Showing papers by "Jason M. White published in 1997"

Patterns of symptom complaints in methadone maintenance patients

Abstract: But: tous les patients ne repondent pas de la meme maniere a la methadone, et plusieurs se plaignent de symptomes de sevrage durant l'intervalle de 24 heures entre les doses (la dose ne suffit pas = ne tient pas). Le persistence de ces plaintes est une source de probleme car elles peuvent signaler un usage de drogue non autorise et une mauvaise reponse au traitement. Cette etude a examine la prevalence et le profil des plaintes concernant les symptomes des patients en maintenance a la methadone qui rapportent que leur dose de methadone ne tient pas. Projet: dans la premiere phase, une etude par sections aupres de 114 patients sous methadone a examine un eventail de symptomes comprenant les effets directs des opioides et du sevrage. La Phase 2 consistait en une comparaison du modele temporel des differents symptomes exprimes entre les patients qui se plaignaient que la dose orale ne tenait pas et ceux qui ne s'en plaignaient pas. Cadre: les participants de cette etude etaient recrutes dans le Programme Public de Maintenance a la Methadone du Sud de l'Australie. Mesures: dans la Phase 1, une liste de controle de 21 de symptomes associes au traitement de maintenance a la methadone etait appliquee. Dans la Phase 2, cette liste etait modifiee afin d'inclure seulement les symptomes qui changeaient durant l'intervalle de 24 heures entre les doses. La liste de controle etait administree 8 fois au cours de cette periode. D'autres donnees ont ete recueillies a l'aide de l'echelle Groupe de Benzedrine Morphine de l'Inventaire du Centre de Recherche sur la Toxicomanie, une mesure de l'effet positif de l'opioide. Resultats: dans la Phase 1, environ un tiers de l'echantillon declarait que la dose de methadone etait inadequate pour prevenir les symptomes de sevrage pour la totalite de l'intervalle entre deux doses. Ils ne pouvaient etre differencies par les caracteristiques demographiques, sanitaires, celles d'autres drogues ou du traitement. Dans la Phase 2, en depit d'avoir une dose de methadone par voie orale plus elevee, les patients rapportant que leur dose quotidienne ne 'tenait' pas, experimentaient un plus faible degre d'effet lie a l'opioide, et une plus grande intensite du sevrage, tout au long de la periode de 24 heures. Conclusion: ces donnees demontrent qu'il existe un changement dans la reponse pharmacodynamique au cours des 24 heures pour tous les patients sous methadone, mais le degre de changement est plus grand dans un sous-groupe de patients. Etablir un graphique des symptomes au cours de l'intervalle entre deux doses peut aider a identifier ces patients qui ont des difficultes avec leur regime de traitement.

Methadone-related overdose deaths in South Australia, 1984-1994. How safe is methadone prescribing?

Abstract: OBJECTIVE To assess the safety of prescribing of methadone tablets and syrup in South Australia by investigating overdose deaths of patients using prescribed methadone and non-patients using illegally obtained methadone. DESIGN Surveillance study of deaths related to methadone overdose, 1984-1994. DATA SOURCES Coroner's Office and the Therapeutic Goods Section of the South Australian Health Commission. RESULTS Per capita prescription of methadone tablets for chronic pain in South Australia was the highest in Australia in 1994. A large increase in deaths, due mainly to methadone tablets prescribed for chronic pain, occurred in 1993-1994. Illegal diversion of methadone to non-patients was responsible for half of the deaths during these two years. Deaths from overdoses of methadone syrup prescribed in maintenance therapy for drug dependence declined from 1984 to 1994. The relative risk for patient deaths due to methadone tablets versus methadone syrup was estimated to be 7.29 (95% confidence limits, 2.15-31.48). Psychotropic drug combinations were present in 86% of deaths. CONCLUSION The methadone syrup program for drug dependence remains relatively safe. Our data raise concerns about prescribing methadone tablets for chronic pain. Better prescriber education and accountability, patient assessment and supervision and advice to patients about concurrent use of alcohol and benzodiazepines are needed.

