Showing papers by "Jason M. White published in 2010"

Psychosocial Treatment for Methamphetamine Use Disorders: A Preliminary Randomized Controlled Trial of Cognitive Behavior Therapy and Acceptance and Commitment Therapy

Abstract: Acceptance and Commitment Therapy (ACT) incorporates developments in behavior therapy, holds promise but has not been evaluated for methamphetamine use disorders. The objective of this study was to test whether ACT would increase treatment attendance and reduce methamphetamine use and related harms compared to cognitive behavior therapy (CBT). One hundred and four treatment- seeking adults with methamphetamine abuse or dependence were randomly assigned to receive 12 weekly 60-minute individual sessions of ACT or CBT. Attrition was 70% at 12 weeks and 86% at 24 weeks postentry. Per intention-to-treat analysis, there were no significant differences between the treatment groups in treatment attendance (median 3 sessions), and methamphetamine-related outcomes; however, methamphetamine use (toxicology-assessed and self-reported), negative consequences, and dependence severity significantly improved over time in both groups. Although ACT did not improve treatment outcomes or attendance compared to CBT, it may be a viable alternative to CBT for metham- phetamine use disorders. Future rigorous research in this area seems warranted.

Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependence

Abstract: Aim To investigate the safety and efficacy of once-daily supervised oral administration of sustained-release dexam- phetamine in people dependent on methamphetamine. Design Randomized, double-blind, placebo-controlled trial. Participants Forty-nine methamphetamine-dependent drug users from Drug and Alcohol Services South Australia (DASSA) clinics. Intervention Participants were assigned randomly to receive up to 110 mg/day sustained- release dexamphetamine (n = 23) or placebo (n = 26) for a maximum of 12 weeks, with gradual reduction of the study medication over an additional 4 weeks. Medication was taken daily under pharmacist supervision. Measurements Primaryoutcomemeasuresincludedtreatmentretention,measuresof methamphetamineconsump- tion (self-report and hair analysis), degree of methamphetamine dependence and severity of methamphetamine withdrawal. Hair samples were analysed for methamphetamine using liquid chromatography-mass spectrometry. Findings Treatment retention was significantly different between groups, with those who received dexamphetamine remaining in treatment for an average of 86.3 days compared with 48.6 days for those receiving placebo (P = 0.014). There were significant reductions in self-reported methamphetamine use between baseline and follow-up within each group (P < 0.0001), with a trend to a greater reduction among the dexamphetamine group (P = 0.086). Based on hair analysis, there was a significant decrease in methamphetamine concentration for both groups (P < 0.0001). At follow-up, degree of methamphetamine dependence was significantly lower in the dexamphetamine group (P = 0.042).Dexamphetaminemaintenancewasnotassociatedwithseriousadverseevents.Conclusions Theresults of this preliminary study have demonstrated that a maintenance pharmacotherapy programme of daily sustained- release amphetamine dispensing under pharmacist supervision is both feasible and safe. The increased retention in the dexamphetamine group, together with the general decreases in methamphetamine use, degree of dependence and withdrawal symptom severity, provide preliminary evidence that this may be an efficacious treatment option for methamphetamine dependence.

Opioid antagonists under heavy sedation or anaesthesia for opioid withdrawal.

Abstract: Objective: To assess the effectiveness of opioid antagonists to induce opioid withdrawal with concomitant heavy sedation or anaesthesia, in terms of withdrawal signs and symptoms, completion of treatment and adverse effects. Drugs that block opioids are sometimes given to opioid dependent people while they are under heavy sedation or anaesthesia to speed up withdrawal. The review of trials shows that this sort of withdrawal treatment is quicker than withdrawal managed with reducing doses of methadone or clonidine plus symptomatic medications. The intensity of withdrawal experienced with anaesthesia-based approaches is similar to that experienced with approaches using only minimal sedation, but there is a significantly increased risk of serious adverse events with anaesthesia-assisted approaches. The lack of additional benefit, and increased risk of harm, suggest that this form of treatment should not be pursued.

