Fetal alcohol spectrum disorders (FASD) refers to a wide array of adverse developmental outcomes in children due to prenatal alcohol exposure. FASD is more widespread than Fetal Alcohol Syndrome, which is more severe, but FASD is harder to accurately diagnose because of fewer objective diagnostic tools. New research indicates than simple eye-movement or oculomotor tasks can be used to assess individuals with FASD.
Results are published in the March issue of Alcoholism: Clinical & Experimental Research.
"Whereas oculomotor tasks have been used to assess brain function in a number of different clinical populations, this is the first such study to be carried out in FASD children," said James N. Reynolds, professor of pharmacology & toxicology at Queen's University and corresponding author for the study. "We wanted to assess the feasibility of using this tool to probe different aspects of brain function and behavior in this specific clinical population."
The impetus for this research was a casual conversation on an airplane on the way back from a neuroscience conference, said Reynolds. "I had been wrestling with the problem of translating basic science research into relevant clinical studies of individuals affected by prenatal exposure to alcohol," he recounted. "There were few, if any, objective tools that could be used to assess brain function in FASD subjects." In the end, Reynolds collaborated with coauthor Doug Munoz, who had for years been using eye-movement tasks to study brain function and behavior in different clinical populations, including children.
Study authors compared the oculomotor performance of 10 children with FASD (4 males, 6 females) with 12 age-matched control subjects (6 males, 6 females). All were instructed to either look toward (prosaccade) or away from (antisaccade) a stimulus that appeared in their peripheral visual field. Researchers measured reaction times, direction errors, and short-latency express saccades (very short latency eye movements).
"We found that FASD children had much longer reaction times - defined as the time required to initiate eye movement - both towards and away from the peripheral visual target," said Reynolds. "FASD children also made a greater number of direction errors, even in the more simple prosaccade task, and exhibited a dramatic reduction in express saccades."
Reynolds is pleased that he and his colleagues have discovered what seems to be a powerful and yet easy tool for assessing executive-function deficits among individuals with FASD.
"In the absence of confirmed maternal alcohol consumption during pregnancy," he said, "the diagnosis of FASD remains a significant clinical challenge. This is especially true when the characteristic facial features are absent, and subtle neurobehavioral problems are the primary feature. Furthermore, many of the children affected by prenatal alcohol exposure live in remote communities, lacking access to FASD diagnostic clinics and sophisticated neuroimaging technology. Moreover, comprehensive evaluation requires the ability to track changes in brain function longitudinally."
Largely due to the findings of this research, Reynolds and his research team have acquired a mobile eye-tracker unit that hooks up to a laptop computer, allowing them to move their research program out of the laboratory and into the communities.
"We have already visited several communities in Ontario, and are establishing collaborations with other research centers across Canada," he said. "At the same time, we have initiated a study of children and young adults performing these same eye-movement tasks while brain activity is recorded using functional magnetic resonance imaging (fMRI). We also plan to apply our findings to other developmental disorders, such as Attention Deficit Hyperactivity Disorder. In this way, we will establish a large database that will enable us to make direct comparisons of task performance and brain function across multiple clinical populations."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Deficits in Eye Movement Control in Children with Fetal Alcohol Spectrum Disorders," were: Courtney R. Green of the Centre for Neuroscience Studies at Queen's University; Douglas P. Munoz of the Centre for Neuroscience Studies, and the Departments of Physiology and Psychology, at Queen's University; and Sarah M. Nikkel of the Department of Genetics at the Children's Hospital of Eastern Ontario, Ottawa. The study was funded by the Canadian Institutes of Health Research, the Botterell Foundation of Queen's University, and the Canada Research Chair Program.
Contact: James N. Reynolds, Ph.D.
Alcoholism: Clinical & Experimental Research
вторник, 21 июня 2011 г.
понедельник, 20 июня 2011 г.
