The goal of our study was to determine the safety and efficacy of 60 mg SR d-AMP as substitution therapy for MA dependence. A variety of preclinical and clinical data indicate that this may be a useful approach for the treatment of MA dependence and could also serve to guide dose selection. Although we found that the overall effect of d-AMP on MA use was not significant, the results show that 30 mg d-AMP taken twice daily is safe for MA users. The main finding of the study is that d-AMP reduces withdrawal symptoms and craving for MA. Although reductions in withdrawal and craving scores do not by themselves confirm the efficacy of d-AMP as a substitution therapy, the findings in these domains do support the need for further exploration of d-AMP as a treatment for MA dependence. Both withdrawal symptoms and craving are postulated to increase relapse rates among MA users. 27–30 Therefore, these findings suggest that one
dose of TPM not to exceed 200 mg/day, a maintenance phase (Days 36 to 84), and a taper phase (Days 85 to 91). To continue in the study, subjects had to maintain a minimum daily dose of 50 mg. Blood samples were col- lected on Day 1 (considered the baseline) and at the end of Weeks 8 and 12 from every participant who con- sented to participate in the genetics/expression study. The rationale for using weeks 8 and 12 of TPM treat- ment in the genetic/expression study was that these two time points were in the middle of the maintenance phase of the maximum dose for each patient and the end of treatment, respectively. At the two time points, because the TPM dose given to each patient became relatively stable, this would reduce variability of drugs received among patients, thus likely increasing statistical power of identifying differentially expressed genes and path- ways. All blood samples for this study were collected in PAXgeneTM blood tubes using standard phlebotomy technique.
Affymetrix GeneChip system. Relative up- or downregu- lated genes after treatment with DRα1-mMOG-35-55 plotted against their expression level in spinal cords of vehicle-treated mice revealed 1049 probes that were downregulated by twofold or greater. Out of these probes, 160 genes were shown to be involved in inflam- mation processes. Conversely, 568 probes were upregu- lated by twofold or greater in the spinal cord of DRα1-mMOG-35-55-treated vs. vehicle-treated mice. Gene ontology analysis of the genes that were upregu- lated did not reveal a distinct pathway as was observed for downregulated pro-inflammatory response genes. However, several of the genes that were relatively upreg- ulated by DRα1-mMOG-35-55 treatment were shown to be involved in neuroregeneration, including Prosaposin (PSAP), Myocilin (MYOC), E3 ubiquitin ligase Huwe1, and 3-phosphoinositide-dependent protein kinase 1 (PDPK-1) [32–37]. We validated these microarray results by real-time PCR analysis of spinal cord mRNA from three individual mice in each group (Fig. 1e). Indeed, pro-inflammatory genes such as CD74, Nlrp3, and IL-1b were significantly downregulated in spinal cords of DR α 1-mMOG-35-55-treated vs. vehicle-treated mice ( p < 0.001, p < 0.01, and p < 0.001, respectively), whereas Huwe1 and MBP were significantly upregulated (p < 0.05). Histone deacetylase 5 (HDAC5) was also upregu- lated, although results did not reach significance [38, 39]. These results indicate the CNS of DR α 1-mMOG-35-55-treated mice is not only less in- flammatory but also that this treatment could inhibit and potentially reverse ongoing demyelination and neu- rodegeneration .
One option to dealing with the problem of accessing detoxification facilities would be to establish a detox unit on site at Harristown House. Full-time qualified medical personnel are generally employed to supervise the clients in such units. Therefore this approach may also facilitate the admission of clients with psychiatric problems, a need identified by several stakeholders. Although having a detox unit on site would be a useful addiction to the Harristown House project, the financial implications of this approach must be taken into consideration. However, introducing detox provision need not be costly. Research has suggested that residential detoxification does not always need to be pharmacologically assisted or medically supervised. Mattick and Hall (1996) report that clinical experience in ‘non-medical’ detoxification units in Canada and Australia has shown that, in many cases, withdrawal symptoms can be managed without medication in a quiet, safe, supportive environment, with counselling, reassurance, and social support from non-medical staff. Such facilities often have access to medical assistance should complications arise, although this is generally not required (Pedersen, 1986).
This TIP provides an overview of current technology-based behavioral health assessments and interventions, and it summarizes the evidence base supporting the effectiveness of such interventions. It also examines opportunities for technology-assisted care (TAC) in the behavioral health arena. It emphasizes use of TAC with clients who might not otherwise receive treatment or whose treatment might be impeded by physical disabilities, rural or remote geographic locations, lack of transportation, employment constraints, or symptoms of mental illness. The TIP covers programmatic, technological, budgeting, vendor selection, data management, privacy and confidentiality, and regulatory considerations likely to arise during adoption of technology-based interventions.
