Self-reported prevalence of dependence of MDMA compared to cocaine, mephedrone and ketamine among a sample of recreational poly-drug users.

BACKGROUND: Evidence regarding MDMA (ecstasy) dependence and the most suitable criteria for its assessment are controversial. This study aimed to assess the prevalence of last year symptoms of dependence upon MDMA compared to cocaine, mephedrone and ketamine among a large global non-treatment seeking sample. METHODS: A cross-sectional anonymous online survey was promoted by a UK-based dance music website between 15 November 2010 and 1 January 2011. Endorsement of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) dependence criteria was sought from all last year users of MDMA, cocaine, mephedrone and ketamine. Reporting ≥3 dependence symptoms was indicative of dependence. Logistic regression models with Generalized Estimating Equations were used to compare dependence symptoms between groups. RESULTS: MDMA users were more likely to report ≥3 DSM-IV dependence symptoms compared to users of cocaine (odds ratio OR 0.81, 95% confidence interval CI 0.71-0.93), mephedrone (OR 0.91, 95%CI 0.78-1.06) and ketamine (OR 0.52, 95%CI 0.44-0.62) (p<0.001). MDMA users were less likely to report desire to use less or get help compared to users of other substances (p<0.001). MDMA got the highest rating of pleasurable high (mean 8.2±1.7) and lowest rating for risk of harm (mean 2.7±2.4). CONCLUSIONS: Our results highlight the self-reported dependence potential of MDMA but low desire to use less or get help. MDMA's pleasurable effects may compensate for drug-related problems and, therefore, DSM-IV criteria may not be suitable for assessing MDMA dependence. Further research is needed on the ability of DSM-V to assess MDMA dependence.

Alcohol use among adolescents, aggressive behaviour, and internalizing problems.

Alcohol use is common among adolescents, but its association with behavioural and emotional problems is not well understood. This study aimed to investigate how self-reported psychosocial problems were associated with the use of alcohol in a community sample consisting of 4074 Finnish adolescents aged 13-18 years. Aggressive behaviour associated with alcohol use and a high level of alcohol consumption, while internalizing problems did not associate with alcohol use. Having problems in social relationships associated with abstinence and lower alcohol consumption. Tobacco smoking, early menarche and attention problems also associated with alcohol use.

Factors associated with buprenorphine compared to amphetamine abuse among clients seeking treatment in Finland.

Abuse of prescription opioids is becoming increasingly widespread. This study compared the social, health and treatment-related factors associated with buprenorphine and amphetamine abuse in Finland. Structured clinical interviews were conducted with clients seeking treatment for buprenorphine (n=670) or amphetamine (n=557) abuse in Helsinki from January 2001 to August 2008. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were computed for factors associated with buprenorphine compared to amphetamine abuse. In multivariate analyses, buprenorphine abuse was associated with male gender (OR 1.57, 95% CI 1.17-2.09), daily abuse (OR 5.45, 95% CI 4.14-7.18), no drug free months during the last year (OR 1.68, 95%CI 1.23-2.29), and inversely associated with increasing age (OR 0.95, 95% CI 0.93-0.97 per year) and psychotic symptoms (OR 0.33, 95% CI 0.24-0.45). Despite more intense abuse patterns, clients seeking treatment for buprenorphine abuse shared similar characteristics to amphetamine clients. These characteristics were different to characteristics of those who abuse prescription opioids in North America. This is important for developing and targeting intervention programs.

First insights into community pharmacy based buprenorphine-naloxone dispensing in Finland.

