Improved Syva MicroTrak Chlamydia trachomatis direct test method.

Recent changes in the MicroTrak Chlamydia trachomatis Direct Specimen Test (Syva Company, Palo Alto, Calif.) have led to improved product performance. The use of the recommended cervical cytology brush can significantly increase the number of endocervical cells collected, and fixation with methanol increases the intensity of elementary-body staining in many specimens.

Excretion patterns of cannabinoid metabolites after last use in a group of chronic users.

The urinary excretion patterns of 86 chronic cannabis users were examined after their last cannabis use by two common screening methods, the semiquantitative EMIT-d.a.u. and the qualitative EMIT-st (Syva Company). We demonstrated that under very strictly supervised abstinence, chronic users can have positive results for cannabinoids in urine at 20 ng/ml or above on the EMIT-d.a.u. assay for as many as 46 consecutive days from admission, and can take as many as 77 days to drop below the cutoff calibrator for 10 consecutive days. For all subjects, the mean excretion time was 27 days. Subject excretion patterns were clearly biphasic, with initial higher rates of excretion not sustained. During the subsequent period of leveling off, most subjects had one or more separate sequences of cannabinoid-negative urine test results, lasting a mean of 3 days each and followed by at least one positive result. Demographic, body type, and drug history variables proved to be only moderate predictors of excretion patterns. Findings were discussed in the context of potential clinical and forensic application.

Naltrexone treatment of heroin addiction: one-year follow-up.

Pre-treatment characteristics and post-treatment outcome measures were compared for 40 patients who began naltrexone maintenance and 77 who did not after a 6-month period of temporary maintenance on L-alpha-acetylmethadol (methadyl acetate LAAM). Patients who chose to begin naltrexone were younger, had fewer incarcerations and fewer months incarcerated prior to LAAM treatment, had fewer opiate-free months following previous treatments, and were more likely to be of Caucasian ethnicity. One year later, significantly more patients who had received any naltrexone than those who had not were no longer in any treatment program and were opiate-free. We found no significant correlations between total duration of naltrexone-treatment and post-treatment outcome variables such as heroin use, arrests, incarcerations or enrollment in a treatment program.

Plasma testosterone and luteinizing hormone levels during levo-alpha-acetylmethadol maintenance and withdrawal.

Nine male heroin addicts maintained on L-alpha-acetylmethadol (LAAM) for about 5 mo had normal plasma levels of testosterone and luteinizing hormone 72 hr after a dose of LAAM and also during 2 wk after abrupt LAAM withdrawal.

Methadyl acetate (LAAM) in the treatment of heroin addicts. II. Double-blind comparison of gradual and abrupt detoxification.

One hundred nineteen patients were admitted to a six-month (26-week) prenaltrexone detoxification program comparing abrupt and gradual withdrawal from methadyl acetate (LAAM) therapy. All patients were brought to a maintenance level of 50, 50, and 65 mg (Monday, Wednesday, and Friday). Patients randomly assigned to the gradual group (group G) began 4-mg/wk reduction the Monday of week 9 and reached zero dosage (placebo) the Monday of week 23; patients in the abrupt group (group A) continued to receive 50, 50, and 65 mg until the Monday of week 23, when their dosage was dropped to zero (placebo). All patients were given placebo for four weeks. This study showed the superiority of abrupt withdrawal over this gradual-withdrawal schedule. Forty-six percent of group P compared with 28% of group G made the transition to naltrexone treatment. Severity of withdrawal problems was in no case significantly greater in group A.

Episodes of heroin use during maintenance treatment with stable dosage of (-)-alpha-acetylmethadol (methadyl acetate, LAAM).

The phenomenon of episodic heroin use by patients maintained on a surrogate opiate has been noted by clinical investigators since the early 1970s. Several investigators have hypothesized that relapse to heroin use is related to stressful events in the patient's life, and retrospective studies give some support to this hypothesis. In the present study, we asked patients every month to rate their situation with respect to 11 life areas. There were significant negative correlations between the absolute scores in most life areas and the amount of heroin use. However, the relationship between changes in life-area scores and changes in heroin use was less clear. Our data indicate that of patients who have substantial increases in heroin use, many do have negative changes in one or more life areas. However, not all patients who have such negative changes in life-area scores respond by increasing their heroin use.

Prediction of long-term outcome for heroin addicts admitted to a methadone maintenance program.