The American Academy Of Child And Adolescent Psychiatry Applauds Representative Kennedy
The American Academy of Child and Adolescent Psychiatry (AACAP) applauds Representative Patrick Kennedy for his courage in speaking openly about his recent struggles with substance use and bipolar illness.
For many years, Representative Kennedy has been a staunch advocate for children and adults living with mental illnesses. He has dedicated much of his time in public service to reducing stigma associated with mental illnesses and to fighting for better access to mental health treatment.
As a public figure, his openness has made a real difference in our ongoing efforts to destigmatize mental disorders and to remove the secrecy and shame that so often accompanies mental illnesses.
Substance abuse is a psychiatric disorder that affects more than 20 million Americans. Those struggling with substance use disorders need treatment that allows them to live full and productive lives. Treatment for substance use disorders is as effective as treatment for other chronic diseases such as diabetes, hypertension, and asthma.
Though treatment works, not enough people seek it. The 2004 National Survey on Drug Use and Health showed that 23.48 million people needed treatment for an alcohol or illicit drug use problem. Of these, only 2.33 million received the type of help that they needed.
In addition, Representative Kennedy has shown leadership in recognizing the tremendous burden that the national shortage of child mental health providers places on our nation's children and families. He responded to this crisis by sponsoring the Child Heath Crisis Relief Act (H.R. 1106), that provides education incentives for more professionals to be trained in treating children with mental illnesses, including substance use disorders.
We greatly appreciate Representative Kennedy's commitment to improving access to quality treatment for children and adolescents living with mental illnesses and their families. We support him in his recovery and look forward to his return to public service.
aacap
For many years, Representative Kennedy has been a staunch advocate for children and adults living with mental illnesses. He has dedicated much of his time in public service to reducing stigma associated with mental illnesses and to fighting for better access to mental health treatment.
As a public figure, his openness has made a real difference in our ongoing efforts to destigmatize mental disorders and to remove the secrecy and shame that so often accompanies mental illnesses.
Substance abuse is a psychiatric disorder that affects more than 20 million Americans. Those struggling with substance use disorders need treatment that allows them to live full and productive lives. Treatment for substance use disorders is as effective as treatment for other chronic diseases such as diabetes, hypertension, and asthma.
Though treatment works, not enough people seek it. The 2004 National Survey on Drug Use and Health showed that 23.48 million people needed treatment for an alcohol or illicit drug use problem. Of these, only 2.33 million received the type of help that they needed.
In addition, Representative Kennedy has shown leadership in recognizing the tremendous burden that the national shortage of child mental health providers places on our nation's children and families. He responded to this crisis by sponsoring the Child Heath Crisis Relief Act (H.R. 1106), that provides education incentives for more professionals to be trained in treating children with mental illnesses, including substance use disorders.
We greatly appreciate Representative Kennedy's commitment to improving access to quality treatment for children and adolescents living with mental illnesses and their families. We support him in his recovery and look forward to his return to public service.
aacap
воскресенье, 19 июня 2011 г.
Single Genetic Change Blocks Morphine Dependency
Morphine's serious side effect as a pain killer - its potential to create dependency - has been almost completely eliminated in research with mice by genetically modifying a single trait on the surface of neurons. The study scientists think a drug can be developed to similarly block dependency.
The research was published online by Current Biology and appears in the journal's print edition. The scientists were led by Jennifer Whistler, PhD, an investigator in the UCSF-affiliated Ernest Gallo Clinic and Research Center, and associate professor of neurology at UCSF.
Millions of people in the U.S. are given the opiate drug morphine for extreme pain caused by cancer, surgery, nerve damage and other conditions. It remains the pain killer of choice for many types of short-term pain, such as surgery, according to Whistler, but it is less useful for the treatment of chronic pain because its effectiveness decreases with continued use in a process called tolerance. As a consequence, an increasingly larger dose is required to treat the pain, thereby increasing the chance of addiction.
