 in urine) confirmed stereoselectivity in methadone metabolism with high individual variability.The enantioselective evaluation of serum methadone concentration might be an interesting tool in methadone maintenance programme. On the other hand, the urinary excretion of methadone and EDDP enantiomers is not reliable as marker of methadone compliance but could be useful for monitoring individual metabolism or for studying the stereoselectivity in pharmacokinetics and metabolism of methadone.
Aims. The objective of the study was to find out, if there is a difference in the prevalence of HCV infection between opiate and methamphetamine users. Patients and Methods. There were 222 patients in the study with the average age 23 years (SD 4.3), males 75%, females 25%. Comparative study was conducted among the patients who requested treatment for drug dependence on opiates (101 patients) and methamphetamines (121). Results. 65% of heroin users and 12% of methamphetamine users were infected with HCV, the prevalence among those who injected drugs was 70% and 28%, respectively. 93% of opiate users and 35% of methamphetamine users were injecting drug some time in their life. The risk of HCV infection was significantly higher among the opiate users (OR 13.4). Conclusions. The prevalence of injecting behavior and the risk of the HCV infection is lower among the methamphetamine in comparison with the opiate users. Still, this is much higher than in the general population. Because no substitution treatment is available for methamphetamine users, the detoxification followed by drug-free treatment is the important part of the risk reduction of the transmission of drug-related infectious diseases in general, and HCV in particular.
Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
ABSTRACT Aims To compare regard for working with different patient groups (including substance users) among different professional groups in different health‐care settings in eight European countries. Design A multi‐centre, cross‐sectional comparative study. Setting Primary care, general psychiatry and specialist addiciton services in Bulgaria, Greece, Italy, Poland, Scotland, Slovakia, Slovenia and Spain. Participants A multi‐disciplinary convenience sample of 866 professionals (physicians, psychiatrists, psychologists, nurses and social workers) from 253 services. Measurements The Medical Condition Regard Scale measured regard for working with different patient groups. Multi‐factor between‐subjects analysis of variance determined the factors associated with regard for each condition by country and all countries. Findings Regard for working with alcohol (mean score alcohol: 45.35, 95% CI 44.76, 45.95) and drug users (mean score drugs: 43.67, 95% CI 42.98, 44.36) was consistently lower than for other patient groups (mean score diabetes: 50.19, 95% CI 49.71, 50.66; mean score depression: 51.34, 95% CI 50.89, 51.79) across all countries participating in the study, particularly among staff from primary care compared to general psychiatry or specialist addiction services ( P < 0.001). After controlling for sex of staff, profession and duration of time working in profession, treatment entry point and country remained the only statistically significant variables associated with regard for working with alcohol and drug users. Conclusions Health professionals appear to ascribe lower status to working with substance users than helping other patient groups, particularly in primary care; the effect is larger in some countries than others.
BACKGROUND Clinical experience reveals a weight increase among patients with opiate dependence after their admission to methadone maintenance treatment (MMT). The objective of the present study was to find out whether there was a significant weight increase among MMT patients, and if so, to what extent this change in weight differed from the existing statistical norm of the general population. METHODS AND RESULTS The sample consisted of 274 MMT patients of the CPLDZ Bratislava with the average age of 26.3 years, 69% were males. Only those patients were included into the study that had stayed in MMT for at least one year. Two main comparisons of their body mass index (BMI) were done: 1. at entry into MMT, and one year after entry; 2. a comparison of BMI one year after treatment entry with BMI of the general Slovak population. Underweight was present in 10% of the patients entering MMT, 72% had BMI within a normal range, 15% were overweight, and 3% were obese. A significant shift towards higher BMI categories was reported one year after treatment entry: 5%, 58%, 29% and 8%, respectively (p < 0.001), which is still significantly lower than in the general population: 4%, 49%, 34% a 13% (p < 0.001). CONCLUSIONS Our results indicate that weight increase in MMT patients should not be considered a direct side-effect, because it is not possible to differentiate between a drug effect and changed behavioural eating stereotypes that could be identical to those in the general population.