Ten pre-treatment and nine during-treatment variables were correlated to outcome 5 years after admission to a methadone program for 171 subjects who were in treatment for at least 6 months. The pre-treatment variables were employment, education, criminal involvement, opiate and non-opiate drug abuse, periods of abstinence, age, sex, and ethnic group. During-treatment variables were employment, arrests or incarcerations, opiate and non-opiate drug abuse, living with an addict, marital status, and months of methadone treatment. Three measures of 'successful' outcome were defined. In general, subjects with more involvement with criminal justice before treatment, heavy alcohol use before or during treatment, continued daily heroin use or living with an addict during treatment, or minority ethnicity were more likely to have a poor outcome. However, the correlation coefficients for even the most significant correlations were weak; the highest was r = 0.26. We conclude that none of these 19 variables provide a basis for a priori judgment about whether or not a patient applying for admission to a methadone program is likely to have a favorable long-term outcome.

Symptom complaints of patients maintained on methadone, LAAM (methadyl acetate), and naltrexone at different times in their addiction careers.

In this study, side effect complaints were compared between methadone patients on a stable dose with no heroin use for at least 3 months and matched non-drug-using controls; between methadone patients when using and not using heroin; and between patients in treatment (stable dosage, no heroin use for at least one month) and at follow-up, when not using any opiates and no longer in treatment. This last comparison was done for methadone, LAAM (l-alpha-acetylmethadol, methadyl acetate), and naltrexone patients. Methadone patients had more complaints than did non-drug-using controls; patients in methadone treatment felt worse when using heroin than when not using heroin; methadone, LAAM, and naltrexone patients felt worse while in treatment than when they left treatment and stopped using all opiates; the level of complaints for patients abstinent from opiates at follow-up was not different from that reported by non-drug-using controls. The difficulty of ascribing the symptom complaints to the drugs, in the absence of placebo-treated control groups, is discussed.

Naltrexone treatment of heroin addiction: efficacy and safety in a double-blind dosage comparison.

The goals of this study were two-fold: (1) to test the hypothesis that retention of patients in naltrexone treatment could be improved by educating and preparing them for it while enrolled in a LAAM (l-alpha-acetylmethadol) detoxification program; and (2) to compare the safety and efficacy of 60 mg vs. 120 mg administered thrice weekly in a double-blind, sequential trial design. Patients were allowed a maximum of 365 days on naltrexone, and a maximum of four admissions; 119 patients received at least one dose of naltrexone. We found no clinically important differences between the two dosages, and retention in treatment was similar to that reported in earlier clinical trials. Slightly more than half the patients ever used heroin while receiving naltrexone, and only 9% of all urine tests were positive for opiates. Craving for heroin decreased dramatically by the end of the first week. We found no side-effect or toxicity due to naltrexone.

A follow-up study of heroin addicts five years after first admission to a methadone treatment program.

A random sample (n = 260) of the first 799 admissions to the Santa Clara County Methadone Treatment Program was sought for interview five years after the date of their first dose; 80% were successfully located. Data from the year prior to entering methadone treatment were compared to data from the year prior to the follow-up interview. The two specific areas showing the most dramatic improvement were in heroin use and employment. During the year prior to the follow-up interview, 24% of the subjects with known outcome had no heroin use; 19% were abstinent from both heroin and methadone and at risk (not in jail or other treatment) for the entire year. Unemployment dropped from 51% to 19%. Subjects drank significantly more alcohol during the year prior to interview, with a 48% increase in the number of daily drinkers. Little or no change was seen in the use of other drugs, in the percentage of subjects with an arrest or jail time, or in the number living with an addicted person. Time in treatment was not a predictor of successful outcome and subjects who had left methadone treatment were doing at least as well as those continuously in methadone treatment.

The naloxone test for opiate dependence.

Naloxone tests for opiate dependence were given to 296 applicants for treatment with the surrogate opiate levomethadyl acetate (LAAM, levo-alpha-acetylmethadol) and to 103 applicants for treatment with the opiate antagonist naltrexone. Thirty-five of the 296 LAAM applicants applied first for LAAM, then following detoxification, for naltrexone. There was a dramatic decrease in withdrawal signs and symptoms when the subject went from opiate-dependent to a nondependent state. From our experience, we devised a scoring guide and testing procedure based on objective signs. We propose a 2-step test, with an initial intramuscular dose, then (if necessary) an intravenous dose, to determine an applicant's eligibility for surrogate opiate or narcotic antagonist treatment.

Levo-alpha-acetylmethadol (LAAM) in the treatment of heroin addicts. I. Dosage schedule for induction and stabilization.