The agony of ecstasy

Abstract: \"Ecstasy\" (MDMA; 3,4-methylenedioxymethamphetamine) was developed by E Merck in 1914 as an appetite suppressant, but was never used clinically for that purpose. In the 1970s, it was used as an adjunct in psychotherapy, principally in the United States, but was banned in that country from 1985 because of its toxicity and potential for abuse. I Over the past decade, the recreational use of MDMA has increased substantially, both in Australia and elsewhere,\" This use has been associated particularly with \"dance parties\" and \"raves\" and has recently captured public attention because of deaths from acute MDMA toxicity. MDMA has a range of effects that can lead to acute toxic reactions, including hyperthermia, raised blood pressure, raised heart rate, cardiac arrhythmias and coagulopathy,? Hypertension may lead in turn to stroke, and hyperthermia to rhabdomyolysis, dehydration and renal failure. These effects appear to be caused by the action of MDMA on serotonergic and dopaminergic systems, resulting in increased release of neurotransmitters.4 This may explain the overlap of signs and symptoms of MDMA toxicity with those of the serotonin syndrome.5 Chronic toxicity has also been reported in animal models, with lesions of serotonergic neurons in the central nervous system after a few doses of MDMA. In primates, recovery of such lesions is slow and possibly incomplete.\" It is not known whether such toxicity occurs in humans. Some of the metabolites of MDMA (e.g., methylenedioxyamphetamine and dihydroxymethamphetamine) may contribute to the toxicity of the drug.t-\" While certainly the best-known derivative of amphetamine, MDMA is only one of a range that have been used illicitly. Numerous other amphetamine analogues have appeared since the 1960s, either as recreational drugs in their own right, or as contaminants in illicit drug samples. Their popularity and availability have varied. Paramethoxyamphetamine (PMA) is one analogue of current importance in Australia. Ingestion ofPMA, either alone or combined with MDMA, has resulted in several \"ecstasy\" deaths in this country over the last two years. It appears that in most of these cases, the drug users thought they were taking MDMA, but PMA was present as a contaminant. As there is no central collection of information on drug overdoses in Australia, it is difficult to determine accurately the number of ecstasy-related deaths. There have been about 12 such deaths in Australia over the last two years, with at least six of these involving PMA, either alone or combined with MDMA (Dr R James, Senior Forensic Pathologist, South Australian Forensic Science Centre, Adelaide, SA, personal communication). There is no published information on the number of individuals who required hospital admission or suffered non-fatal serious consequences from MDMA-PMA ingestion. It is important to recognise that the number of deaths related to MDMA is relatively small compared with the likely frequency of its use. Deaths from heroin overdoses are cer-

The effects of central and peripheral angiotensin on hypertension and nociception in rats.

Abstract: Spontaneously hypertensive rats (SHRs) rats have been reported to have decreased sensitivity to pain, but as yet a mechanism has not been identified. This study investigated the effects of subcutaneous and intracerebroventricular (ICV) infusions of angiotensin II on blood pressure, locomotor activity, and tailflick and hot plate latencies in the Wistar–Kyoto (WKY) and outbred Wistar rat. Peripheral but not central administration of angiotensin II (567 μg/kg/day) increased hot plate latencies in WKY and Wistar rats to a level equivalent to that observed in the SHR. Peripheral administration of norepinephrine (50 and 100 mg/kg/day) to WKYs increased blood pressure but had no effect on hotplate latency. ICV administration of losartan (1&3 mg/kg/day) to SHRs had no effect on blood pressure or nociception. The results indicate that angiotensin II has a role in the altered pain perception observed in the SHR and that its site of action is peripheral.

Drug-seeking behaviour

Abstract: Prescribers should be alert to drug-seeking behaviour. Appropriate responses require careful

The effectiveness of other opioid replacement therapies: LAAM, heroin, buprenorphine and naltrexone

Abstract: The "scientific studies of medically prescribed narcotics" in Switzerland (hereafter for brevity the Swiss trials) were set up to investigate the feasibility and effectiveness of prescribing injectable opioid drugs (including heroin, morphine and methadone) to severely opioid dependent and destitute patients under medical supervision. The aim of prescribing injectable opioids was to improve the health and psychosocial well-being of the dependent drug users who either had not responded to, or had not been reached by, existing forms of treatment (Swiss Strategy Against Illicit Drug Use, 1988). A three-year program of studies was approved by the Swiss Council of Ministers in 1992. The first studies were set up in multiple sites throughout Switzerland in January 1994 to provide places for 700 patients (250 places for injectable heroin, 250 places for injectable morphine, and 200 places for injectable methadone). During the course of 1994 and 1995 the design was modified. The number of places on injectable heroin was increased to 800, of which 707 had been filled by April 1996 (as against 33 of 100 places for morphine and 35 of 100 places for intravenous methadone).