Use of Street Methadone in Italian Heroin Addicts Presenting for Opioid Agonist Treatment

ABSTRACT

It is commonly assumed that people who are addicted to certain substances would abuse any substance. This position has never been supported by validly collected and analyzed research data. In this study, the authors examine the use of street methadone by heroin addicts seeking their first agonist opioid treatment in a clinical setting. Fifty-four heroin addicts who resorted to street methadone use were compared by socio-demographic, current clinical, and disease-related variables to 251 peers who do not use street methadone. Heroin addicts who resort to street methadone use are more likely to be females and to have a higher degree of education, are less likely to engage in polyabuse (use of more than three substances), are less severely ill, have been addicted for a shorter period of time, and have been seeking treatment sooner in the course of their disease. Also, they suffer from a wider range of psychopathological distress symptoms. In Italy, resorting to street methadone does not seem to be a surrogate form of heroin addiction, but rather represents means of harm reduction, with treatment seeking occurring shortly after its initiation. This should be accounted for when deciding on take-home policies and issues of potential methadone diversion.     

Intentions,actions and outcomes: A follow up survey on harm reduction practices after using an English festival drug checking service

BackgroundDrug checking is a health service whose behavioural outcomes have been assessed primarily through reported intentions of service users after receiving healthcare consultations or brief interventions (BIs). This study contributes to the evidence base through utilising a follow-up design to compare outcomes of risk communications on risk management and harm reduction practices both at and after attending drug checking services at three English music festivals in 2017.MethodsData were collected and analysed from: (i) 1,482 self-complete questionnaires at sample drop-off; (ii) 1,482 nominated primary service users at 1,482 face-to-face BIs; and (iii) an anonymous online self-report follow-up survey completed by a sub-sample of 130 primary service users (one quarter of legible, functioning email addresses received) followed up three months later. Ten measures (one verified action and nine intentions) were recorded at point of BI and compared with retrospectively reported outcomes and ongoing changes post-BI.ResultsOutcomes at follow-up were correlated with actions and intentions at BI for nine of the ten measures, including over half of service users disposing of samples identified as other than expected and two in five reporting reduced dosage for samples identified as expected. One in five reported alerting their friends to substances of concern.ConclusionEvent-based drug checking services can access and engage productively with young adults earlier in drug taking careers and not in touch with health services, through tailored polydrug BIs. Rapid identification of substances of concern, dissemination of test results and associated risk communications during and after events through friendship networks, support services and early warning systems suggest that the benefits of drug checking can extend beyond service users and point of BI and can increase strategies and behaviours to reduce drug-related harm such as poisoning and overdose.     

Texture-Modified Diets are Associated with Poor Appetite in Older Adults who are Admitted to a Post-Acute Rehabilitation Hospital

ObjectiveThis study aimed to clarify the association between texture-modified diets and poor appetite in older adults, as it is not fully understood.DesignCross-sectional study.Setting and ParticipantsWe included 208 inpatients who were aged ≥65 years (mean age 78.9 ± 7.6 years, 57.7% female) and admitted to a rehabilitation unit with stroke, musculoskeletal disease, or hospital-associated deconditioning covered by the Japanese insurance system, between January 2019 and January 2020.MethodsParticipants were divided into 2 groups according to their food texture level: International Dysphagia Diet Standardization Initiative (IDDSI) levels 3 to 5 for the texture-modified diet group and levels 6 and 7 for the normal diet group. Appetite was assessed using the Simplified Nutritional Appetite Questionnaire for the Japanese elderly, and a score ≤14 was defined as poor appetite. The relationship between IDDSI levels and poor appetite was analyzed using the Cochrane-Armitage trend test. Logistic regression analysis was used to investigate the relationship between the consumption of texture-modified diets and poor appetite. Statistical significance was set at P < .05.ResultsThe numbers of participants on modified diets according to the IDDSI framework were as follows: 4, 11, 41, 76, and 76 in levels 3, 4, 5, 6, and 7, respectively. In total, 152 and 56 patients were classified into the regular diet group and texture-modified diet group, respectively. A significantly higher prevalence of poor appetite was observed with the consumption of texture-modified diets (P < .001 for trend). Logistic regression analysis showed that poor appetite was independently associated with the consumption of texture-modified diets (odds ratio 3.443, P = .011).Conclusions and ImplicationsThese findings indicate that the consumption of texture-modified diets is associated with poor appetite. Further studies are required to verify whether a multimodal approach involving improvement in the appearance, taste, flavor, and nutrients of the food can improve poor appetite.     