The body's natural pain killers, such as endorphins, ease pain by first binding to receptors on the surface of neurons. The receptors cycle on and off "like a light switch," Whistler says, regulating the intake of endorphin. This crucial control is absent when the neurons encounter morphine. The researchers' strategy in their study was to try to trick neurons into responding to morphine in the more regulated way.
Strong evidence suggests that the natural on-off cycling occurs because the endorphin receptor withdraws from the cell surface, toward the cell's interior, Whistler says. The migration from the cell surface is called endocytosis.
When the neuron receptors encounter morphine the light switch is broken, and the nervous system responds by becoming more tolerant of the drug, making the recipient more dependent on the drug.
To demonstrate their hunch that morphine's unwanted effects were caused by the failure of its receptor to withdraw from the cell surface, the researchers genetically engineered mice with a single difference from normal mice: Receptors that encounter morphine in these mice can undergo endocytosis, as they normally do in the presence of endorphins. The researchers showed that with this single change, morphine remained an excellent pain killer without inducing tolerance and dependence.
"As more pain medications are being removed from the market, new strategies to overcome chronic pain become crucial," Whistler says. "If new opiate drugs can be developed with morphine's pain killing properties but also with the ability to promote endocytosis, they could be less likely to cause the serious side effects of tolerance and dependence."
The research is the first direct demonstration that this single cellular change can block the body's tendency to become tolerant of the drug, she points out.
Several strategies are now being tested to counter morphine addiction, Whistler says. These include development of morphine derivatives such as oxycontin, that are delivered in a time released manner or only once they have been processed in the digestive system. Other approaches seek to develop morphine derivatives that target only certain opioid receptors but not others.
"The most promising aspect of these other approaches is that they have the potential to prevent or delay dependence and addiction to morphine, but few of them address the development of tolerance," Whistler said.
Coauthors on the paper are Joseph Kim, PhD; Selena Bartlett, PhD; Li He, MD; Carsten K. Nielsen, PhD; Amy Chang, BS; Viktor Kharazai, PhD, Maria Waldhoer, PhD, Chrissi Oul, BS, and Stacy Taylor, BS, all at the Gallo Center.
Also: Madeline Ferwerdal, BS, and Dragana Cado, PhD, both at the Caner Research Laboratory, UC Berkeley.
The research was supported by the National Institute of Drug Abuse and funds provided by the State of California for medical research on alcohol and substance abuse through UCSF.
The Ernest Gallo Clinic and Research Center (Gallo Center) is one of world's preeminent academic centers for the study of the biological basis of alcohol and substance abuse. Gallo Center discoveries of potential molecular targets for the development of therapeutic medications are extended through preclinical and proof-of-concept clinical studies.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate level education in the life sciences and health professions, and excellence in patient care.
Source: Wallace Ravven
University of California - San Francisco
View drug information on OxyContin.
The research was published online by Current Biology and appears in the journal's print edition. The scientists were led by Jennifer Whistler, PhD, an investigator in the UCSF-affiliated Ernest Gallo Clinic and Research Center, and associate professor of neurology at UCSF.
Millions of people in the U.S. are given the opiate drug morphine for extreme pain caused by cancer, surgery, nerve damage and other conditions. It remains the pain killer of choice for many types of short-term pain, such as surgery, according to Whistler, but it is less useful for the treatment of chronic pain because its effectiveness decreases with continued use in a process called tolerance. As a consequence, an increasingly larger dose is required to treat the pain, thereby increasing the chance of addiction.
The body's natural pain killers, such as endorphins, ease pain by first binding to receptors on the surface of neurons. The receptors cycle on and off "like a light switch," Whistler says, regulating the intake of endorphin. This crucial control is absent when the neurons encounter morphine. The researchers' strategy in their study was to try to trick neurons into responding to morphine in the more regulated way.
Strong evidence suggests that the natural on-off cycling occurs because the endorphin receptor withdraws from the cell surface, toward the cell's interior, Whistler says. The migration from the cell surface is called endocytosis.
