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1.
J Subst Abuse Treat ; 53: 71-7, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25736625

ABSTRACT

Blood-borne viral infections (BBVIs) are important health consequences of illicit drug use. This study assessed predictors of inpatient hospital admissions for BBVIs in a cohort of 4817 clients seeking treatment for drug use in Finland. We examined clients' data on hospital admissions registered in the Finnish National Hospital Discharge Register from 1997 to 2010 with diagnoses of BBVIs. Cox proportional hazards regression analyses were separately conducted for each of the three BBVI groups to test for association between baseline variables and hospitalizations. Findings were reported as adjusted hazard ratios (aHRs). Based upon primary discharge diagnoses, 81 clients were hospitalized for HIV, 116 for hepatitis C, and 45 for other types of hepatitis. Compared to those admitted for hepatitis C and other hepatitis, drug users with HIV had higher total number of hospital admissions (294 versus 141 and 50 respectively), higher crude hospitalization rate (7.1 versus 3.4.and 1.2 per 1000 person-years respectively), and higher total length of hospital stay (2857 days versus 279 and 308 respectively). Trends in hospitalization for all BBVI groups declined at the end of follow-up. HIV positive status at baseline (aHR: 6.58) and longer duration of drug use (aHR: 1.11) were independently associated with increased risk for HIV hospitalization. Female gender (aHR: 3.05) and intravenous use of primary drug (aHR: 2.78) were significantly associated with HCV hospitalization. Having hepatitis B negative status at baseline (aHR: 0.25) reduced the risk of other hepatitis hospitalizations. Illicit drug use coexists with blood-borne viral infections. To address this problem, clinicians treating infectious diseases need to also identify drug use in their patients and provide drug treatment information and/or referral.


Subject(s)
HIV Infections/epidemiology , Hepatitis C/epidemiology , Patient Acceptance of Health Care , Patient Admission , Substance-Related Disorders , Adult , Cohort Studies , Female , Finland/epidemiology , HIV Infections/mortality , Hepatitis C/mortality , Humans , Length of Stay , Male , Proportional Hazards Models , Retrospective Studies , Surveys and Questionnaires , Survival Analysis , Young Adult
2.
Int J Drug Policy ; 25(6): 1047-53, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25151335

ABSTRACT

BACKGROUND: Although mortality is a known complication of illicit drug use, robust epidemiological studies on drug-related mortality in Finland are scarce. We examined all deaths, specific causes of death, and trends in mortality among a large number of illicit drug users in Finland during a 14-year period. METHODS: Details of 4817 clients who sought treatment for drug use at Helsinki Deaconess Institute between 1997 and 2008 were linked to national cause of death register to identify all deaths and causes of death. Standardised mortality ratios (SMRs) were calculated to compare all-cause deaths in our study cohort with those in the general population. Trends in mortality rates were assessed using Poisson (log-linear) regression. RESULTS: A total of 496 deaths occurred during 41,567.5 person-years with crude mortality rate of 1193.2 per 100,000 person-years. Mean follow-up was 8.6 years and the mean age at death was 33.8 years. Most deaths (84.1%) occurred among male clients, 189 deaths occurred in the 25-34 age-group and all-cause SMR was 8.9 [95% confidence interval (CI)=8.1-9.7]. Two-thirds (64.9%) were deaths from external causes and 35.1% from disease-related causes. The four leading causes of death were accidental poisoning/overdose (n=165), suicide (n=108), mental and behavioural disorders (n=49) and circulatory system diseases (n=45). Younger clients died from acute effects of drug use while older clients died more from chronic health conditions. A decline in annual rates was noted for all-cause mortality (P=0.01), deaths from mental and behavioural disorders (P<0.001) and suicides (P<0.001). CONCLUSION: The four leading causes of death among illicit drug users are preventable. Overdose management training, drug education and other preventive measures could help reduce mortality.


