A model for treating HCV hepatitis in patients receiving methadone maintenance therapy.

INTRODUCTION: Although hepatitis C virus (HCV) is associated with substance abuse, treatment of addicts is problematic. We report the results of a pilot scheme for treatment of HCV - infected substance abusers in a methadone maintenance center (MMC). METHODS: The treatment program was carried out at a single MMC. Patients were not using illicit drugs or alcohol and received regular treatment with methadone. The program consisted of 5 stages: 1. An explanatory lecture concerning HCV (50/114 attended). 2. 25 of the 50 presented for examination including HCV RNA, genotype and viral load. 3. HCV treatment with pegylated alfa-interferon-1b and ribavarin. 4. The MMC physician and staff aided the clients' medical compliance. 5. A hepatologist (SM) volunteered his services on the basis of one 3 hourly session every 4-6 weeks, in addition to open access telephone consultation with the MMC staff physician. RESULTS: 50 of 114 HCV seropositive clients attended the initial meeting , 25 (50%) were candidates for treatment, of whom 20 were treated. 10 had genotype 3 infection, 9 genotype 1 and 1 genotype 2. The sustained virological response (SVR) on an intention-to-treat basis was 8/20 (40%). DISCUSSION: We present a model for the successful treatment of chronic HCV hepatitis in patients receiving methadone.

Neurodevelopmental and psychological assessment of adolescents born to drug-addicted parents: effects of SES and adoption.

OBJECTIVES: Prenatal exposure to heroin may have long-term consequences for development during early and middle childhood. The present research studied the cognitive, social, and emotional functioning of adolescents exposed to drugs prenatally, and investigated the extent to which the early adoption of children exposed prenatally to drugs would alleviate the possible effects of exposure. METHODS: The study included 191 adolescents (12-16 years of age) and their parents in Israel, who had or had not been exposed prenatally to drugs and differing in socio-economic status (SES), and in adoptive status. They were administered five subtests of the Wechsler Intelligence Scale for Children (WISC-III), and the Youth Self-Report Form for assessing behavior problems that measures problems associated with attention deficit, self-esteem and risk-taking. Parents were administered the Child Behavior Checklist (CBCL) for assessing behavior problems, the Conners Rating Scale (CRS) for assessing attention deficit problems in their children and the Wender Utah Rating Scale (WURS), a self-report measure of ADHD-related problems. RESULTS: Adolescents exposed to at least one risk factor (exposure to drugs, low SES, or adoption) performed more poorly than those exposed to none of these risk factors on the WISC-III subtests, the CBCL and the CRS. The effects of risk factors did not cumulate. Contrary to our hypothesis, adoption did not mitigate the effects of prenatal exposure to drugs: for cognitive functioning exposure to drugs was associated with poorer performance among the exposed High SES Adopted versus non-exposed High SES non-adopted children on three of the WISC-III subtests. Exposed low SES children living with their parents performed at the same relatively low level as non-exposed low SES controls. Exposure to drugs was associated with adult ADHD-related problems assessed by the WURS. There were no direct or interaction effects of exposure on neurological functioning, self-competence, behavior problems on the CBCL or risk-taking. CONCLUSIONS: Children exposed to drugs of abuse prenatally, including those adopted away, and children who grow up in low SES backgrounds, may be at risk of relatively reduced cognitive functioning (though still within the normal range) in adolescence. Children exposed to drugs, who are from low SES backgrounds, or who are adopted, may be at risk for lower cognitive or social functioning than children who have not experienced such risks. PRACTICE IMPLICATIONS: There is a need for implementing early monitoring and long-term intervention programs featuring encouragement of cognitive and social skills for children prenatally exposed to drugs in order to alleviate the possible long-term effects of exposure to risk.

["Injecting clean or being clean?" The international and Israeli experiences of Syringe Exchange Programs among injecting drug users].

Injecting drug users (IDU) are a hard-to-reach population. The treatment objectives are to reduce their risk factors, to guide them to total abstinence or to antagonist treatment. When IDU are not ready for detoxification, they are referred to Syringe Exchange Programs (SEP). The objective of SEP is harm reduction of blood-borne viruses (of HIV, HBV, HCV). The authors aimed to define the issues related to harm reduction, to discuss the results of SEP in the world, and to describe our experience. We analyzed the world literature and our experience. In this article, we describe the rehabilitation school of thought (which supports complete drug abstinence), the harm reduction school of thought (which refers to drug addiction as a chronic disease), and the possible continuum between these two schools of thought. The AIDS pandemic and the epidemiology of world drug addiction by injection are described, together with the principles of SEP and their evaluation in the world. In addition, we describe drug use in Israel and HIV infection among IDU. Finally, we analyze our preliminary results of the SEP pilot in Israel, during the years 2004-2005, and included 462 IDUs. In conclusion, considering the difficulties that exist with IDUs, most articles emphasize the importance of SEP in this population while sometimes also expressing its effectiveness in preventing transmissions of blood-borne viruses. In Israel, a pilot project has existed since the end of 2003, and has expanded progressively to three cities. An overall evaluation of this program is under preparation.