From illegal poison to legal medicine: a qualitative research in a heroin-prescription trial in Spain.

INTRODUCTION AND AIMS: In recent decades, studies have been made of the possible benefits of treatments using heroin, although qualitative methodologies have not usually been employed. In 2004, in Granada (Spain), a clinical experiment was launched: the Experimental Narcotics Prescription Programme in Andalusia (PEPSA). This project attempted to evaluate the effectiveness of intravenous heroin and orally-administered methadone prescription for long-term socially-excluded opiate addicts for whom other treatments have failed. The research described herein is qualitative and has been carried out within the framework of the aforementioned experiment. The objective was to discover the attitudes, opinions and experiences of patients (and relatives) once they had been included in the program and are receiving heroin in a therapeutic environment. DESIGN AND METHODS: Focused ethnographic procedures were used to establish the study population. During the field work, we carried out in-depth interviews and observations using 21 patients and relatives. Analysis was carried out by a team according to grounded theory. RESULTS: Our results show how the treatment process and the administering of heroin in a therapeutic context manages to break the habit of consuming heroin obtained illegally, thus changing the significance given to the substance and bringing about improvements in aspects such as the workplace, family relations and physical and mental health. DISCUSSION AND CONCLUSIONS: The move from 'substance addiction' to chronic 'illness' upon beginning the treatment provides a chance for a population with a long history of rejection and exclusion to become part of society once again.

[Evaluation of the SF-36 health index applied to methadone maintenance program users. Reference values for the Basque Autonomous Community, Spain]. / Valoración del índice de salud SF-36 aplicado a usuarios de programas de metadona. Valores de referencia para la Comunidad Autónoma Vasca.

BACKGROUND: The questionnaires that measure perceived health are used in clinical practice to determine the impact of illnesses and the benefits of treatments. Population-based norms have been proposed to increase their interpretability. The aim of this paper was to obtain reference values for users of Methadone Maintenance Programs (MMP) in the Basque Autonomous Community (BAC). METHODS: Cross-sectional study carried out in 2000 on a stratified random sample of users included in MMP of BAC (n=726). SF-36 Health Survey was used; central trend, dispersion and percentile data were estimated for each of the SF-36 dimension scores to generate reference values according the dwell time in the methadone program. RESULTS: All Cronbach's alpha coefficients were higher than 0.7, and the percentage or non-responds were lower 1%. The MMP users had lower punctuations in all dimensions of SF-36 than population values of reference (p<0.001). The health status of the participants was worse among those than they began the treatment that among those that took more than six months in the MMP; the differences in all SF-36 dimensions scores were statistically significant (p<0.001). CONCLUSIONS: The SF-36 as a measure of health status in MMP population shows a high internal consistence, and is able to discriminate patients with different stages of treatment evolution. Results presented should be considered the population-based norms for monitoring the improvement progression or response to treatment in patients included in MMP.

Valoración del índice de salud SF-36 aplicado a usuarios de programas de metadona. Valores de referencia para la Comunidad Autónoma Vasca / Evaluation of the SF-36 health index applied to methadone maintenance program users. Reference values for the Basque Autonomous Community, Spain

Fundamento: Los cuestionarios que miden la salud percibida sirven en la práctica clínica para determinar el impacto de la enfermedad y los beneficios del tratamiento. Para aumentar su interpretabilidad se ha propuesto obtener normas de referencia. El objetivo principal del estudio ha sido obtener valores de referencia del cuestionario de salud SF-36 aplicado a usuarios de Programas de Mantenimiento con Metadona (PMM) en la Comunidad Autónoma Vasca (CAV). Métodos: Diseño transversal realizado en el año 2000 sobre una muestra estratificada aleatoria de usuarios PMM de la CAV (n= 726). Se utilizó el cuestionario de salud SF-36, y se calcularon datos de tendencia central, dispersión y percentiles para generar los valores de referencia en función del tiempo de permanencia en el programa de metadona. Resultados: Los valores alfa de Cronbach se situaron por encima de 0,7, siendo el porcentaje de no respuestas inferior al 1%. En todas las dimensiones del SF-36 las puntuaciones fueron inferiores para los usuarios de PMM respecto a los valores poblacionales de referencia (p<0,001). El estado de salud de los participantes era peor entre los que iniciaban el tratamiento que entre los que llevaban más de seis meses en el PMM (diferencias significativas en todas las dimensiones, p<0,001). Conclusiones: El SF-36 como medida del estado de salud muestra una alta fiabilidad y es capaz de discriminar pacientes en estadios diferentes de tratamiento. Los valores obtenidos podrían tomarse como valores de referencia para ayudar a monitorizar la progresión de mejora o la respuesta al tratamiento en personas incluidas en programas de metadona (AU)

