Maintenance treatment with opium tincture: a preliminary qualitative study of the factors related to treatment entry

The current preliminary study aimed to explore the reasons that a group of opiate-dependent patients reported for entry into opium tincture treatment [OTT]. Through examinations of 52 qualitative focus group interviews with patients from six OTT centers and 10 health providers [in key informant interviews] in Tehran, this study highlights the factors that participants reported as the reasons associated with entry into OTT. Quantitative data including demographic data and details of drug use were analyzed by using SPSS.v.18.0. Qualitative data was analyzed by using Atlas-ti software. 86.5% of patients were male and 13.5% were female. The median age of patients was 39 yr. The most frequently reasons associated with entry into OTT included methadone misconceptions including dissatisfaction with taking methadone as a chemical medication, methadone dependence, and long duration of MMT. The other reasons included the recommendation of other people in treatment and OT-related characteristics and expectations including the herbal compound of OT, treating opiate craving and withdrawal symptoms, and improving general health. The study findings preliminarily showed the reasons associated with entry into OTT in a sample of treatment seekers. Longitudinal studies with more representative samples and follow-up stages are required to evaluate the clinical effectiveness of OTT as a maintenance treatment in comparison with methadone and buprenorphine. Patient-centered program and policy implications are discussed

Attention deficits in chronic methamphetamine users as a potential target for enhancing treatment efficacy

Methamphetamine [MA] is a potent, addictive psychostimulant that has dramatic effects on the central nervous system [CNS]. The onset of methamphetamine use has been linked to heightened attention, and chronic methamphetamine use has been associated with deficits in different aspects of attention that can significantly persist into abstinence. Attention deficits in chronic methamphetamine users may be associated with severity of methamphetamine use, craving, relapse, and as a result, poor treatment outcomes. This review summarizes evidence that the continuity of attention deficits, especially during abstinence, should be considered as a potential target during methamphetamine use treatment. Implementing attention rehabilitation techniques during treatment may enhance motivation for treatment in chronic methamphetamine users, and may facilitate treatment adherence, craving control and promote relapse prevention. This issue has important clinical implications for enhancing treatment efficacy and as a result, increasing treatment outcomes

Sexual dysfunction in male crystalline heroin dependents before and after MMT: a pilot study

Sexual dysfunction [SD] is a common problem among chronic opiate dependents. The purpose of this study is to examine the prevalence of SD and to investigate whether there is a change in SD after six months of methadone maintenance treatment [MMT] compared with baseline. We recruited 30 patients mean age 34.5 years from an MMT center in Damghan, Iran. Patients underwent structured interviews that consisted of the following: [i] socio-demographic characteristics, drug use, and sexual behavior; [ii] the international index of Erectile Function [IIEF-15] test for SD: [iii] the Zung test for depression; and [iv] analysis of serological status. Overall, 8% of participants reported no SD, 69% reported mild to moderate SD, and 23% reported severe SD upon admission. After completion of the MMT program, these results decrease to 61% and 20%, respectively. In comparison with admission, the mean IIEF 15 scores showed moderate improvement from 16.77 +/- 7.08 to 21.8 +/- 6.40 [P=0.003]. The mean IIEF-15 score for intercourse satisfaction completely improved from 12.20 +/- 4.55 to 15 +/- 3.76 [P=0.001]. Slight improvements were noted in the mean IIEF-15 score for sexual desire which increased from 5.10 +/- 2.28 to 6.57 +/- 2.12 [P= 0.017] and the mean IIEF-15 score for overall satisfaction which increased from 5.10 +/- 2.29 to 6.58 +/- 2.12 [P=0.017]. However, the mean IIEF-15 score for orgasmic function very slightly decreased from 4.73 +/- 4.50 to 4.57 +/- 1.92 [P=0.191], which showed no statistically significant improvement after MMT. There was no relation with depression. The findings of this study reveal a prevalence of SD and improvements in some aspects of SD in patients after six months of MMT. Patients should be screened for SD at the onset of opioid replacement treatment. Future studies on SD should examine the potential benefits of androgen replacement, hormone assay and the role of psychosocial factors