Subject(s)
Cause of Death/trends , Drug Users/statistics & numerical data , Registries , Substance-Related Disorders/mortality , Adolescent , Adult , Age Factors , Aged , Child , Female , Finland/epidemiology , Humans , Male , Middle Aged , Sex Factors , Young Adult
3.
Addiction ; 108(7): 1279-86, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23297867

ABSTRACT

AIMS: To assess the efficacy of methylphenidate as a substitution therapy for amphetamine/methamphetamine dependence in Finland and New Zealand. DESIGN: Parallel-group, double-blind, randomized placebo-controlled trial. SETTING: Out-patient care. PARTICIPANTS: Amphetamine-/methamphetamine-dependent, aged 16-65 years. MEASUREMENTS: The primary outcome measure was presence/absence of amphetamine/methamphetamine in urine samples collected twice weekly. Secondary measures included treatment adherence, alterations in craving scores and self-reported use. Primary analysis was by intention-to-treat (ITT). The study drug, methylphenidate (as Concerta(®) ), was up-titrated over 2 weeks to a maximum dose of 54 mg daily and continued for a further 20 weeks. Doses were given under daily supervision at the clinics. FINDINGS: Seventy-nine participants were randomized (40 methylphenidate; 39 placebo); 76 received allocated treatment and 27 completed the trial. ITT analysis (n = 78) showed no statistically significant difference in the percentage of positive urines between the methylphenidate and placebo arms (odds ratio: 0.95, 95% confidence interval: 0.83-1.08). However, there was a significant difference (P < 0.05) between the active and placebo arms in retention, the placebo arm displaying a significantly lower retention from 6 weeks that persisted until the end of the trial. CONCLUSIONS: The trial failed to replicate earlier findings suggesting that methylphenidate was superior to placebo. The low retention rate confounded the ability to draw firm conclusions about efficacy. The higher retention rate was observed in the methylphenidate arm. Any replication of this work would need to consider alternatives to the rigid clinic attendance criteria, and consider an increased dose.


Subject(s)
Amphetamine-Related Disorders/drug therapy , Dopamine Uptake Inhibitors/administration & dosage , Methylphenidate/administration & dosage , Adolescent , Adult , Amphetamines/adverse effects , Central Nervous System Stimulants/adverse effects , Double-Blind Method , Female , Finland , Humans , Male , Methamphetamine/adverse effects , Middle Aged , New Zealand , Treatment Outcome , Young Adult
4.
Am J Psychiatry ; 169(5): 531-6, 2012 May.
Article in English | MEDLINE | ID: mdl-22764364

ABSTRACT

OBJECTIVE: The majority of drug addicts are polydrug dependent, and no effective pharmacological treatment is currently available for them. The authors studied the overall real-world effectiveness of naltrexone implant in this patient population. METHOD: The authors assessed the effectiveness of a naltrexone implant in the treatment of coexisting heroin and amphetamine polydrug dependence in 100 heroin- and amphetamine-dependent outpatients in a 10-week randomized, double-blind, placebo-controlled trial. The main outcome measures were retention in the study, proportion of drug-free urine samples, and improvement score on the Clinical Global Impressions Scale (CGI). Analyses were conducted in an intent-to-treat model. RESULTS: At week 10, the retention rate was 52% for patients who received a naltrexone implant and 28% for those who received a placebo implant; the proportions of drug-free urine samples were 38% and 16%, respectively, for the two groups. On the CGI improvement item, 56% of the patients in the naltrexone group showed much or very much improvement, compared with 14% of those in the placebo group (number needed to treat=3). CONCLUSIONS: Naltrexone implants resulted in higher retention in the study, decreased heroin and amphetamine use, and improved clinical condition for patients, thus providing the first evidence of an effective pharmacological treatment for this type of polydrug dependence.