When the neuron receptors encounter morphine the light switch is broken, and the nervous system responds by becoming more tolerant of the drug, making the recipient more dependent on the drug.
To demonstrate their hunch that morphine's unwanted effects were caused by the failure of its receptor to withdraw from the cell surface, the researchers genetically engineered mice with a single difference from normal mice: Receptors that encounter morphine in these mice can undergo endocytosis, as they normally do in the presence of endorphins. The researchers showed that with this single change, morphine remained an excellent pain killer without inducing tolerance and dependence.
"As more pain medications are being removed from the market, new strategies to overcome chronic pain become crucial," Whistler says. "If new opiate drugs can be developed with morphine's pain killing properties but also with the ability to promote endocytosis, they could be less likely to cause the serious side effects of tolerance and dependence."
The research is the first direct demonstration that this single cellular change can block the body's tendency to become tolerant of the drug, she points out.
Several strategies are now being tested to counter morphine addiction, Whistler says. These include development of morphine derivatives such as oxycontin, that are delivered in a time released manner or only once they have been processed in the digestive system. Other approaches seek to develop morphine derivatives that target only certain opioid receptors but not others.
"The most promising aspect of these other approaches is that they have the potential to prevent or delay dependence and addiction to morphine, but few of them address the development of tolerance," Whistler said.
Coauthors on the paper are Joseph Kim, PhD; Selena Bartlett, PhD; Li He, MD; Carsten K. Nielsen, PhD; Amy Chang, BS; Viktor Kharazai, PhD, Maria Waldhoer, PhD, Chrissi Oul, BS, and Stacy Taylor, BS, all at the Gallo Center.
Also: Madeline Ferwerdal, BS, and Dragana Cado, PhD, both at the Caner Research Laboratory, UC Berkeley.
The research was supported by the National Institute of Drug Abuse and funds provided by the State of California for medical research on alcohol and substance abuse through UCSF.
The Ernest Gallo Clinic and Research Center (Gallo Center) is one of world's preeminent academic centers for the study of the biological basis of alcohol and substance abuse. Gallo Center discoveries of potential molecular targets for the development of therapeutic medications are extended through preclinical and proof-of-concept clinical studies.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate level education in the life sciences and health professions, and excellence in patient care.
Source: Wallace Ravven
University of California - San Francisco
View drug information on OxyContin.
суббота, 18 июня 2011 г.
Royal College Of Physicians Responds To Alcohol Tax Speculation, UK
Professor Ian Gilmore, RCP President and a liver expert, responds to reports over the weekend that the Conservative Party social justice policy group is recommending an increase in tax on alcohol:
"Increased taxation on alcoholic drinks could be used to inject badly-needed resources into alcohol services across the NHS, which currently remain woefully inadequate.
"Research from across the world shows a direct link between affordability of alcohol and level of consumption. Raising the tax on alcohol would help reduce our consumption, and reduce the future burden of ill-health from alcohol misuse, while generating more funding for treatment services. This is a win-win for the nation's health.
rcplondon.ac
"Increased taxation on alcoholic drinks could be used to inject badly-needed resources into alcohol services across the NHS, which currently remain woefully inadequate.
"Research from across the world shows a direct link between affordability of alcohol and level of consumption. Raising the tax on alcohol would help reduce our consumption, and reduce the future burden of ill-health from alcohol misuse, while generating more funding for treatment services. This is a win-win for the nation's health.
rcplondon.ac
пятница, 17 июня 2011 г.
CT Best At Uncovering Drug Mule Payload
According to a study presented at the annual meeting of the Radiological Society of North America (RSNA), the best way to detect cocaine in the body of a human drug courier, known as a mule, is through computed tomography (CT).
"Cocaine from South America is making its way to Europe through Africa," said Patricia Flach, M.D., a radiologist at University Hospital of Berne and Institute of Forensic Medicine of Berne in Switzerland. "From Africa, drug mules most commonly try to enter the European Union and Switzerland."