The current study tested the association of number of children and the age at which parents sought treatment for alcohol dependence for the first time in the life. From the sample of 1,316 patients 1,109 were included for analysis. The mean age was 44 (SD ± 12.6) years; 71% were males. Their histories were retrospectively reviewed for the descriptive study that focused on the number of children at the first time of patient entry into a specialized health facility for alcohol dependence treatment. The data were subjected to one-way analysis of variance (ANOVA). The results showed that a higher mean age of the patients at the time when they were for the first time seeking treatment for the problems diagnosed as alcohol dependence was associated in both sexes with having more children: male and female patients without children, 36 (SD ± 11.8) and 35 (SD ± 10.0) years, respectively; male and female patients with one child, 44 (SD ± 11.7) and 43 (SD ± 10.8) years; with two children, 50 (SD ± 10.1) and 50 (SD ± 9.5) years, respectively; with three and more children, 50 (SD ± 10.3) and 51 (SD ± 10.8) years. The association between number of children and age at treatment was statistically significant (p ≤ 0.000). Conversely, there were no significant differences between female and male patients. Parents with more children tended to seek the first treatment for alcohol use problems diagnosed as dependence later, than those with one child or those who were childless.
The most risk group with high rate of infection of viral hepatitis C represents the former drug abusers (IDUs).The objectives of the clinical study were to assess the sustained virological response (SVR) in the group of former IDUs with chronic hepatitis C (CHC) treated with pegylated interferon-α and ribavirin.Of 293 previously untreated (naive) former IDUs with CHC who have started treatment, we assessed 239 (69 women, 170 men) with an average age of 27 years who completed treatment and received a follow-up examination after 24 weeks. Prior to therapy abstinence to drug abuse 6 and more months has been required. The CHC has been diagnostics by the standard virological diagnostic tests, increased activity of aminotranferases (ALT) and histology of liver biopsy. Patients were treated with combined immunomodulatory therapy in the standard duration and standard regimen. SVR was considered if qualitative test HCV RNA was negative 24 weeks after the completion of the treatment.End-of-treatment virological response was in 224/94 % patients. Overall SVR rate was 95 %, 227 subjects had negative HCV RNA and only 12 patients no response. During treatment there was a statistically significant decrease in ALT. Treatment was accompanied by the expected side effects.Young age, short duration of HCV infection, high prevalence of genotype 3 and low grade of liver fibrosis in majority of patients and good adherence of patients to treatment were crucial predictive factors resulting in high SVR.
Objectives: The goal of the study was to fi nd out if and what is a difference between clinical signs of alcohol intoxication (AI) and a detected blood alcohol concentration (BAC) among the patients with syndrome of alcohol dependence.Background: The relation between BAC and clinical assessment of AI is a complicated issue.People with dependence form a special group due to their altered tolerance to alcohol.Methods: Clinical, prospective study of 1,277 patients seeking treatment for alcohol-related problems.The average age was 43.1 (SD ± 11.8) years, 74 % males.Alcohol dependence and diagnosis of AI was done by a psychiatrist during a standard examination.This was followed by a laboratory testing for the presence of alcohol in the exhaled air calculated into BAC.The clinical and laboratory fi ndings were compared in a descriptive and statistical way under codes Y 91 and Y 90 in accordance with the ICD-10/WHO diagnostic criteria.Results: The clinical signs of AI were found in 275 (22 %) patients.Of these, 57 (21 %) showed no presence of alcohol in blood laboratory testing.Alcohol was found in blood in 383 (30 %) patients, of whom 165 (43 %) did not show the clinical signs of AI.21 % had no clinical signs of AI at BAC ≥ 2 ‰.Conclusions: Our fi ndings showed that there was a substantial discrepancy between the clinical signs of AI and the detected BAC in people with dependence.These differences do not seem to result from insuffi cient diagnostic skills of the physicians but they are rather due to the non-specifi c nature of the signs, which can be of different etiology.Therefore, an enhanced diagnostic alertness and routine laboratory testing for the presence of alcohol is important, especially in the emergency and addiction medicine (Fig. 2, Ref. 19).
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