One hundred and seventy-nine patients who were dependent on street narcotics were inducted into LAAM. Ninety-two were inducted using a slow schedule: 20, 20, 30, 30, 40, 40, 50, 50, 60, 60, 70, 70, 75 mg on successive clinic visits (Mon., Wed., Fri.). Only 23% of the patients followed this schedule to 50 mg; 55% requested and received a faster induction. Eighty-seven patients were inducted using a rapid schedule: 20, 30, 40, 40, 50 mg. This schedule was acceptable to the majority of patients and caused no complaints of overdosing. We suggest that this schedule be used in clinics where patients who have been shown to be dependent are inducted directly onto LAAM.

Measurement of urine temperature as an alternative to observed urination in a narcotic treatment program.

Upper and lower limits have been determined for the temperature of freshly voided ur;ne. When specified procedures are followed, more than 99% of measurements lie between 32.5 and 36.7 degrees C. This provides a basis for monitoring urine collection in a drug abuse treatment program in a manner that does not invade privacy. The method is not foolproof, but it provides sufficient control if there are no penalties for illicit drug use so that there is no strong incentive to turn in a fraudulent urine sample.

Genetic control of opiate-induced locomotor activity in mice.

Swiss-Webster stock male and female mice were tested for running activity after a 20 mg/kg dose of levorphanol. The best runners and worst runners were then bred. Within each litter, brother-sister pairs with the highest and lowest running activity after a test dose of levorphanol (20 mg/kg) were segregated and bred. This procedure was followed to the F4 generation. Running activity, analgesia and brain catecholamines were studied. The results showed that the "non-running" (NR) trait segregated at the F1 generation, while the "running" (R) trait diverged more slowly. However, by the third generation, the R mice differed significantly from the F0 stock mice. NR mice also did not show locomotor activity when tested with amphetamine. While the NR mice showed reduced running response to levorphanol they were significantly more sensitive than the F0 stock to the analgesic effect. Measurement of brain catecholamines showed no difference between R and NR mice in dopamine or serotonin, but did show a significant increase in norepinephrine in the NR strain.

Acceptability of methadyl acetate (LAAM) as compared with methadone in a treatment program for heroin addicts.

Heroin addicts who had been maintained for at least three months on LAAM (levo-alpha-acetylmethadol, methadyl acetate) and at least three months on methadone were asked to compare the two drugs on a number of criteria. The responses were highly selective, indicating that a desire to please the investigators was not an important factor. Overwhelmingly, the majority of patients reported that LAAM provided better heroin "blockade", that it was more effective in reducing craving, and that actual use of heroin was less on LAAM than on methadone. In other respects, such as sexual performance, sleep, and appetite, most patients perceived no difference between the drugs. In no respect was methadone preferred by a majority, although methadone was viewed more favorably on some criteria by some patients. These findings indicate that for most heroin addicts LAAM will be an acceptable maintenance drug.

Side effects of levomethadone and racemic methadone in a maintenance program.

Sixty-six patients participated in a double-blind, crossover study comparing side effects, drug use, clinic attendance, and dose changes on levomethadone and d,l (racemic) methadone. The hypothesis under examination was that dextromethadone, while adding no narcotic actions to the racemate, was contributing to side effects. An earlier single-blind pilot study showed that 9 out of 11 side effects improved while patients were receiving levomethadone, but this larger study did not duplicate those results. Analysis of 25 variables showed no significant between levo- and racemic methadone. There appears to be no advantage in levomethadone over racemic methadone in the treatment of patients in maintenance programs.

Cellular and metabolic tolerance to an opioid narcotic in mouse brain.

1. Running activity and brain levorphanol concentration were measured in nontolerant and tolerant mice given various doses of (3)H-levorphanol.2. The principal factor responsible for tolerance in the mouse is a loss of sensitivity to the narcotic drug at the cellular level in brain; despite adequate brain concentrations, the pharmacological effects are diminished or absent.3. There is also metabolic tolerance; a given dose establishes a lower brain concentration in tolerant than in non-tolerant animals.4. The two kinds of tolerance are distinguished here and the contribution of each is assessed.

Alcohol dependence and opiate dependence: lack of relationship in mice.

According to a recently proposed hypothesis, physical dependence upon alcohol is due to the formation of an endogenous opiate. We tested the hypothesis by determining whether or not ethanol-dependent mice would show typical opiate-dependent behavior (withdrawal jumping syndrome) when challenged with the opiate antagonist naloxone. Our results do not support the hypothesis.