Self-efficacy and illicit opioid use in a 180-day methadone detoxification treatment.

Self-efficacy ratings coincided with illicit opioid use across the 3 phases of a 180-day methadone detoxification treatment. Efficacy ratings increased after patients received their first dose of methadone, did not change while they were maintained on a stable dose of methadone, and declined during the taper as they attempted to face high-risk situations without the full benefit of methadone. Efficacy ratings measured at a point before a phase of treatment predicted illicit opioid use across that phase. For clarification of the relation between self-efficacy and illicit opioid use, 3 conceptual models proposed by J. S. Baer, C. S. Holt, and E. Lichtenstein (see record 1987-13846-001) were tested. Self-efficacy influenced subsequent drug use in parallel with previous behavior, but this influence was found only at the start of the stabilization phase and immediately before the start of the taper phase. These findings highlight the usefulness of the self-efficacy concept for the treatment of opioid addiction (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contracting for treatment termination to reduce illicit drug use among methadone maintenance treatment failures.

Evaluated the effectiveness of a contingency contracting intervention on reducing illicit drug use by 21 25–60 yr old male methadone maintenance patients selected on the basis of positive urinalysis results during a 60-day baseline. The intervention consisted of a 30-day contract, which stated that Ss would continue to receive a specified dosage of methadone, would not be asked to leave the program or detoxify, and would not use illicit drugs during the contract period. Illicit drug use was significantly reduced during the 30-day intervention and remained below baseline levels during a 60-day follow-up. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-prescribed drug use during methadone treatment by clinic- and community-based patients

We investigated the efficacy of methadone maintenance treatment in clinic-based (n = 10) and community-based (n = 10) patients by studying the relationships between dose, plasma concentrations of methadone and non-prescribed drug-use using logistic regression. We found that clinic-based patients had significantly reduced odds of having a urine sample test positive for illicit drugs when compared to community-based patients (OR = 0.20; 95% confidence interval 0.10-0.38: p < 0.001). There was no relationship between either methadone dose or plasma methadone concentration and testing positive for non-prescribed drugs (including cocaine, cannabis, amphetamine, ecstasy, benzodiazepines). We looked specifically at the misuse of opiate drugs. Location was again important and clinic-based patients had significantly reduced odds of having a urine sample test positive for opiate drugs (OR = 0.36, 95% confidence interval 0.18-0.71: p approximately 0.004). Opiate drug use in our patients was also significantly related to plasma methadone concentration, increasing noticeably when the drug concentration < 0.48 nmol/L (p approximately 0.04). We found no relationship between methadone dose and odds of having a positive urine drug test in either clinic- or community-based patients.     

Fluoxetine treatment for dually diagnosed methadone maintained opioid addicts: a pilot study

Twenty-two methadone maintained opioid addicts with either depression or persistent cocaine use received open label fluoxetine in addition to their methadone. Fluoxetine significantly decreased depressive symptoms from pre-treatment to endpoint in subjects with depression, while its effect on substance use was inconclusive.     

Frequent ED users: patterns of use over time

The objective of this study was to examine the pattern of emergency department (ED) use by frequent ED users over time. This study was a retrospective study of adults with more than 10 visits to a university hospital ED from 8/90 through 7/91. ED visits of this cohort to all hospitals in the metropolitan area were followed for 3 years. Records were reviewed for the etiology of each patient's ED visits. This cohort was comprised of 76 patients making 1,119 (1.9%) of the total 59,051 ED visits. Thirty-five of the 76 (46%) were frequent ED users in only the initial year. Thirteen of the 76 (17%) made more than 10 visits in all 4 years. The remainder had sporadic episodes of ED use. Thirty-five (46%) were evaluated at three or more EDs in years in which they were frequent users. Forty-two (55%) had a medical problem for the cause of the majority of their ED visits. Fifty-eight percent of patients making more than 10 visits in more than 1 year had psychiatric or substance abuse problems. The pattern of ED use in this cohort changed over time and was influenced by substance abuse and psychiatric problems. These data suggest that most patients do not remain frequent ED users over time.     