When legal authorities suspect an individual of being a drug mule, they often turn to radiologists to help quickly detect the presence of cocaine concealed in the body. Cocaine containers, which may be swallowed or inserted in the vagina or rectum, can be as large as a banana or as small as a blueberry.
"In these cases it is important for us to know that we have identified all the drug containers in a body, both for legal purposes and for the health of the patient," Dr. Flach said. "However, there was no research telling us which imaging modality was best in detecting cocaine containers in the stomach, intestines or other body orifices."
Dr. Flach and colleagues analyzed images from 89 exams performed on 50 suspected drug mules over a three-year period at University Hospital. The study group included 45 men and five women between the ages of 16 and 45. Forty-three of the suspects were ultimately identified as drug mules.
Of the imaging exams conducted, 27 were CT, 50 were digital x-ray and 12 were low-dose linear slit digital radiography (LSDR), an extremely fast, high-resolution, full-body x-ray system primarily used for trauma patients. The radiologic findings were compared with a written record of the drug containers recovered from the feces of suspects.
"As we expected, CT imaging allowed us to see all the drug containers, especially when we knew what to look for," Dr. Flach said.
The results showed that the coating and manufacture of the containers changed their appearance, especially on CT images. Rubber coated condoms filled with cocaine appeared very hyper-dense, or white, on CT, while other containers of similar size with plastic foil wrapping appeared iso- to hypo-dense, or gray to black. This contradicts some previous reports that have suggested image density may correlate with the drug content.
The sensitivity of CT was 100 percent, meaning CT was able to find all cocaine containers that were present in the drug mules' bodies. LSDR had a sensitivity rate of 85 percent, and digital x-ray was able to identify the presence of cocaine containers only 70 percent of the time.
"There were positive findings on CT that were clearly not detectable on x-rays due to overlap of intestinal air, feces or other dense structures," Dr. Flach said.
While CT was clearly the most accurate imaging modality in detecting the drug containers, the increased ionizing radiation associated with the exam is a concern when imaging people who are presumably healthy.
"CT is the way to go," Dr. Flach said. "But low-dose protocols need to be implemented to ensure the safety of the people undergoing the procedure."
Coauthors are Steffen Ross, M.D., Gary Hatch, M.D., Ulrich Preiss, M.D., Thomas Ruder, M.D., Michael Thali, M.D., and Michael Patak, M.D.
Source:
Radiological Society of North America (RSNA)
"Cocaine from South America is making its way to Europe through Africa," said Patricia Flach, M.D., a radiologist at University Hospital of Berne and Institute of Forensic Medicine of Berne in Switzerland. "From Africa, drug mules most commonly try to enter the European Union and Switzerland."
When legal authorities suspect an individual of being a drug mule, they often turn to radiologists to help quickly detect the presence of cocaine concealed in the body. Cocaine containers, which may be swallowed or inserted in the vagina or rectum, can be as large as a banana or as small as a blueberry.
"In these cases it is important for us to know that we have identified all the drug containers in a body, both for legal purposes and for the health of the patient," Dr. Flach said. "However, there was no research telling us which imaging modality was best in detecting cocaine containers in the stomach, intestines or other body orifices."
Dr. Flach and colleagues analyzed images from 89 exams performed on 50 suspected drug mules over a three-year period at University Hospital. The study group included 45 men and five women between the ages of 16 and 45. Forty-three of the suspects were ultimately identified as drug mules.
Of the imaging exams conducted, 27 were CT, 50 were digital x-ray and 12 were low-dose linear slit digital radiography (LSDR), an extremely fast, high-resolution, full-body x-ray system primarily used for trauma patients. The radiologic findings were compared with a written record of the drug containers recovered from the feces of suspects.
"As we expected, CT imaging allowed us to see all the drug containers, especially when we knew what to look for," Dr. Flach said.