Methadone is stable and does not need refriger- ation when in diskette or tablet form. However, when methadone diskettes are reconstituted or liquid methadone oral concentrate is used and diluted with juice or some other sugar- based liquid, the mixture may not remain stable beyond a few days without refrigeration. Manufacturer instructions call for adding a minimum of 30 mL or 1 fluid ounce of liquid per dose when reconstituting methadone. Although methadone has a significant street value, a National Institutes of Health consen- sus statement refers to it as “a medication that is not often diverted to individuals for recre- ational or casual use but rather to individuals with opiate dependence who lack access to [methadone maintenance treatment] pro- grams” (National Institutes of Health 1997b, p. 20). Nevertheless, reported deaths attributed to methadone have increased significantly in some States. According to data from the Drug Abuse Warning Network, more than 10,000 emergency room visits related to methadone were reported in 2001 compared with more than 5,000 in 1999 (Crane 2003). This increase has occurred in the context of overall increases in abuse of prescription opioids, in particular hydrocodone and oxycodone. Local reports indicate that most diverted methadone comes from medical prescriptions because it has gained acceptance as an excellent chronic pain treatment (Belluck 2003). Although the slow onset of methadone makes it less attractive than prescription opioids to potential abus- ers, it also makes methadone more dangerous because respiratory depression can become significant hours after ingestion. To guard against the possibility of methadone-related respiratory depression, the consensus panel recommends the following diversion control policies for take-home medication:
Intervention here and throughout this Report means a professionally delivered program, service, or policy designed to prevent substance misuse or treat an individual’s substance use disorder. It does not refer to an arranged meeting or confrontation intended to persuade a friend or loved one to quit their substance misuse or enter treatment—the type of “intervention” sometimes depicted on television. Planned surprise confrontations of the latter variety—a model developed in the 1960s, sometimes called the “Johnson Intervention”—have not been demonstrated to be an effective way to engage people in treatment. 68 Confrontational approaches in
Almost half the recruited participants were male (45%), 60% were Caucasian, 18% Hispanic and 17% Asian/Pacific Islander. Other participant characteristics at baseline included: age: 32.8 years on average; educa- tion: 12.2 years on average; employment: 69%; and mar- ried and not separated: 16%. Participants were recruited through a variety of means, including media advertise- ments, referrals from community agencies (medical, sub- stance abuse, mental health and criminal justice) and word of mouth. Although the inclusion and exclusion cri- teria for the study may have precluded participation by the most severely disabled individuals, the characteristics of the participating cohort were consistent with clinical treatment samples studied previously [2,8]. Multiple sub- stances of abuse were documented in participants’ drug- use histories, but both self-reports and urinalyses con- firmed that there was practically no use of substances other than MA, marijuana and alcohol throughout the duration of the study. The participants had on average 7.54 years of life-time MA use and 11.53 days of MA use in the past 30 days. The preferred route of administration
After the study project had been approved at Jahrom University of Medical Sciences, the required permit was submitted to the treatment center and the files of all the patients who had completed their treatment plans were examined. At the center in question, method of treatment for each patient was determined thus: based on the type and amount of the substance used, method of administration, length of addiction, the number of attempts made to quit in the past and the doctor’s judgment, one of the three methods of MMT, BMT, or opium tincture would be prescribed for each addict. Regardless of the type of treatment prescribed, the treatment procedure is as follows: 1. Induction (the initial administration of a certain amount of the prescribed drug based on the patient’s symptoms and history); 2. Stability (fixing the amount of the drug administered based on the patient’s withdrawal symptoms); 3. Maintenance (regular administration of the prescribed drug); 4. Tapering (gradually decreasing the amount administered).
Realizing There's a Problem. According to the University of Utah, during the pre- contemplation phase when a person isn't aware of or ready to accept that there's a problem, denial is a big obstacle preventing many addicts and their families from seeking help. The problem with denial is that it provides only a temporary fix and momentary relief from the pain and suffering caused by addiction. Realizing and admitting there's a problem is something that might occur in a moment, or it can develop over time. But the moment it's understood that a real problem exists, the first step has been made toward change.