Sit,breathe, smile: Effects of single and weekly seated Qigong on blood pressure and quality of life in long-term care

Long-term care (LTC) facilities house individuals with diverse combinations of cognitive and physical impairments, and the practice of Seated Qigong eliminates common exercise barriers. This study hypothesized: 1) a single session would lower blood pressure (BP) and improve quality of life (QOL) in a generalized LTC population, and 2) these responses would be attenuated with chronic (weekly) Seated Qigong practice. Ten residents (6 female; 86 ± 7 years) participated in 1X/week Seated Qigong sessions for 10-weeks. BP and QOL were assessed pre- and post-session at baseline and following 5- and 10-weeks of Qigong. Systolic BP was significantly reduced immediately post-session after 10-weeks of Qigong (P = 0.03), yet unchanged at baseline and after 5-weeks (all P > 0.05). Diastolic BP and QOL remained unchanged (P > 0.05). A session of Seated Qigong elicits a hypotensive response with exposure, supporting the notion that repeated sessions may provide advantageous health benefits.     

State sanctioned killing in the name of drugs: Laws,practice and conflicting trends in Asia

The last decade has seen a significant amount of progress in the struggle to abolish the death penalty for drug offences, a practice that is both illegal under international law and proven to be ineffective. Political, legal and policy developments at the international, regional and national level have led to a progressive shift away from capital punishment as a tool for drug control, resulting in a relatively sharp decrease in global executions. Yet a small number of countries, primarily in Asia, continue to aggressively pursue the policy, executing hundreds of disadvantaged individuals every year, often following trials that do not meet international standards of fairness. At the same time, populist rhetoric advocating for the death penalty for drugs is on the rise in the region, reinvigorating aggressive drug wars and threatening to undermine the framework of existing international legal obligations and unravel decades of progress.     

A patient in the clinic; a person in the world. Why shared decision making needs to center on the person rather than the medical encounter

Interest in shared decision making (SDM) has increased and become widely promoted. However, from both practical and measurement perspectives, SDM’s origin as an outgrowth of patient autonomy has resulted in narrowly conceptualizing and operationalizing decision making. The narrow focus on individual patient autonomy fails in four main ways: 1) excluding several facets of the roles, actions, and influences of decision partners in decision making; 2) focusing solely on the medical encounter; 3) ignoring the informational environment to which patients have access; and 4) treating each encounter as independent of all others. In addition to creating a research agenda that could answer important outstanding questions about how decisions are made and the consequences thereof, reconceiving SDM as centered on the person rather than the medical encounter has the potential to transform how illness is experienced by patients and families and how clinicians find meaning in their work.     

Smartphone-based support system (SoberDiary) coupled with a Bluetooth breathalyser for treatment-seeking alcohol-dependent patients

BackgroundRelapse prevention in patients with alcohol dependence (AD) has long been a clinical challenge. It is vital to provide services with minial restrictions for patients to have access to continuous after-treatment care. The study was aimed to examine the benefits of a smartphone application (SoberDiary) coupled to a Bluetooth breathalyser to assist patients recovering from alcohol dependence (AD).MethodsThis study recruited 38 patients that fulfilled the DSM-IV-TR criteria for AD and who were undergoing an outpatient maintenance program for abstinence. The participants were provided a breathalyser and smartphone-equipped SoberDiary and followed for 12 weeks. The participants were divided into highly adherent (HA) and less adherent (LA) groups according to the medium number of reward points they were awarded for using the SoberDiary system throughout the follow-up period based on the average amount of time spent on using the application, the number of function modules they accessed, and the number of BrAC tests they completed each day.Results19 of the patients were classified as HA and 19 patients were classified as LA group. Members of the HA group recorded fewer drinking days and drinks consumed per week, a higher cumulative number of abstinence days, a higher abstinence rate, less pronounced anxiety, and superior quality of life.ConclusionsThe proposed smartphone-assisted support system coupled with a Bluetooth breathalyser might be a feasible supplement to conventional treatment for AD. Higher SoberDiary compliance appears to be associated with better clinical outcomes.     

Distance learning strategies for weight management utilizing social media: A comparison of phone conference call versus social media platform. Rationale and design for a randomized study

Management of obesity in the context of the primary care physician visit is of limited efficacy in part because of limited ability to engage participants in sustained behavior change between physician visits. Therefore, healthcare systems must find methods to address obesity that reach beyond the walls of clinics and hospitals and address the issues of lifestyle modification in a cost-conscious way. The dramatic increase in technology and online social networks may present healthcare providers with innovative ways to deliver weight management programs that could have an impact on health care at the population level. A randomized study will be conducted on 70 obese adults (BMI 30.0–45.0 kg/m²) to determine if weight loss (6 months) is equivalent between weight management interventions utilizing behavioral strategies by either a conference call or social media approach. The primary outcome, body weight, will be assessed at baseline and 6 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity will be assessed on the same schedule. In addition, a cost analysis and process evaluation will be completed.