Criminal involvement of cocaine users enrolled in a methadone treatment program

This was a study of criminal activities of cocaine users versus non-users enrolled in a methadone treatment program in New York City. Of those 140 methadone clients studied, 100 (71%) were cocaine users. There were no demographic differences between the two groups except marital status. Married clients (including common-law married) were more likely than never-married single clients to be non-users. Cocaine users were significantly more depressed, using the subscale of the Symptom Checklist-90. Although numbers of lifetime arrests and criminal involvement (in the year immediately preceding the research interview) of cocaine non-users were distinctively lower than those of users, the differences were not significant. In a multiple regression analysis, length of stay in the methadone program was the strongest predictor of criminal involvement. Those who were retained longer in the treatment were significantly less likely to be involved in criminal activities, regardless of cocaine use.     

Predictors of outcome in LAAM, buprenorphine, and methadone treatment for opioid dependence.

This study examined (1) predictors of treatment outcome for opioid-dependent participants in a single-site controlled trial comparing methadone, buprenorphine, and LAAM treatments and (2) the extent to which various subpopulations of patients may have more successful outcomes with each medication. The relationships between patient demographics, drug use history, and psychological status and outcome measures of treatment retention, opiate use, and cocaine use were assessed. We believe this study to be the first to demonstrate that predictors of treatment success appear to be largely similar in LAAM, buprenorphine, and methadone treatment for opioid dependence. We did not find any factors that would strongly guide selection of one medication over others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal patterns of heroin and cocaine use among methadone patients

A sample of 1,038 patients newly admitted to 15 methadone clinics in New York City were studied for up to three years in treatment or until discharge. Cluster analysis identified distinct patient groups with very different heroin and cocaine usage patterns during treatment. About 80% either started in or transitioned to a low heroin use group and 50% either started in or transitioned to a low cocaine use group during treatment. One-third of patients used cocaine extensively during treatment. Other "high risk" groups, such as those not recently employed, younger, or involved with criminal justice, could benefit from special interventions very early in treatment.     

Determinants of condom use among intravenous drug users

OBJECTIVE: To examine the factors associated with condom use among a cohort of sexually active intravenous drug users (IVDU). DESIGN: Data were collected via personal interview at the fourth-month assessment point of a longitudinal study monitoring HIV infection and risk behaviors among IVDU. SETTING: A community-based methadone clinic. PARTICIPANTS: A total of 158 sexually active heterosexual male and female IVDU, including both methadone patients and out-of-treatment individuals with a history of opiate abuse. MAIN OUTCOME MEASURES: We describe a new approach to identify the determinants of condom use. Previous studies have described subjects as either 'condom users' or 'condom non-users', using an individual's overall behavior as the unit of analysis. By analyzing condom use during the most recent sexual encounter, we avoided the problem of interpreting inconsistent condom use. Data were analyzed using forward stepwise logistic regression. RESULTS: Thirty-four per cent of the heterosexual subjects (n = 160) reported using a condom during their last sexual encounter. Being HIV-positive and having either a causal or commercial partner were each associated with increased probability of using a condom (odds ratio, 10.6, 4.4 and 12.1, respectively). No interactions with sex were found. CONCLUSIONS: Our results suggest that knowing that one is HIV-positive is an important determinant of condom use; HIV testing may therefore increase the use of condoms. In addition, interventions to change sexual behaviors may need to focus on the type of sexual partner.     

Sexual and drug use behaviors among women crack users: implications for prevention

The literature suggests that important and contributing factors in the rise of HIV and AIDS among women are crack use and the exchange of sex for drugs or money. However, not all women who use crack report they are exchanging sex for drugs or money. Thus, women are at differential risk for HIV and AIDS. The purpose of this study is to compare and describe women crack users (n = 292) who reported exchanging sex for drugs and money with women crack users who did not report exchanging sex. Results indicated that both women crack users who exchanged sex (n = 162) and women crack users who did not exchange sex (n = 130) were likely to be African American, to be about the same age, to have had incomes below +500 during the previous month, to have had similar education and martial backgrounds, to have had unprotected sexual intercourse as often, to have had similar drug use patterns, and to have initiated drug use at similar ages. However, women who exchanged sex had more sexual partners, had unprotected oral sex more often, used drugs before and during sex more often, and had a higher rate of sexually transmitted diseases than women who did not exchange sex. In addition, women who exchanged sex were also twice as likely to be homeless, four times more likely to have been in treatment, and twice as likely to have been arrested and charged/booked two or more times in their lifetime than women who did not exchange sex.     

Contingent take-home incentive: Effects on drug use of methadone maintenance patients.