Background: The questionnaires that measure perceived health are used in clinical practice to determine the impact of illnesses and the benefits of treatments. Population-based norms have been proposed to increase their interpretability. The aim of this paper was to obtain reference values for users of Methadone Maintenance Programs (MMP) in the Basque Autonomous Community (BAC). Methods: Cross-sectional study carried out in 2000 on a stratified random sample of users included in MMP of BAC (n= 726). SF- 36 Health Survey was used; central trend, dispersion and percentile data were estimated for each of the SF-36 dimension scores to generate reference values according the dwell time in the methadone program. Results: All Cronbach's alpha coefficients were higher than 0.7, and the percentage or non-responds were lower 1%. The MMP users had lower punctuations in all dimensions of SF-36 that population values of reference (p < 0.001). The health status of the participants was worse among those than they began the treatment that among those that took more than six months in the MMP; the differences in all SF-36 dimensions scores were statistically significant (p < 0.001). Conclusions: The SF-36 as a measure of health status in MMP population shows a high internal consistence, and is able to discriminate patients with different stages of treatment evolution. Results presented should be considered the population-based norms for monitoring the improvement progression or response to treatment in patients included in MMP (AU)

Mujeres y psicofármacos: la investigación en atención primaria / Women and psychotropics: the researching in the field of primary care

En este artículo se revisan algunos resultados obtenidos en investigaciones nacionales e internacionales realizadas sobre el uso de psicofármacos, especialmente de aquellos estudios sobre la prescripción y uso por las mujeres. Los resultados muestran que una parte importante de la producción científica se centra en el estudio de la detección de los trastornos en Atención Primaria o Especializada y en la morbilidad psiquiátrica de manera comparada entre los sexos. La mayor parte de las investigaciones realizadas en este ámbito tiene un carácter clínico y epidemiológico. Constituyen una excepción investigaciones realizadas en Estados Unidos o en el norte de Europa que buscan explicar los motivos y razones para un consumo y prescripción diferencial de psicofármacos, siendo las mujeres las principales afectadas. Se han analizado investigaciones que aportan información para poder responder a la pregunta: ¿Por qué las mujeres reciben los dos tercios de las prescripciones con psicofármacos? Vemos que las mujeres tienen mayor probabilidad que los varones de que les prescriban psicofármacos (AU)

This paper presents some of the results arising from an analysis of the researching performed -at both domestic and international levels- on the usage of psychotropic drugs, specially on their prescription and use by women. These results come to show that a significant part of the scientific production in this area focuses on studies about the detection of disorders in Primary or Specialized Care and about psychiatric morbidity, applying a comparative methodology between sexes. Much of the researching performed in this field has a clinical and epidemiologic nature. An exception to this trend come from some surveys performed in the USA and the North of Europe intended to clarify the causes and reasons that may explain the persisting differences in both prescription and use of such drugs, a situation that adversely impacts women. The surveys analyzed on this paper offer some information that may help us to find an answer to the question: Why are two thirds of the prescriptions involving psychotropics aimed to women? It is clear that women are more prone than men to be prescribed with such drugs (AU)

Violencia doméstica, consumo de sustanciasy otras circunstancias concurrentes. ¿El derecho versus derecho a la salud? / Domestic violence, substances use and other concurrenting circunstances

Tras reflexionar sobre la violencia de género padecida sobre todo en el ámbito doméstico, se aportan algunos datos procedentes de un estudio realizado sobre las sentencias dictadas durante un año en el País Vasco y referidas a tipología delictiva relacionada con la violencia intrafamiliar. Los resultados reflejan que el consumo de alcohol, de otros tipos de drogas, la existencia de trastornos mentales o la precariedad económica no aparecen como factores criminógenos tan determinantes como en otros trabajos anteriormente realizados sobre el tema. Las medidas y actuaciones en muy diversos campos de intervención son una urgente necesidad (AU)