Suchergebnisse

<b><i>Aims:</i></b> The aim of this exploratory analysis of European Quality Audit of Opioid Treatment data was to identify areas of improvement for current opioid maintenance treatment (OMT) approaches. <b><i>Methods:</i></b> Factors facilitating treatment entry, retention and refusal were compared between 8 European countries and between OMT patient (OMT-P) and active opioid user (AOU) sample groups. Both groups were divided into those who had never had OMT before (un-experienced OMT-P (n = 573) and AOU (n = 360)) and those who had been maintained at least once prior to this investigation (experienced OMT-P (n = 746) and AOU (n = 377)). <b><i>Results:</i></b> The European comparison showed that motives for starting OMT vary distinctly between countries (p ≤ 0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p ≤ 0.05). <b><i>Conclusion:</i></b> Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.

Hintergrund: Opioidabhängigkeit während der Schwangerschaft stellt ein signifikantes und wachsendes Problem im Gesundheitswesen dar. Die Suchterkrankung wird mit gesundheitlichen Risiken für Mutter und Kind assoziiert, vor allem aufgrund von im Rahmen dieser Erkrankung auftretenden Risikoverhaltensweisen. Methodik: Es wurde aktuelle Literatur zum Thema Opioid-Erhaltungstherapie (OET) während der Schwangerschaft in Zusammenhang mit neonatalen Outcome-Parametern über die Datenbank «pubmed.gov» recherchiert. Ergebnisse: OET mit Methadon (MMT) stellt die «state-of-the-art» Behandlung bei Opioidabhängigkeit während der Schwangerschaft dar, wird jedoch mit einer Prävalenz des Neonatalen Abstinenz Syndroms (NAS) von 60–80 % assoziiert. Als vielversprechende Alternative erscheint Buprenorphin, einzelne Studien weisen auf eine geringere Prävalenz von NAS bei OET mit Buprenorphin. Schlussfolgerungen: Bisherige, hauptsächlich retrospektiv durchgeführte Studien zu Buprenorphin und Methadon lassen aufgrund von methodischen Mängeln nur bedingt Rückschlüsse auf Vor- und Nachteile bezüglich NAS zu. Die «MOTHER» Studie soll hier als Modell für evidenzbasierte klinische Studien fungieren.

<b><i>Objective:</i></b> Attention-deficit hyperactivity disorder (ADHD) often coincides with substance abuse and delinquency. A sample of opioid-maintained inmates was assessed for symptoms of ADHD, substance abuse history, types of offense, psychiatric comorbidities, and psychopharmacological treatment using a standardized battery of instruments. <b><i>Method:</i></b> Adult inmates (<i>n</i> = 133, mean age 35.7 years, 21.8% female) in opioid-maintenance therapy (OMT) were administered the Adult ADHD self-report scale, Wender Utah Rating Scale, Mini International Neuropsychiatric Interview, ­European Addiction Severity Index. <b><i>Results:</i></b> Fifty percent screened positive for childhood and 17% for adult ADHD, four (3.1%) received ADHD medication. Inmates with ADHD symptom status were significantly younger at first substance abuse, reported more drug overdoses, longer duration of cocaine and prescribed medication abuse and more in- and outpatient treatments (all <i>p</i> &#x3c; 0.05). For all inmates in OMT a high rate of psychiatric comorbidities was observed (78.9%). <b><i>Conclusion:</i></b> There is a need for assessment of ADHD and other psychiatric comorbidities in OMT prisoners. Evidence-based treatment should be routinely provided.

<i>Background:</i> Multi-center trials enable the recruitment of larger study samples, although results might be influenced by site-specific factors. <i>Methods:</i> Site differences of a multi-center prospective double-blind, double-dummy randomized controlled trial (7 centers: Central Europe (Vienna)/USA (3 urban/3 rural centers)) comparing safety and efficacy of methadone and buprenorphine in pregnant opioid-dependent women and their neonates. <i>Results:</i> Urban US women had the highest rate of concomitant opioid (p = 0.050) and cocaine consumption (p = 0.003), the highest dropout rate (p = 0.001), and received the lowest voucher sums (p = 0.001). Viennese neonates had significantly higher Apgar scores 1 min (p = 0.001) and 5 min after birth (p < 0.001) and were more often born by cesarean section (p = 0.024). Rural US newborns had a significantly shorter neonatal abstinence syndrome treatment duration compared to Viennese and urban US sites (p = 0.006), in addition to other site-specific differences, suggesting a more severely affected group of women in the urban US sites. <i>Conclusion:</i> This clinical trial represents a role model for pharmacological treatment in this unique sample of pregnant women and demonstrates the clinical importance of considering site-specific factors in research and clinical practice.