Examined contingent methadone take-home privileges for effectiveness in reducing on-going supplemental drug use of methadone maintenance patients. 53 new intakes were randomly assigned to begin receiving take-home privileges after 2 consecutive weeks of drug-free urines or to a noncontingent procedure in which take-homes were delivered independently of urine test results. The contingent procedure produced more individuals with at least 4 consecutive weeks of abstinence (32 vs 8%); 28% of noncontingent Ss also achieved abstinence after shifting to the contingent procedure. Lower baseline rate of drug-free urines was strongly associated with successful outcome, whereas the type of drug abused (cocaine vs benzodiazepines) did not influence outcomes. Findings support a recommendation for using contingent take-home incentives to motivate abstinence during methadone maintenance treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heroin craving and drug use in opioid-maintained volunteers: Effects of methadone dose variations.

Recent data indicate that opioid agonist and antagonist challenges decrease and increase (respectively) heroin craving in physically dependent individuals. This study investigated effects of methadone dose variations on craving and new drug use in 18 outpatients who were given money contingencies. In Phase 1, volunteers were told in different test sessions that methadone dose would increase, decrease, or stay the same; drug-abstinence contingencies were suspended for 24 hr. Craving significantly increased and new heroin use marginally increased (relative to maintenance dose) only when a dose reduction was paired with a dose decrease instruction. In Phase 2 (detoxification), craving and heroin use significantly increased as methadone dose decreased. Thus, loss of μ-receptor agonist effect increased craving and risk of relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of smoking and methadone dose in drug treatment patients.

Cigarette smoking prevalence is very high, and cessation rates are very low, among people in methadone treatment. This may in part be due to interactions between methadone administration and cigarette smoking. The present study explores relationships between methadone dose timing and smoking rates. Twenty methadone patients, over a period of 19 days, used electronic cigarette packs to record their smoking patterns and called a voice mailbox daily to report their methadone dose and timing. The average proportion of daily cigarettes smoked was calculated for 2-hr blocks preceding and following methadone dose administration. For all participants, peak smoking rates occurred after methadone administration. Participants smoked a greater proportion of cigarettes in their first 2-hr block after methadone dosing (M = 0.368, SD = 0.135) than during their first 2-hr block of smoking of the day (M = 0.245, SD = 0.010; S = 85.5, p     

Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program

The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. A computerized medical encounter data base, with frequencies of primary care visits and with diagnoses for each visit, was linked to the cohort study data base that contained information on patients' demographic characteristics, serologic status, and CD4+ T-lymphocyte counts. Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program. Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.     

Drug abuse treatment as HIV prevention: changes in social drug use patterns might also reduce risk

Fifty one individuals (37 male and 14 female) were asked to report on the social and behavioral circumstances related to their opiate drug use prior to and during a 90-day methadone detoxification treatment. Data were collected by means of a weekly structured interview. Questions were asked about each occasion of opiate use in the previous week with respect to time, source, cost, social circumstance, etc. Monitored urine samples were tested x 3/week to verify verbal reports. The study demonstrated beneficial effects of the detoxification treatment by showing dramatic decreases in rates and amounts of opiate drug use during treatment. Of perhaps greater significance, large scale changes were also noted in the frequency of use with others. This decline in use with others was most dramatic with respect to strangers and acquaintances. Implications of these observations for HIV transmission are discussed.     

Recent patterns of use and associated risks of illicit drug use in adolescents

Hematocrit, sodium, chloride, potassium, calcium, glucose, and pH were measured in whole blood of 1,522 channel catfish collected from 3 commercial food-fish ponds in the Mississippi Delta. Samples were collected from March 1995 to March 1996 to monitor seasonal fluctuations. A total of 10-20 fish were arbitrarily collected with snag lines from each pond on each sample day. The mean monthly hematocrits fluctuated seasonally from a low of 14.5% in midwinter to a high of 25.7% in midsummer (annual x = 21%, SE = 0.15). Sodium levels were consistent throughout the year with a mean (SE) of 134 (0.13) mM/liter. Mean chloride values for the year were 120 (0.14) mM/liter but increased to 132 mM/liter in midwinter. By March 1996, the chloride levels had returned to levels observed during spring 1995. Potassium and glucose levels varied throughout the year with means of 4.43 (0.06) mM/liter and 26.9 (0.46) mg/dl, respectively, and coefficients of variation of 51.8% and 63.3%, respectively. Calcium and pH values were fairly stable with means of 1.31 (0.004) mM/liter and 7.13 (0.004), respectively. All parameters except glucose and potassium may be adequately evaluated with a sample size of 25 or less. These data were collected to provide baseline information for ongoing pond health studies.     

