Sustained-release bupropion for smoking cessation in a Chinese sample: a double-blind, placebo-controlled, randomized trial.

INTRODUCTION: Bupropion is a first-line pharmacological aid for smoking cessation; however, no clinical trials have been conducted in a Chinese population. METHODS: We enrolled 248 smokers in a hospital-based, randomized, smoking cessation trial conducted at four outpatient centers in Beijing. A total of 123 participants received an 8-week course of sustained-release bupropion (Bup-SR) and 125 participants received 8 weeks of placebo. All participants received brief education and counseling on smoking cessation. We determined rates of abstinence and smoking reduction based on chemical verification and self-report at 8 and 12 weeks. RESULTS: At the end of the medication treatment (8 weeks) and at the end of the trial (12 weeks), the abstinence rates for Bup-SR were 29.3% and 39.8%, respectively, and 10.4% and 8.0% for placebo, respectively (both p < .001). Bup-SR was also superior to placebo in reducing cigarettes per day and urinary cotinine levels. CONCLUSION: Bup-SR is efficacious for smoking cessation in healthy Chinese patients treated in the outpatient setting. It is well tolerated with a few mild side effects.

Nocturnal sleep architecture disturbances in early methadone treatment patients.

The subjective and objective sleep patterns of patients with opioid dependence have been previously reported, but the sleep characteristics of patients in early methadone treatment, especially the objective sleep patterns, remain largely unexamined. This study was designed to explore the nocturnal sleep structure of patients on early methadone treatment. Twenty male methadone treatment (MT) patients and 20 male age- and body mass index-matched controls were assessed with overnight limited polysomnography. Subjective sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Compared with healthy controls, MT patients had lower sleep efficiency, shorter total sleep time, more awakenings and shorter slow wave sleep (SWS). The PSQI and ESS scores in MT patients were significantly higher than in the controls. ESS scores of the patients were significantly associated with the SWS. The findings indicate that patients in early MT have poor sleep quality and abnormal sleep architecture.

Family support and employment as predictors of smoking cessation success: a randomized, double-blind, placebo-controlled trial of nicotine sublingual tablets in chinese smokers.

BACKGROUND: The purpose of this study is to assess social support and demographic factors that influence the success of smoking cessation aided with sublingual nicotine tablets in a Han Chinese population. METHODS: We randomly allocated 211 Beijing residents who smoked >or= 10 cigarettes a day for at least 1 year into a double-blind, placebo-controlled 3-month randomized smoking cessation trial using sublingual nicotine replacement therapy (NRT). Self-reports of sustained smoking cessation were verified during the study by expired carbon monoxide concentrations and urine-cotinine concentrations. Logistic regression analysis used an intent to treat sample for sociodemographic associations with abstinence and reduction in smoking. RESULTS: The abstinence rates at the end of treatment for NRT vs. placebo were 52 % vs .19%, and smoking reduction (reduced to at least 50% of baseline) rates for NRT vs. placebo were 43% vs .15% for a total response rate with NRT of 95% for either stopping completely or reducing smoking by 50%. The only factor strongly associated with successful smoking cessation after 3 months of sublingual NRT was being married (adjusted odds ratio 2.18; 95%confidence interval 1.10-4.33). Smoking association, on the other hand, was associated with being married and with employment as a white collar worker (2.24; 1.03 to 4.86). CONCLUSIONS: These findings suggest the need for a more in-depth examination of the impact of being married and employment as a white collar worker (rather than manual laborer) in order to develop better targeted interventions for improving smoking cessation interventions.

Alterations in pituitary-thyroid axis function among opioid-dependent subjects after acute and protracted abstinence.

The aim of the present study was to investigate the changes in the pituitary-thyroid axis (PTA) and the time course of the hormonal alterations in subjects with opioid dependence after abstinence. Blood samples from in-patients with opioid dependence and age- and sex-matched healthy controls were collected. The severity of opioid abuse and of withdrawal symptoms was assessed. Results were compared between patients with opioid dependence (n = 30) and healthy controls (n = 30). We found that free triiodothyronine and free thyroxine levels were comparable with healthy controls while thyroid-stimulating hormone (TSH) was lower in patients in acute opioid abstinence period. Also, TSH levels in patients remained lower than controls after 30 days of abstinence. These results indicate that PTA function is altered in opioid-dependent subjects. These data highlight the importance of screening the thyroid function for individuals with chronic opioid dependence.

Dysfunction of the hypothalamic-pituitary-adrenal axis in opioid dependent subjects: effects of acute and protracted abstinence.

OBJECTIVES: The function of the Hypothalamic-Pituitary-Adrenal (HPA) axis during opioid dependence has been inconsistent. We compared HPA axis measures between subjects during methadone stabilization and drug-free detoxification with healthy controls. METHODS: Sixty heroin dependent patients received either non-opiate treatment (NOT) with benzodiazepines and clonidine (n = 30) or methadone stabilization treatment (MT, n = 30), and their serum levels of corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and cortisol (COR) were measured and compared to those of healthy, nondependent controls. RESULTS: Compared with healthy controls, CRH was significantly lower (p < .001) while COR was higher (p < .001) during acute withdrawal in the NOT group. CRH and COR was lower (p < .001), while ACTH was normal in the MT group compared to healthy controls. CONCLUSIONS: Our findings suggest that chronic opioid dependence may cause reduced function of the HPA axis, while opioid withdrawal may decrease the response of the pituitary to CRH and increase the adrenal response to ACTH.