Exploring the Clinical Variables among Drug-Dependent HIV-Positive Patients: Implications for Treatment Strategies

This study explored the profile of HIV positive patients seeking treatment at a tertiary care addiction treatment facility. A retrospective study was done to collet detailed information on clinical characteristics: drug use (type, age of initiation, duration), general medical condition and past treatment history. The study included 138 patients with mean (SD) age 30.2 (8.3) years. Opioid dependence with injecting drug use (IDU) was diagnosed in 97% of the patients. The median age of injecting onset was 24.5 years (IQR 20-31 years). The most frequently injected substances were pheniramine (60.1%) and buprenorphine (59.4%). Past treatment seeking was reported by 57% patients and interestingly they were less likely to present any medical condition (2 =69.611, p < 0.001). Variability in the age of onset of drug use indicates the need for broad based approach to prevent IDU and motivation to seek treatment may lead to better health conditions.

Comparison of self-reported benzodiazepine use and urinalysis among consecutive treatment seekers at a tertiary care drug dependence treatment centre.

Information provided by drug dependent patients might be incomplete and/or discrepant. Benzodiazepines are frequently abused, but not necessarily reported, even by the treatment seeking population. The study aims to compare the self reported benzodiazepine use with a quick and effective urinalysis method. A total of 51 consecutive adult patients were included after an informed consent during their first visit to a tertiary care drug dependence treatment centre. The socio-demographic and clinical details were recorded on a semi-structured proforma. Patients were specifically asked for ever, current and recent benzodiazepine use and thereafter ten ml urine sample was collected to perform urinalysis with cassette test for benzodiazepines. The sample, predominantly males, had a mean age of 37.86 ±10.46 years. The common primary drugs of use were heroin (52.9%), alcohol (23.5%) and other opioids (21.6%).Drug use was uninterrupted in most of users (72.5%) and ranged from one to forty years. The recent benzodiazepine use was reported by 21.6% of all users whereas urinalysis by cassette test was positive in 50.9% of the treatment seekers. Denial among users was 69.2% and denial among negative self report was 45%. A poor level of agreement (K) was found between results of self-report and urinalysis for all the treatment seekers. Self report of benzodiazepine use is highly questionable among treatment seekers. The urinalysis with cassette test is a quick objective method which is recommended for routine screening.

Impact of alcohol and substance abuse on adolescent brain: A preclinical perspective.

Use of alcohol and addictive substances by human juveniles and adolescents is common. Animal models offer researchers unique insight into the effects of alcohol and drugs on adolescents. Recent work in rat indicates that periadolescent substance use may disrupt normal pubertal development and may induce stronger effects on system subserving plasticity and cognition than in adults. Several processes may influence the adolescent risk of neurocognitive damage. The brain goes through various dynamic changes during adolescence and can seriously affect the short term growth process. The features of the adolescent brain may in fact predispose a youngster to behave in ways that place him or her at particular risk of experimenting with alcohol or other drugs. In addition to behavioral and neurochemical changes, a number of important physiological alterations occur during adolescence, including changes in brain regions implicated in the reinforcing properties of alcohol and other drugs of abuse. Damage during early stages can cause long term damage which is irreversible. The present review discusses the neurobehavioral, neurochemical and neuroendocrinal effects of alcohol and other drugs of abuse on the adolescent brain in rats.

Neurobiology of cannabis addiction.

Cannabis has emerged as a common substance of abuse and dependence and the peculiarities associated with this widely available and used substance has triggered substantial research in this field. The earlier held concept of rather benign nature of this compound as a substance of abuse and dependence has changed as a result of the ongoing clinical and research findings. Cannabis has been found to have multiple physical and mental effects in human beings. But still a lot remains to be answered regarding the basis for the development of dependence on cannabis. However, the discovery of various cannabis receptors and their endogenous and synthetic ligands have added fuel to the ever growing interest in this substance. Various hypotheses have been postulated in this regard based on the findings of both the animal and human studies which serve as potential explanations to the observations. These findings have helped in the better understanding of the issue and have provided substrate for the clinical application.

Assessment of differential doses of buprenorphine for long term pharmacotherapy among opiate dependent subjects.

The aim of the present study was to evaluate, two different doses of sublingual buprenorphine (2 mg and 4 mg) among patients on maintenance treatment and to assess the relationship of steady state plasma level with craving. Twenty three male opioid dependent (ICD-10 DCR) subjects, were assigned to double blind randomized controlled trial of 2 and 4 mg/day doses of buprenorphine in an inpatient setting. They were evaluated thrice (2nd, 7th and 14th day) in 2 weeks for withdrawal symptoms (acute and protracted), sedation, euphoria, craving, side effects, global rating of well being and for measurement of plasma levels of buprenorphine. The data showed that there were no significant difference in scores of euphoria and sedation, protracted withdrawal symptoms and side effects, craving and overall well being and plasma level of buprenorphine among the subjects. However, both the groups had significant difference in score on almost all the measurements on final observation in comparison to initial observation. Both 2 mg/day and 4 mg/day dose of buprenorphine were effective in long term pharmacotherapy of opioid dependence without significant difference as compared by different measures used in the study.

Self-reported drug use and urinalysis results.

The study examined the consistency between retrospective self-reported drug use and urinalysis data among 281 male opioid dependent subjects attending out patient clinic of National Drug Dependence Treatment Centre from January 2001 to December 2001 at All India Institute of Medical Sciences, New Delhi. Preliminary analysis indicated that there was moderate to high concordance between the two measures among different drug types. On an average 85% of urine test results matched with self-report. Subject's over-reported drug use as indicated by the low positive predictive value. In contrast, subjects were more accurate when they were reporting no drug use as suggested by the high negative predictive value. The study suggests that urine analysis is a critical variable in substance abuse treatment programs. Clinicians should be cautious while prescribing agonist drug due to frequent over-reporting of drug use by patients in our setting. This will make the substance abuse program more meaningful.

Blocking of enhanced sensitivity to behavioral effects of naloxone induced by narcotic agonists in rats.

The present experiment evaluated whether prior treatment with naloxone could block the sensitization to opiate antagonist induced by single dose administration of pure agonist (morphine) or mixed agonist (buprenorphine). Food deprived male Wistar rats were trained to respond for food on a multiple-trial, fixed-interval 3 min schedule. Reinforcement was contingent upon a response within a 10-s limited hold period following a fixed-interval of 3 min. A trial consisted of three fixed interval of 3 min separated by a 10 min timeout period during which responses were not reinforced. The rate decreasing effects of the opioid antagonist naloxone was determined by cumulative dosing. Pretreatment with morphine (0.3 mg/ kg, SC) and buprenorphine (0.03 mg/kg, SC) resulted in an increase sensitivity to the rate decreasing effect of naloxone compared to saline pretreatment. Administration of naloxone (0.3 mg/kg) 10 min prior to pretreatment doses of buprenorphine (0.03 mg/kg; 1.0 mg/kg) and morphine (0.3 mg/kg) increased sensitization to naloxone. However, greater sensitization was observed at low dose of buprenorphine. The increased sensitivity was partially blocked at high dose of buprenorphine (1.0 mg/ kg) by naloxone pretreatment. These results suggest that the doses of naloxone used to block opioid induced sensitization might be different from those required in animals with normal sensitivity to opioid antagonists. Further agonist-induced sensitization to behavioral effects of opioid antagonist appears to be opioid receptor specific.