The results showed that the coating and manufacture of the containers changed their appearance, especially on CT images. Rubber coated condoms filled with cocaine appeared very hyper-dense, or white, on CT, while other containers of similar size with plastic foil wrapping appeared iso- to hypo-dense, or gray to black. This contradicts some previous reports that have suggested image density may correlate with the drug content.
The sensitivity of CT was 100 percent, meaning CT was able to find all cocaine containers that were present in the drug mules' bodies. LSDR had a sensitivity rate of 85 percent, and digital x-ray was able to identify the presence of cocaine containers only 70 percent of the time.
"There were positive findings on CT that were clearly not detectable on x-rays due to overlap of intestinal air, feces or other dense structures," Dr. Flach said.
While CT was clearly the most accurate imaging modality in detecting the drug containers, the increased ionizing radiation associated with the exam is a concern when imaging people who are presumably healthy.
"CT is the way to go," Dr. Flach said. "But low-dose protocols need to be implemented to ensure the safety of the people undergoing the procedure."
Coauthors are Steffen Ross, M.D., Gary Hatch, M.D., Ulrich Preiss, M.D., Thomas Ruder, M.D., Michael Thali, M.D., and Michael Patak, M.D.
Source:
Radiological Society of North America (RSNA)
четверг, 16 июня 2011 г.
Moms, Tell Your Kids If You Have Done Drugs
Moms who have used drugs may be doing their teens a favour by admitting to it, University of Alberta research shows.
A survey of 3,530 Alberta youth Grades 7 to 12 revealed that teens were more likely to use drugs if they knew that their mothers had used drugs but did not pressure their kids to avoid the practice.
"The findings suggest that adolescents might benefit from parental talks about the dangers of drug use, especially when their mothers have experience with drugs," said researcher Lori Harach, a professor of human ecology at the University of Alberta in Edmonton, Canada.
"That factor may give extra credibility to the messaging in the eyes of the teen," she suggested.
Harach presented her findings recently at a conference organized by the Society for Research in Child Development.
Source:
Bev Betkowski
University of Alberta
A survey of 3,530 Alberta youth Grades 7 to 12 revealed that teens were more likely to use drugs if they knew that their mothers had used drugs but did not pressure their kids to avoid the practice.
"The findings suggest that adolescents might benefit from parental talks about the dangers of drug use, especially when their mothers have experience with drugs," said researcher Lori Harach, a professor of human ecology at the University of Alberta in Edmonton, Canada.
"That factor may give extra credibility to the messaging in the eyes of the teen," she suggested.
Harach presented her findings recently at a conference organized by the Society for Research in Child Development.
Source:
Bev Betkowski
University of Alberta
среда, 15 июня 2011 г.
Methadone-associated Deaths Not Caused Primarily By Methadone Diverted From Methadone Treatment Programs
Methadone-associated deaths are not being caused primarily by methadone diverted from methadone treatment programs, according to a panel of experts convened by SAMHSA (Substance Abuse and Mental Health Services Administration).
"While deaths involving methadone increased, experiences in several states show that addiction treatment programs are not the culprits," said SAMHSA Center for Substance Abuse Treatment (CSAT) Director H. Westley Clark, M.D., J.D., M.P.H. He cited the expert panel consensus report at the Sixth International Conference on Pain and Chemical Dependency in New York City in early February.
Methadone-Associated Mortality, Report of a National Assessment concludes that "although the data remain incomplete, National Assessment meeting participants concurred that methadone tablets and/or diskettes distributed through channels other than opioid treatment programs most likely are the central factor in methadone-associated mortality."
Hospital emergency department visits involving methadone rose 176 percent from 1995 to 2002. The rise from 2000 to 2002 was 50 percent, according to SAMHSA's Drug Abuse Warning Network.
SAMHSA convened the panel in May 2003 to determine whether its methadone regulations were allowing diversion of methadone from clinics or whether the rise of methadone mentions in hospital emergency rooms and reports of deaths were due to methadone coming from other sources.
