A screening trial of amantadine as a medication for cocaine dependence.

This screening trial evaluated whether amantadine hydrochloride (100 mg bid) demonstrated sufficient clinical efficacy compared to placebo to recommend development as a pharmacotherapy for cocaine dependence. Participants were randomized to amantadine (n=34) or placebo (n=35) conditions in a 16-week, placebo-controlled, double blind trial with three times per week group counseling. Amantadine-treated participants were retained significantly longer than placebo. Based on results of a joint probability index for urine drug testing results (i.e. the proportion of cocaine-metabolite free urine samples divided by the number of participants assigned to the condition), participants assigned to amantadine were found to be significantly more likely to be cocaine abstinent on the last day of 8-weeks of treatment than participants assigned to placebo. Results at the end of 16 weeks of treatment were similar. Standard measures of urine drug testing consistently favored the amantadine condition over placebo, although not at levels of statistical significance. There was no statistical significance infrequency or severity of reported adverse events by treatment condition. Participants assigned to amantadine exhibited greater reductions in global staff ratings of cocaine dependence severity from baseline to termination compared with placebo. There were no significant differences in frequency or severity of reported adverse events by treatment condition. These results provide moderate support for further study of amantadine for the treatment of cocaine dependence.

Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial.

AIMS: To evaluate the safety and efficacy of an 8 mg/day sublingual dose of buprenorphine in the maintenance treatment of heroin addicts by comparison with a 1 mg/day dose over a 16-week treatment period. As a secondary objective, outcomes were determined concurrently for patients treated with two other dose levels. DESIGN: Patients were randomized to four dosage groups and treated double-blind. SETTING: Twelve outpatient opiate maintenance treatment centers throughout the United States. PARTICIPANTS: Two hundred and thirty-nine women and 497 men who met the DSM-III-R criteria for opioid dependence and were seeking treatment. INTERVENTION: Patients received either 1, 4, 8 or 16 mg/day of buprenorphine and were treated in the usual clinical context, including a 1-hour weekly clinical counseling session. MEASUREMENT: Retention in treatment, illicit opioid use as determined by urine toxicology, opioid craving and global ratings by patient and staff. Safety outcome measures were provided by clinical monitoring and by analysis of the reported adverse events. FINDINGS: Outcomes in the 8 mg group were significantly better than in the 1 mg group in all four efficacy domains. No deaths occurred in either group. The 8 mg group did not show an increase in the frequency of adverse events. Most reported adverse effects were those commonly seen in patients treated with opioids. CONCLUSIONS: The findings support the safety and efficacy of buprenorphine and suggest that an adequate dose of buprenorphine will be a useful addition to pharmacotherapy.

Croissance des larves de Culicidae a Kinshasa (Zaire) : influence physico-chimique des principaux gites de reproduction

Cette etude experimentale a porte sur les principaux gites permanents de reproduction des moustiques representes par les neuf plus importants cours d'eau drainant la ville de Kinshasa. La culture in vitro des larves d'Anopheles gambiae s.l. et de Culex quinquefasciatus a permis d'etudier leur croissance dans differents echantillons d'eau preleves dans ces gites. Les resultats ont montre que la croissance des larves de moustiques depend des conditions physico-chimiques du milieu de culture; reflet des conditions physico-chimiques qui regnent dans l'environnement draine par les collections d'eau etudiees. L'analyse multivariee a permis de caracteriser cinq profils physico-chimiques. Il existe des gites de reproduction plus favorable que d'autres; c'est les cas notamment des mares a vegetation aux eaux propres et ensoleillees qui offrent les meilleures conditions de survie et de croissance aussi bien pour les Anopheles que pour les Culex par rapport aux autres gites etudies. Quel que soit le profil physico-chimique du gite considere; le taux d'emergence des images pour le Culex s'est avere significativement plus eleve que celui des Anopheles; une larve de Culex a presente une chance sur deux de se transformer en image contre une chance sur trois pour une larve d'Anopheles. Cette difference est due au taux de mortalite relativement eleve des larves d'Anopheles par rapport aux larves de Culex durant la premiere semaine d'observation