BACKGROUND: Finnish community pharmacies have been permitted to dispense buprenorphine-naloxone since February 2008. This study explored the dispensing practices, service experiences, problems encountered and opportunities for future development. METHODS: In August 2011, a questionnaire was mailed to all Finnish community pharmacies dispensing buprenorphine-naloxone (n=69). RESULTS: Sixty-four pharmacies responded (93%), of which 54 had dispensed buprenorphine-naloxone to 155 clients since 2008. Forty-eight pharmacies had 108 current clients (10% of all buprenorphine-naloxone clients in Finland). Overall satisfaction with buprenorphine-naloxone dispensing was high, with all respondents indicating dispensing had gone 'well' or 'very well'. Fourteen pharmacies (26%) had experienced one or more problems, predominately in relation timing or non-collection of doses. Problems were more common in pharmacies with more than one buprenorphine-naloxone client (odds ratio 1.39, 95% confidence interval 1.05-1.86). Most pharmacies (n=43, 80%) identified opportunities for improvement, including the need for more education and financial remuneration. Forty-six pharmacies (85%) were willing to dispense buprenorphine-naloxone to more clients; however, 43 pharmacies (80%) perceived that supervision of buprenorphine-naloxone dosing is not a suitable task for pharmacists in Finland. CONCLUSION: Provision of buprenorphine-naloxone in Finnish community pharmacies has remained relatively small-scale. As experiences have been generally positive and problems rare, it may be possible to expand these services.

The effect of an electronic medicine dispenser on diversion of buprenorphine-naloxone-experience from a medium-sized Finnish city.

Providing unobserved opioid substitution treatment (OST) safely is a major challenge. This study examined whether electronic medicine dispensers (EMDs) can reduce diversion of take-home buprenorphine-naloxone (BNX) in a medium-sized Finnish city. All BNX treated OST patients in Kuopio received their take-home BNX in EMDs for 4months. EMDs' effect on diversion was investigated using questionnaires completed by patients (n=37) and treatment staff (n=19), by survey at the local needle exchange service and by systematic review of drug screen data from the Kuopio University Hospital. The majority of patients (n=21, 68%) and treatment staff (n=11, 58%) preferred to use EMDs for the safe storage of tablets. Five patients (16%) declared that EMDs had prevented them from diverting BNX. However, EMDs had no detectable effect on the availability or origin of illegal BNX or on the hospital-treated buprenorphine-related health problems. EMDs may improve the safety of storage of take-home BNX, but their ability to prevent diversion needs further research.

[Designer drugs in Finland]. / Muunto- eli designhuumeet Suomessa.

Designer drugs are synthetic psychotropic drugs which are marketed as "legal drugs". Their emergence, rapid spreading and unpredictable effects have challenged the health and substance abuse care. The slow process of classification of an abusable drug has provided too many possibilities for spreading the designer drugs. Once a certain substance receives an illegal drugs classification, dealers and users usually move to another, slightly different molecule that is still legal. In Finland, the Narcotics Act has been amended to the effect that the addition of a new substance to the illegal drug list does not require an amendment to the law.

[Assessment and treatment of cannabis use disorders in primary health care]. / Kannabiksen käyttäjä perusterveydenhuollossa.

In Finland every fourth young adult (25 to 34 years of age) has experience with the use of cannabis and in younger people (15 to 24 years) about 10% have used it during the previous year. The majority (about 90%) neither becomes addicted nor develops significant psychiatric symptoms, but in some individuals regular cannabis-use can cause a variety of problems (health, emotional, behavioural, social, legal). If problems have not yet developed or are still minor, patient's cannabis-use may be addressed by brief intervention in a primary care setting. Also, treatment of uncomplicated cannabis withdrawal as well as of minor symptoms from smoking (bronchitis, sleep disturbances), can be treated in community health centres. Children and adolescents, pregnant individuals or those with psychiatric symptoms should be treated by services with expertise in addiction medicine.

A pilot study about the feasibility and cost-effectiveness of electronic compliance monitoring in substitution treatment with buprenorphine-naloxone combination.

