Treatment of pain in methadone-maintained patients.

Patients with opioid dependency experience trauma, acute medical illness and chronic diseases, and may have to undergo surgery to the same extent as other individuals. They need to be treated for relief of symptoms, including pain. Undertreatment or inadequate treatment of pain for these individuals is a particular problem because of opioid dependency and/or methadone maintenance treatment.

Three oral formulations of methadone. A clinical and pharmacodynamic comparison.

This study was done to determine whether there were any differences in subjective symptoms of opiate withdrawal or methadone pharmacodynamics among patients as they were switched between three different oral formulations of methadone. Patients enrolled in a three-way double-blind crossover trial of three methadone formulations. Subjective symptoms and pharmacodynamic measures were assessed throughout the study period.

Conditioned place preference induced by delta 9-tetrahydrocannabinol: comparison with cocaine, morphine, and food reward.

The rewarding property of delta 9-tetrahydrocannabinol (THC), the psychoactive constituent of marijuana and hashish, was studied using the conditioned place preference paradigm, and compared to that of cocaine, morphine, and food reward. The results of Experiment 1 demonstrated that 2.0 and 4.

Marijuana's interaction with brain reward systems: update 1991.

The most pervasive commonality amongst noncannabinoid drugs of abuse is that they enhance electrical brain stimulation reward and act as direct or indirect dopamine agonists in the reward relevant dopaminergic projections of the medial forebrain bundle (MFB). These dopaminergic projections constitute a crucial drug sensitive link in the brain's reward circuitry, and abused drugs derive significant abuse liability from enhancing these circuits. Marijuana and other cannabinoids were long considered "anomalous" drugs of abuse, lacking pharmacological interaction with these brain reward substrates.

Strain-specific facilitation of dopamine efflux by delta 9-tetrahydrocannabinol in the nucleus accumbens of rat: an in vivo microdialysis study.

This study tests the hypothesis that delta 9-tetrahydrocannabinol (delta 9-THC) has a strain-specific facilitatory effect on dopamine (DA) efflux in rat nucleus accumbens, a crucial forebrain convergence of reward-relevant DA neural fibers that has been implicated as a focal brain locus mediating the euphorigenic properties of drugs of abuse. The dependent variable is presynaptic DA efflux measured by in vivo microdialysis in the nucleus accumbens. The independent variables are: (1) intraperitoneal injections of delta 9-THC at 0.

Delta 9-tetrahydrocannabinol enhances presynaptic dopamine efflux in medial prefrontal cortex.

Acute administration of 1.0-2.0 mg/kg delta 9-tetrahydrocannabinol (delta 9-THC) increased presynaptic dopamine (DA) efflux in the medial prefrontal cortex of rats, as measured by intracerebral microdialysis in awake, behaving rats.

Changes in AIDS risk behavior among intravenous drug abusers in New York City.

Forty newly admitted patients to a methadone treatment clinic in New York City were interviewed to assess their patterns of intravenous (IV) drug abuse, sexual activity, and other risk behaviors for the acquired immunodeficiency syndrome (AIDS). The study revealed a marked decline in needle sharing since 1984 (46% to 14%), despite a concurrent doubling of the number of weekly IV drug injections per subject (10 to 21). High rates of promiscuous heterosexual activity were noted among men (80% said they were currently active with more than one woman), while the rates of condom use were low, as reported by both men and women (less than 30%).

Delta 9-tetrahydrocannabinol produces naloxone-blockable enhancement of presynaptic basal dopamine efflux in nucleus accumbens of conscious, freely-moving rats as measured by intracerebral microdialysis.

This study examined the effects of acute administration of delta-9-tetrahydrocannabinol (delta 9-THC), the psychoactive ingredient in marijuana, on extracellular efflux of dopamine (DA) and its metabolites as measured by in vivo microdialysis in nucleus accumbens of conscious, freely-moving rats. delta 9-THC, at low doses (0.5-1.

The treatment of alcoholic methadone patients: a review.

Alcoholism is a major problem among methadone maintenance patients. Although alcoholism in the methadone patient is recognized as a problem, few treatment studies have been conducted. Treatment studies have examined abstinence oriented and controlled drinking therapies, voluntary disulfiram treatment, and combined behavioral-pharmacological treatment.

Issues of transference in methadone maintenance treatment.

Methadone maintenance treatment involves a great deal of governmental regulations and controls which have to be enforced by the clinician, thus having important transferential implications for therapy. This issue is explored on the basis of a case example, and recommendations are made to detach rule enforcement from therapy.

Locus of control and initiation of detoxification among male methadone maintenance patients.

Two hypotheses were derived linking locus of control to voluntary, "completion of treatment" detoxification from methadone maintenance: (1) methadone maintenance patients with an internal locus of control will be more likely to indicate a willingness to begin detoxification, and (2) among patients indicating a willingness to begin, those with an internal locus of control would be more likely to actually begin. Subjects were 115 male methadone patients. A nonsignificant trend was found in support of the first hypothesis, while the second was reversed at a statistically significant level (r = -.

Rehabilitation of the Puerto Rican addict: a cultural perspective.

Drug addiction has assumed major proportions in the Hispanic population. This paper questions whether treatment programs in Puerto Rican communities adequately relate their rehabilitative services to the realities of Hispanic culture. The experience of a clinic in the South Bronx is reviewed, and it is suggested that programs need to be aware of cultural differences, provide Hispanic staff to treat Hispanic patients, and build up acknowledged strengths, values, and folkways.

Methadone treatment and physical complaints: a clinical analysis.

In this study 102 male patients on the Harlem Hospital Methadone Maintenance Treatment Program were asked about physical complaints which they attributed to taking methadone. The most common complaints were sweating, constipation, drowsiness, sexual problems, and aches in bones and joints. There were no statistically significant differences between new patients and long-term patients, but long-term patients appear more likely to be bothered by sweating than new patients, and constipation occurs most frequently during the initial stages of treatment.

The narcotic-dependent mother: fetal and neonatal consequences.

During the years 1971--1974, 230 infants born to drug-dependent women and 33 infants born to ex-addicts were studied. Heroin abuse declined while methadone usage increased during those years. Compared to heroin abuse, methadone maintenance treatment during pregnancy was associated with more consistent prenatal care, more normal fetal growth and reduced fetal mortality.

Commonly asked clinical questions about methadone maintenance.

Clinical questions about methadone maintenance are posed and answered. The areas include eligibility, size of clinic, number of patients, optimal maintenance dose, special populations, side effects, services, schedules, and the involvement of others.

Social rehabilitation of addicts: a two-year evaluation.

This paper points out the relationship that exists between treatment approaches with drug addicts and sociodemographic characteristics of the communities affected. It has been shown that while poor and middle class communities show good results with methadone maintenance approaches, in the area of secondary drug abuse they show marked dissimilarities. Also, the reasons for discharge are markedly different.

Differential effects of maternal heroin and methadone use on birthweight.

An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken. Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm).

Detoxification of long-term methadone patients: problems and prospects.

Various aspects of the detoxification of rehabilitated methadone patients are considered in the light of experience at the Albert Einstein College of Medicine-Bronx Psychiatric Center MMTP and the reports of others in the field. Patients studied met certain eligibility requirements which were thought to enhance the probability of successful detoxification. A total of 228 (10.