Mortality among HIV-infected intravenous drug addicts in Stockholm in relation to methadone treatment

The aim of the study was to estimate the mortality rate and evaluate the causes of death in all diagnosed HIV-positive IDUs in the Stockholm area, 1986-90, and to compare the risk of death of those who received methadone treatment with that of those never admitted to or discharged from the programme. Data were collected from the Swedish National Bacteriological Laboratory, the Methadone Maintenance Programme (MMTP) and the Department of Forensic Medicine, as well as from hospitals in the Stockholm region. In Sweden 90% of all IDUs are HIV-tested. Most deceased IDUs are examined forensically. This examination always includes HIV-testing. During the observation period, 472 HIV-infected IDUs were reported from the Stockholm area. Of these addicts 135 participated in the methadone maintenance programme for a shorter or longer time during the study period. Most of them had received the HIV-diagnosis more than 1 year before first entering the programme. Sixty-nine subjects died during the observation period. A majority, 52 persons, died from violence or poisoning. Seventeen died from somatic complications of drug abuse. Nine of them were diagnosed as suffering from AIDS. Eight of the deceased had participated in the MMTP. The relative risk of death from external violence and poisoning was 0.25 (95% confidence interval 0.1-1.0) when participants in the MMTP were compared with HIV-infected IDUs never attending the programme. When all causes of death are compared the relative risk was 0.8. Those patients discharged from the programme have a higher mortality rate than those who never participated.(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV risk in intravenous drug users and crack cocaine smokers: Predicting stage of change for condom use.

This study examined the utility of the Transtheoretical Model of Change and the AIDS Risk Reduction Model for predicting condom use with not-in-treatment crack cocaine smokers and intravenous drug users. The sample included 265 participants; 99 reported having casual partners and 166 reported having main partners. All participants must have used drugs in the preceding 48 hrs and received no drug treatment for at least 1 year. Participants were grouped into 3 stages of change; precontemplation, contemplation, and action. Logistic regression analyses indicated that both the benefits of change and condom assertiveness varied across the stages of change for main and casual partners, whereas the costs of change were important for predicting stage only with main partners. Age was a significant predictor of stage with casual partners, whereas ethnicity and nonherpes sexually transmitted diseases significantly predicted stage with main partners. The utility of the stages of change for choosing intervention strategies and the need for more qualitative and longitudinal research to determine additional predictors of intention to use condoms are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Progesterone effects on cocaine use in male cocaine users maintained on methadone: A randomized, double-blind, pilot study.

Previously, the authors reported that progesterone treatment attenuated reports of cocaine-induced high in male and female cocaine users. In this pilot clinical trial, the authors tested the safety and efficacy of oral progesterone as a treatment for cocaine dependence in methadone-stabilized male cocaine users. This was a 10-week, randomized, double-blind, placebo-controlled trial. Forty-five male methadone-stabilized cocaine users were randomized to receive placebo (n=15) or progesterone (n=30) for 9 weeks. The progesterone dose was gradually increased from 100 mg to 300 mg twice daily by Week 4 and maintained through Week 10. Treatment retention for the clinical trial was 80%, without significant group differences (log rank=2.4, p=.12). Hierarchical linear modeling estimates of obtaining a cocaine positive urine result across 10 weeks showed a very slight reduction in cocaine use for the progesterone group (Z=-2.89, p     

Places and patterns of drug use in the Scottish dance scene

Interviews were conducted with 135 participants in the Glasgow dance (rave) scene. Drug use in this group was varied and not merely restricted to drugs associated with dance events, such as MDMA (Ecstasy). The setting in which each drug was used varied greatly. Amphetamine, nitrites and Ecstasy were the drugs most commonly used at dance events. Pharmaceuticals were least likely to be used in such settings. However, some drugs, such as Temazepam, were sometimes used prior to or after attending rave events. It is suggested that dance drug users are polydrug users who use drugs in a setting specific fashion. As such it would be wrong to classify such users solely on the grounds of their very visible behaviour in the public arena (at dance events). Other forms of substance use engaged in by this group may have a greater potential for harm than that seen at raves. The implications of these findings are discussed.