[Changes in psychosocial symptoms of opiate users over six months with buprenorphine/naloxone substitution therapy]. / Buprenorphin/naloxon szubsztitúció alatt álló ópiátfüggök pszichoszociális tüneteinek változásai hathónapos terápia során.

AIMS: The main target of our research was to measure the changes in psychological symptoms (anxiety, depression, craving) of patients receiving buprenorphine-naloxone substitution treatment for six months, and the evaluation of the changes using the clients' dependency parameters (ASI). METHODS: The level of dependency was investigated using the Addicton Severity Index (ASI). The psychiatric symptoms related to Axis I and II disorders were examined using the Structured Clinical Interview for DSM-IV, SCID I and SCID II. The degree of craving was measured using the Heroin Craving Questionnaire, the assessment of the symptoms of depression using BDI and HAM-D, recorded by the medical attendant of the patient. To survey the extent of anxiety, we used STAI-S, and HAM-A. All patients receiving Suboxone therapy in Hungary between November 2007 and April 2008 were included in the study (n=80). During this time, Suboxone therapy was available in 6 locations. RESULTS: We found significant improvement in almost all observed fields of behavioural and symptomatic dimensions during the first month. The only exception was the dimension of subsistence/livelihood of ASI, the changes were only at the tendency level. During the next five months of therapy, there was no further sign of improvement or decline in the observed fields, the only exception was again the subsistence/livelihood dimension of the ASI. CONCLUSIONS: Our results indicate that buprenorphine/naloxone treatment is a promising possibility for patients in need of opiate-substitution treatment.

[Monitoring and evaluation of the Hungarian methadone maintenance programmes]. / A magyarországi metadon-fenntartó programok monitorozása és értékelése.

INTRODUCTION: Methadone maintenance has an important role in the treatment of injecting heroin users and the reduction of harm connected to drug abuse. In their study, the authors aimed to identify methadone maintenance and substitution programmes and service providers, addiction and psychosocial characteristics of clients, their satisfaction with the programmes and the realization of methadone maintenance "methodological letter" (guideline) issued by the Ministry of Health. METHODS: During the study all the eight outpatient centres providing methadone maintenance were involved as well as their clients and experts. The client sample was 150 clients according to the National Methadone Register: sampling according to the centre and national gender distribution. The expert sample consists of two-two experts from each centre. Sociodemographic characteristics, satisfaction and Treatment Demand Indicator (TDI) of the clients were investigated while experts were asked about the recommendations of the methodological letter. In case of 119 clients, the intake and current TDI-s were compared. RESULTS: clients are satisfied with the treatment; the treatment causes positive perceived changes in their life both in psychosocial and drug use characteristics. Recommendations of the methodological letters were not realized totally. CONCLUSION: According the study, authors propose development of the methodological letter as well as detailed and exact definitions of the letter.

Sex and drugs: the correlations of injecting drug users' risk perception and behavioral patterns.

A low-level blood-borne virus infection exists among Hungary's injecting drug users (IDUs). Assessing the relationship between risk perception and risk behaviors is necessary in order to predict future drug-injecting trends. During 1999 -and 2000, 197 IDUs were interviewed in Budapest using the Risk Assessment Questionnaire developed by the National Institute on Drug Abuse. Certain IDUs perceived high risks but did not act accordingly. High-risk perception of sexual behavior correlates with high-risk perception of drug use, which should be taken into consideration when planning intervention strategies targeting IDUs. Additional research with a larger sample is needed to explain our results in more detail. The study's limitations have been noted.

["Treatment instead of punishment"--how a theory is put into practice, based on evaluation of patients at an outpatient drug treatment center (in Budapest)]. / A "büntetés helyett kezelés" elvének érvényesülése egy drogambulancia betegeinek vizsgálata alapján.