Subject(s)
Naltrexone/therapeutic use , Narcotic Antagonists/therapeutic use , Substance-Related Disorders/drug therapy , Adult , Amphetamine-Related Disorders/complications , Amphetamine-Related Disorders/drug therapy , Double-Blind Method , Drug Implants , Female , Heroin Dependence/complications , Heroin Dependence/drug therapy , Humans , Male , Naltrexone/administration & dosage , Narcotic Antagonists/administration & dosage , Treatment Outcome , Unsafe Sex/drug effects
5.
Am J Psychiatry ; 164(1): 160-2, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17202560

ABSTRACT

OBJECTIVE: Problems related to illegal amphetamine use have become a major public health issue in many developed countries. To date, evidence on the effectiveness of psychosocial treatments has remained modest, and no pharmacotherapy has proven effective for amphetamine dependence. METHOD: Individuals meeting DSM-IV criteria for intravenous amphetamine dependence (N=53) were randomly assigned to receive aripiprazole (15 mg/day), slow-release methylphenidate (54 mg/day), or placebo for 20 weeks. The study was terminated prematurely due to unexpected results of interim analysis. An intention-to-treat analysis was used. The primary outcome measure was the proportion of amphetamine-positive urine samples. RESULTS: Patients allocated to aripiprazole had significantly more amphetamine-positive urine samples than patients in the placebo group (odds ratio=3.77, 95% CI=1.55-9.18), whereas patients who received methylphenidate had significantly fewer amphetamine-positive urine samples than patients who had received placebo (odds ratio=0.46, 95% CI=0.26-0.81). CONCLUSIONS: Methylphenidate is an effective treatment for reducing intravenous drug use in patients with severe amphetamine dependence.


Subject(s)
Amphetamine-Related Disorders/drug therapy , Methylphenidate/therapeutic use , Piperazines/therapeutic use , Quinolones/therapeutic use , Substance Abuse, Intravenous/drug therapy , Adult , Amphetamine/urine , Amphetamine-Related Disorders/urine , Aripiprazole , Female , Humans , Male , Placebos , Severity of Illness Index , Substance Abuse Detection , Substance Abuse, Intravenous/urine , Treatment Outcome
6.
Eur J Public Health ; 17(4): 381-6, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17130140

ABSTRACT

BACKGROUND: Incidence of newly diagnosed HIV infections among injecting drug users (IDUs) in Helsinki rose from 0 per 100,000 inhabitants in 1997 to 2.9 in 1998 and to 11.1 in 1999. Thereafter incidence declined to 2.1 in 2003. METHODS: Data were collected from interviews with HIV-positive IDUs who attended the University Hospital in Helsinki from 1998 until 2003. We studied the sociodemographic profile and spatial distribution of IDUs who were diagnosed in the beginning of the outbreak and those diagnosed later. The indicator for the spatial differentiation within the metropolitan area is % employed males aged 25-64. RESULTS: The outbreak occurred among a marginalized population of IDUs characterized by a long history of injecting drug use (10.7 years), mean age 32 years, homelessness (66.3%), history of imprisonment (74.7%) and psychiatric hospital care (40.6%). Compared with 98 early cases diagnosed during the first 2 years until 2000, 47 recent cases diagnosed after 2001 were 4 years older, and as marginalized. Except for the city centre, both early and recent cases had been living or using drugs in the same deprived neighbourhoods with the highest unemployment rates. Up to 40% of cases in the two big geographical clusters did not have contact with the city centre, where the needle exchange services were available. CONCLUSIONS: The Finnish HIV outbreak is restricted socially to a very marginalized IDU population, and spatially to local pockets of poverty. In low prevalence countries, prevention programs should be targeted early at high-risk areas and populations.


Subject(s)
HIV Infections/epidemiology , Social Environment , Substance Abuse, Intravenous , Adult , Demography , Disease Outbreaks , Female , Finland/epidemiology , HIV Infections/prevention & control , Hospitals, University , Humans , Interviews as Topic , Male , Middle Aged , Poverty , Urban Population
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