24. All new patients should receive an orientation to medication-assisted treatment for opioid addiction (MAT), and the orientation should include documentation of the consent to treatment, program record keeping and confidentiality requirements, program rules, including patient rights, grievance procedures, and circumstances under which a patient can be discharged involuntarily, and
In the United States, approved pharmacotherapies for the treatment of opioid dependence are methadone, bu- prenorphine and naltrexone. Methadone and buprenorphine are controlled medications and thus the dispensing of methadone and prescription of buprenrophine is controlled by federal regulations (Kresina, Litwin, Marion, Lubran, & Clark, 2009). Federal regulations in the United States require methadone, for the purpose of addictiontreatment, to be dispensed in opioid treatment programs and in liquid form on a daily basis. Initially, liquid me- thadone was dispensed using manual pumps for individual dosing. Technological advances have brought about computer controlled automated dispensing pumps, allowing for accurate measured dosing and integration with patient management software (IVEK Corporation. Accuvert Controlled Methadone Dispensing System; SciLog, Bio Processing Systems. Lab Tec Smart Methadone Dispensing Pump). Other automated dispensing systems identify patients through biometrics (iris or fingerprint recognition), dispensing the individual dosage based on the patient electronic dispensing record and upon completed dosing updating the patient electronic medical record (DRX Systems, Automated Methadone Dispensing). This integrated automated system can complete the dosing of methadone or buprenorphine to patients in as little as twenty seconds, substantially increasing effi- ciency. Additional clinic addiction management systems can provide inventory control, dispensing, administra- tion, regulatory agency reporting and patient/medical provider electronic signatures (Netsmart, Clinic Addiction Management Systems). These technological advances not only increase efficiency but also are important tools for research studies that address patient and treatment issues related to pharmacologic dosing (Cleary, Reynolds, Eogen, O’Connell, Fahey, Gallagher, Clarke, White, McDermott, O’Sullivan, Carmody, Gleeson, & Murphy, 2013; Walley, Cheng, Pierce, Chen, Filippell, Same, & Alford, 2012).
Supporting Peers to Embrace Recovery (PROSPER), a peer-driven recovery community that provides a number of peer-driven supports for members to be able to recover from drug use and criminality as they transition back into the com- munity and to provide support to their family members and loved ones. PROSPER provided a strategic mix of services, all planned, implemented, and delivered by peers including peer-run groups and group activities that take place in a light-hearted social environment away from traditional treat- ment settings. The aims of the program were to: 1) provide peer support environment, 2) build positive self-concept and achievement motivation, 3) reinforce family/significant oth- ers’ relationships and support, and 4) amplify the treatment continuum. 77 The study outcome measures were self-efficacy,
methadone maintenance. He had a long history of alcohol- ism and was using cocaine regularly. He had done fairly well on methadone as far as illicit opioid use was concerned, but his clinic attendance and ability to comply with clinic rules, especially regarding take-home doses, were severely compromised by alcohol use. In the past, he would remain in treatment for about a year, then become angry over his inability to obtain take-home doses because of positive breathalyzer tests, drop out, and have a relapse to opioid use. He had frequently been offered inpatient detoxification for alcoholism but always refused because ‘‘alcohol’s not my problem, heroin’s the problem,’’ and he could not take time off from work (as a stockperson in a liquor store). When he presented for treatment most recently, he was unemployed (secondary to alcohol problems) and living with his parents, who were threatening to put him out because of drug use. He agreed that, as part of his treatment plan, he would go into the hospital for alcohol detoxification and stabilization on methadone and then be discharged to maintenance ther- apy. After inpatient discharge, he attended AA-style coun- seling, requested daily alcohol breath tests, and turned down an offer to return to his job at the liquor store. He remained stable for 3 years on 65 mg per day of methadone with no urine samples positive for opioids (but occasionally positive for cocaine), and he enrolled (and continued) in school.
After you complete treatment, it’s important to establish a new and healthy routine. You need to find productive ways to fill the time that was once filled with drugs and alcohol. During your stay at JourneyPure, you will discover new hobbies, activities and renewed interest in things that once mattered to you (such as your career or your family). Happiness in your life is key to maintaining sobriety.
Through counseling, you learn about the motivations and behaviors that led to your opioid addiction. You learn how to commit to a more healthful lifestyle. You gain support and skills while working with others to manage your recovery long term. Counseling can provide you with encouragement and with motivation to stick to treatment. It can help you learn how to make healthy decisions, handle setbacks and stress, and move forward with your life.
A total of 111 participants were randomly assigned to receive oral methadone, and 115 participants were randomly assigned to receive injectable di- acetylmorphine (diacetylmorphine hydrochloride, DiaMo Narcotics). In addition, 25 participants were randomly assigned to receive injectable hydromor- phone instead of diacetylmorphine, for validation of the self-reported use of illicit heroin by means of urine testing. The investigators and participants were aware of whether the assigned study drug was oral methadone or one of the injectable drugs, but diacetylmorphine and hydromorphone were administered in a double-blind fashion. The in- jectable medications were self-administered under supervision in the treatment clinics up to three times daily, with a maximum daily dose of 1000 mg of diacetylmorphine. Patients receiving injectable medications could at any time switch partially or totally to oral methadone if such a switch was deemed appropriate by the patient and his or her physician. Methadone dosages and delivery were based on best practices and current clinical prac- tice guidelines. 15 Methadone was dispensed at the