(R)- and (S)-methadone and buprenorphine concentration ratios in maternal and umbilical cord plasma following chronic maintenance dosing in pregnancy.

Abstract: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Both methadone and buprenorphine cross the placenta during pregnancy which can result in neonatal abstinence syndrome (NAS) Reduced NAS in buprenorphine-exposed infants may be as a result of relatively less buprenorphine reaching the foetal circulation compared with methadone WHAT THIS STUDY ADDS Under chronic dosing conditions in humans, the transfer of methadone and buprenorphine appears greater than previously found in human placental tissue in vitro models Infants born to buprenorphine maintained women may be exposed to relatively less of the maternal dose compared with infants born to women maintained on methadone during pregnancy There is stereoselectivity in the transfer of the individual enantiomers of methadone across the placenta to the foetal circulation AIMS The aim of this study was to compare the transfer of buprenorphine and methadone between maternal and cord blood in women under chronic dosing conditions and to determine if differences exist in the transfer of the two methadone enantiomers METHODS Maternal and cord blood samples were collected at delivery from women maintained on methadone (35, 25–140 mg day−1) (median; range) or buprenorphine (600, 2–20 mg day−1) during pregnancy Plasma concentration ratios are presented as an indicator of foetal exposure relative to the mother RESULTS Methadone was quantified in all samples, with cord : maternal plasma methadone concentration ratios (n= 15 mother-infant pairs) being significantly higher (P < 00001; mean difference (MD) 007; 95% confidence interval (CI) 0048, 0092) for the active (R)-methadone enantiomer (041; 019, 056) (median; range) compared with (S)-methadone (036; 015, 053) (R)- : (S)-methadone concentration ratios were also significantly higher (P < 00001; MD 024 95% CI 0300, 0180) for cord (140; 095, 167) compared with maternal plasma (116; 081, 138) Half the infant buprenorphine samples were below the assay lower limit of quantification (LLOQ) (0125 ng ml−1) The latter was four-fold lower than the LLOQ for methadone (050 ng ml−1) The cord : maternal plasma buprenorphine concentration ratio (n= 9 mother-infant pairs) was 035; 014, 047 and for norbuprenorphine 049; 024, 091 CONCLUSIONS The transfer of the individual methadone enantiomers to the foetal circulation is stereoselective Infants born to buprenorphine maintained women are not exposed to a greater proportion of the maternal dose compared with methadone and may be exposed to relatively less of the maternal dose compared with infants born to women maintained on methadone during pregnancy

Opioids: Heroin and Prescription Drugs

Abstract: A number of approaches have been used in the treatment of opioid dependence. Methadone maintenance has been demonstrated to be efficacious and cost-effective in a number of clinical trials. There are also good guidelines on various aspects of its use, including doses during induction and maintenance, supervision of doses and potential adverse effects. Buprenorphine is a μ-opioid receptor partial agonist that has been proven effective for maintenance treatment in clinical trials. There appears little difference in outcomes between methadone and buprenorphine, although methadone maintenance may be associated with slightly higher retention rates. Conversely, buprenorphine is associated with lower risk of respiratory depression and may also be associated with lower risk of some of the adverse effects of chronic opioid administration such as hypogonadism and low bone mineral density. Both morphine in slow-release formulations and diacetyl morphine have been used in maintenance treatment, but do not have the evidence base of methadone or buprenorphine. Naltrexone has shown some evidence of efficacy in treatment of dependence, but is associated with very low retention rates. Newer implant and depot formulations may prove more successful. For treatment of withdrawal both opioid agonists such as buprenorphine and the α2 adrenergic agonists such as clonidine have shown efficacy, although the degree of withdrawal suppression is likely to be greater with the opioids. While psychosocial and ancillary treatment is widely regarded as important, there are as yet very few studies to indicate the optimal form of such treatment.