Drug addicts treatment for ten years in Thanyarak Hospital (1989-1998).

The problem of drug addicts has increased over the past 3-4 years. A retrospective descriptive study of inpatient drug addicts at Thanyarak Hospital was done. Data from the record pool from October 1989 to September 1998 was reviewed for demographic information, diagnosis, HIV infection and the outcome of treatment. The study showed that the total number of patients increased from 7,595 cases in 1989 to 10,661 cases in 1995, but decreased in the next three years to 7,633 cases in 1998. Males constituted more than 91.5 per cent in each year. Mean ages decreased from 31.1+/-8.8 to 26.5+/-9.3 years. Most of the patients were labourers or were unemployed. The number of students also increased. Initially, students constituted only 1.3 per cent but in the last 3 years this increased to 4.0, 8.0 and 17.1 per cent, respectively. The education level has gradually increased. Heroin addiction was approximately 80.6-92.4 per cent in the first 8 years but markedly decreased to 38.0 per cent in the last year. Opium addiction decreased from 3.8 per cent to 1.0 per cent. Methamphetamine addiction markedly increased from 0.4 per cent to 51.5 per cent. The outcome of the treatments showed that patients who attended the 2-3 weeks detoxification treatment program was 30.9-43.5 per cent but patients who joined the therapeutic community rehabilitation program was only 0.8-4.2 per cent. The mortality rate increased from 2.1 per thousand to 5.2 per thousand and more HIV infected patients died than non-HIV infected patients. This rate varied from 1.7 times in 1989 to 8 times in 1995 and 4.5 times in 1996. We conclude from this study that drug addicts changed from heroin to Methamphetamine especially among young students in the last 2-3 years. HIV infection was still high in old cases (about 40%).

Methadone maintenance: results of treatment in heroin addict at Thanyarak Hospital (1990-1996).

Methadone maintenance is a treatment program designed for chronic heroin addicted patients. The purpose is to make them maintain their productive function and adaptive social behavior. The retrospective descriptive study was done from 1990 to 1996. 195 cases joined the Methadone Maintenance Program (MMP) during this period. 188 cases were men and 7 cases were women. The average age was 31.9 +/- 7.2 yr. (19-49 yr. old). 105 cases were single and 90 cases were married. 155 cases were labourers (79.2%). 159 cases (81.5%) used more than 500 mg of heroin a day, it may be assumed that they spent 327 +/- 159 baht a day ($13 +/- 5). The duration of heroin usage before MMP was 8.7 +/- 5.4 yr. (4-25 yr.) In and out of the detoxification treatment program was 12.7 +/- 10.1 times (4-44 times). We found that 11 cases successfully decreased and then stopped the methadone. 32 cases were in the program for more than 1 year and also joined the program until the end of this study. This meant that 43 cases (22%) were successful in stopping their heroin addicted behavior. The average dose of methadone administration was 61.5 mg (40-80 mg mostly). The average time for the patients attending the program was 8.2 months (2-80 months). 38 cases who attended the program for more than 1 1/2 years were in the older-aged and married group. We found no difference in the previous heroin usage or methadone dose in these patients before they attended the MMP. The 32 cases which remained on MMP used mostly less than 40 mg of methadone a day. Two-thirds of the cases discontinued the program due to their positive urine test findings for heroin up to 8 times. Although the MMP was a good way to decrease the heroin addicted behavior, it's not a promising way to stop this problem.

Clinical effect of dynorphin on heroin addicts.

This study assessed the clinical effectiveness, physiological responses and also adverse effects of dynorphin in heroin dependent detoxication. The subjects were randomly assigned into three groups and received intravenous injections of dynorphin at the dose of 180 (6 patients) or 60 (7 patients) or 0 (8 patients) micrograms/kg three times a day for 6 days. There was no statistical difference in withdrawal syndrome between each group. However, the drug craving feeling in the dynorphin groups was reduced when compared to the placebo group. There was no report of any adverse effects of the drug or abnormal laboratory results from the subjects during the study period.