OBJECTIVES: The purpose of the study was to investigate whether or not compliance monitoring by microchip could offer a feasible method for reducing abuse and/or diversion of medication from unsupervised substitution treatment for opioid addiction. DESIGN: Naturalistic, 4-week pilot study in out patients. PATIENTS AND INTERVENTIONS: All our patients (N = 12) on buprenorphine-naloxone combination (Suboxone) received their medication for 6 days in a compliance-monitoring device (PharmaDDSi, StoraEnso), which registers date and time of tablet removal. Patients were instructed to take all tablets as one dose. Time cues were displayed and discussed with the patients during their weekly visits for supervised drug administration and counseling. MAIN OUTCOME MEASURES: Regularity of registered time cues, treatment costs in comparison with routine treatment, patients' answers from a questionnaire on acceptability, and effect on drug diversion. RESULTS: Six patients showed good compliance, in two patients irregularities were minor, but in two others lack of adherence to treatment instructions was detected. Patients with several comorbid psychiatric diagnoses showed on an average the longest intervals between removal of first and last tablet of the daily dose. One-fourth of the patients reported that compliance monitoring had helped to avoid diversion. Total cost savings during the 4-week period was a reduction of 39 percent, which was mainly due to fewer visits to the clinic. CONCLUSIONS: Compliance monitoring by PharmaDDSI with weekly feedback was well accepted and subjectively increased compliance with substitution treatment. Future studies will show whether a technical solution for compliance monitoring in real time can help to reduce drug abuse and noncompliance in substitution treatment and other opioid treatments.

Gender-related changes in suicide rates and methods in Eastern Finland from 1988 to 1997.

The first aim of the study was to investigate the changes in regional suicide rates for the province of Kuopio, Eastern Finland, from 1988 to 1997 and compare rates with those for the whole Finland. The second aim was to investigate gender-related changes in suicide rates and methods during the study period. Altogether, 777 suicides were examined. Between 1988 and 1997, regional male suicide mortality decreased, approaching the mean national level, which was rising during the same interval. From 1992 to 1997, there was a rise in regional suicide mortality, which coincided with a decrease at the national level. Female suicide rates in Eastern Finland also initially decreased, but thereafter remained variable and slightly higher than the national level. Gender-related differences in suicide mortality diminished. The initial difference between genders in mean age (49.5 years in women, 41.8 years in men) disappeared towards the end of the study period (47.0 years in women, 45.2 years in men). The decline in mean ages of women was mostly due to change in urban suicides, whereas the increase in the mean age of men was caused by change in rural suicides. Among men, the relative proportion of self-poisoning suicides rose significantly. The divergent development of suicide rates from the province of Kuopio and the entire nation may reflect differences in the development of social structures in rural Eastern Finland compared to more densely populated parts of the country. Gender differences and local variation in suicide mortality should be taken into account when assessing and developing further suicide prevention strategies.

The effect of tobacco smoking on subjective symptoms of inadequacy ("not holding") of methadone dose among opiate addicts in methadone maintenance treatment.

The objective of this study was to examine the relationship between subjective symptoms of inadequacy of methadone dose (not feeling "held") and tobacco smoking in patients in methadone maintenance treatment (MMT). This was a cross-sectional study of smoking behaviour, investigating subjective, physiological and psychological symptoms. The study took place in a community-based methadone maintenance clinic of a psychiatric teaching hospital in South London. Fifty adult opiate addicts (37 males and 13 females) were on a stable daily methadone dose; the number of cigarettes smoked during the day and previous day of investigation, salivary cotinine measurements and carbon monoxide (CO) from expired air were measured. The Methadone Symptom Checklist (MSC) was used to score withdrawal symptoms encountered in patients not feeling "held" during MMT The Hamilton Anxiety Score was also used. The prevalence of tobacco-smoking was high (98%), with two-thirds (68%) smoking self-fabricated cigarettes ("roll-ups"). Scores from rating scales measuring symptoms of not being "held" correlated with number of cigarettes smoked the previous day (p < 0.05). A similar correlation was found with the Hamilton Anxiety Score. However, there was no correlation between rating scale scores and either salivary cotinine concentration or CO from expired air. Methadone patients who smoke more are significantly more likely to report problems of not feeling "held" by their methadone dose and they also show a higher level of anxiety. However, this increased cigarette consumption is not reflected in increased salivary continine levels or levels of CO in expired air, and it may be that the raised level of anxiety leads to a smoking-pattern consisting of frequent lighting-up of cigarettes or "roll-ups" which are consumed incompletely and/or not smoked by inhalation.