INTRODUCTION: An amendment to the 1993 law allowed illegal substance users to participate in "treatment alternative to prison" ("quasi compulsory treatment") in Hungary. The law was further modified in 2003, allowing a wider range of users to enter the programme. AIM: To examine how the theory of quasi compulsory treatment was put into practice in a drug treatment centre located in Budapest in the period between 2001 and 2005. Are they illegal substance users with real treatment demand who enter the treatment system and are target groups with real treatment demand reached? METHODS: The authors analysed the Addiction Severity Index-based data of a total of 628 illegal substance users who were under treatment in a drug treatment centre in Budapest between 2001 and 2005. The composite scores of users who were and who were not under quasi compulsory treatment were analysed through cluster analysis and Student's T-statistics. RESULTS: The proportion of users entering quasi compulsory treatment significantly increased from 24% to 72.6% after 2003. There was a clearly separable subgroup (50% of the total client population) which had no treatment demand. Following 2003, users under quasi compulsory substance abuse treatment make up 60% of this sub-group without real treatment demand. CONCLUSIONS: The institution of "treatment alternative to prison" needs to be reconsidered.

Low-threshold services for problem drug users in Hungary.

OBJECTIVES: The main objective of this study was to explore how harm reduction (HR) approach and low-threshold approach are realised at low-threshold services (LTSs) in Hungary in comparison with the guidelines presented in different policy papers (European Union drugs strategies) and national regulations. MATERIALS AND METHODS: Hungarian LTSs were investigated: 29 organisations out of 44 (66% return rate) were reached with questionnaires and 40 LTS workers were interviewed. RESULTS: The LTSs have difficulties reaching their target group, distributing sufficient sterile syringes and interpreting the concept of 'low-threshold' and HR, sometimes defining them as a transient stage to abstinence-based treatment. CONCLUSION: The study results suggest that Hungarian LTSs need to be re-orientated toward more emphasis on health-related issues.

[Sex and drug: correlation of risk perception and behavioral patterns among intravenous drug users]. / Szex és drog: intravénás droghasználók kockázatészlelése és viselkedési mintáinak összefüggései.

BACKGROUND: Hungary is a country which has low level of HIV infection and relatively low HCV and HBC prevalence among intravenous drug users (IDUs). Despite this favourable situation, due to the proximity of some Eastern European countries which have high prevalence and incidence of HIV, HCV and HBV infections, there is a potential danger of a rapid outbreak of AIDS and hepatitis epidemic. These infectious diseases can be transmitted through needle and equipment sharing as well as by sexual contact among IDUs, with the latter one receiving less emphasis in the research related to the use of injected drugs. Assessing the relationship between the perception of the risks involved in i.v. drug use and sexual acts and the subsequent behaviour is indispensable for predicting present and future trends among i.v. drug users. AIMS: To assess the correlation between 1. IDUs' risk perception and behaviour with respect to drug use and sex, 2. IDUs' risk perception concerning drug use and sex, 3. IDUs' behaviour concerning drug use and sex as well as 4. to categorize IDUs according to their risk perception and behaviour. METHOD: A total of 197 IDUs were interviewed in Budapest, using a questionnaire developed by National Institute on Drug Abuse (NIDA), which is applied partly to assess the risks involved in drug use and in various forms of sexual behaviour. Correlation between risk perception and behaviour was assessed by bivariate (cross-tables) and multivariate quantitative analyses (factor, cluster analyses). RESULT: IDUs underestimate the dangers of having sex while under the effect of a drug (heroin) but perceive intravenous use as the most dangerous way of drug abuse. As regards the relationship between risk perception and subsequent behaviour, although IDUs seem to perceive the risks associated with sex and intravenous drug use, they do not act accordingly both in their sexual behaviour and drug use. It has also been shown that risk-takers in drug use will behave in a risky way in their sexual activity. CONCLUSIONS: When intervention strategies targeted at IDUs are worked out, users' perception of sexual risk and behaviour should be taken into consideration as well. Interventions should also be developed considering the heterogeneity of the population of intravenous drug users.