The panel - state and Federal experts, researchers, epidemiologists, pathologists, toxicologists, medical examiners, coroners, pain management specialists, addiction medicine specialists, and others - concluded that the methadone from reported deaths came from sources other than opioid treatment programs.
"The participants in the meeting reviewed data on methadone formulation, distribution, patterns of prescribing and dispensing, as well as relevant data on drug toxicology and drug-associated morbidity and mortality, before concluding that the cases of overdosing individuals were not generally linked to methadone derived from opioid treatment programs," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W.
The panel based its conclusion that methadone is coming from other sources on data showing that the greatest growth in methadone distribution in recent years is associated with its use as a prescription analgesic prescribed for pain, primarily in solid tablet or diskette form, and not in the liquid formulations that are the mainstay of opioid treatment programs that treat patients with methadone for abuse of heroin or prescription painkillers.
The experts surmise that current reports of methadone deaths involve one of three scenarios: illicitly obtained methadone used in excessive or repetitive doses in an attempt to achieve euphoric effects; methadone, either licitly or illicitly obtained, used in combination with other prescription medications such as benzodiazepines (anti-anxiety medications), alcohol, or other opioids; or an accumulation of methadone to harmful serum levels in the first few days of treatment for addiction or pain, before tolerance is developed.
"SAMHSA will continue to monitor the situation to ensure that SAMHSA's supervision of opioid treatment programs is always in the public interest," Mr. Curie emphasized.
va
"While deaths involving methadone increased, experiences in several states show that addiction treatment programs are not the culprits," said SAMHSA Center for Substance Abuse Treatment (CSAT) Director H. Westley Clark, M.D., J.D., M.P.H. He cited the expert panel consensus report at the Sixth International Conference on Pain and Chemical Dependency in New York City in early February.
Methadone-Associated Mortality, Report of a National Assessment concludes that "although the data remain incomplete, National Assessment meeting participants concurred that methadone tablets and/or diskettes distributed through channels other than opioid treatment programs most likely are the central factor in methadone-associated mortality."
Hospital emergency department visits involving methadone rose 176 percent from 1995 to 2002. The rise from 2000 to 2002 was 50 percent, according to SAMHSA's Drug Abuse Warning Network.
SAMHSA convened the panel in May 2003 to determine whether its methadone regulations were allowing diversion of methadone from clinics or whether the rise of methadone mentions in hospital emergency rooms and reports of deaths were due to methadone coming from other sources.
The panel - state and Federal experts, researchers, epidemiologists, pathologists, toxicologists, medical examiners, coroners, pain management specialists, addiction medicine specialists, and others - concluded that the methadone from reported deaths came from sources other than opioid treatment programs.
"The participants in the meeting reviewed data on methadone formulation, distribution, patterns of prescribing and dispensing, as well as relevant data on drug toxicology and drug-associated morbidity and mortality, before concluding that the cases of overdosing individuals were not generally linked to methadone derived from opioid treatment programs," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W.
The panel based its conclusion that methadone is coming from other sources on data showing that the greatest growth in methadone distribution in recent years is associated with its use as a prescription analgesic prescribed for pain, primarily in solid tablet or diskette form, and not in the liquid formulations that are the mainstay of opioid treatment programs that treat patients with methadone for abuse of heroin or prescription painkillers.
The experts surmise that current reports of methadone deaths involve one of three scenarios: illicitly obtained methadone used in excessive or repetitive doses in an attempt to achieve euphoric effects; methadone, either licitly or illicitly obtained, used in combination with other prescription medications such as benzodiazepines (anti-anxiety medications), alcohol, or other opioids; or an accumulation of methadone to harmful serum levels in the first few days of treatment for addiction or pain, before tolerance is developed.
"SAMHSA will continue to monitor the situation to ensure that SAMHSA's supervision of opioid treatment programs is always in the public interest," Mr. Curie emphasized.
va
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