纳曲酮用于海洛因依赖治疗

目的 :了解纳曲酮抗复吸治疗效果。方法 :采用回顾性临床资料分析方法 ,分析 5 0例海洛因依赖者躯体脱毒后使用纳曲酮抗复吸治疗的临床资料。结果 :应用纳曲酮抗复吸治疗 6个月 ,患者对海洛因渴求程度分值从1 96±s 0 88降至 0 2 5±s 0 4 4 (P <0 0 1) ,复吸率从 2 8 6 %降至 5 0 % (P <0 0 1) ,17例原静脉注射毒品者复吸时11例改为烫吸 ,1例改为肌肉注射。结论 :纳曲酮能减轻或消除海洛因正性强化作用 ,间接淡化患者对海洛因的渴求程度 ,降低复吸率 ,无明显毒副作用 ;可使静脉注射海洛因者改变滥用方式 ,降低毒品危害     

纳曲酮与酒依赖的治疗

纳曲酮作为酒依赖的辅助治疗药物的新适应证于 1994年由美国FDA批准开始使用。酒滥用与内阿片系统关系密切。纳曲酮作为阿片受体拮抗剂 ,可以消除饮酒后因内阿片系统活性升高而产生的正性强化作用。临床研究表明 ,纳曲酮治疗期间酒依赖病人对酒渴求程度减轻 ,饮酒次数 ,饮酒量均明显减少 ,复发饮酒率降低 ;不良反应轻微 ,主要为恶心和头晕等。纳曲酮可以为多数病人所耐受     

纳曲酮用于阿片类药物依赖者抗复吸治疗的结果分析

目的··：了解纳曲酮抗复吸治疗效果。方法··：采用回顾性临床资料分析方法，分析５４例阿片类药物依赖后自愿戒断者使用纳曲酮脱瘾及抗复吸治疗的临床资料。结果··：纳曲酮对于有固定职业、戒毒愿望强烈、家庭关注较多和个人支持系统相对较好者抗复吸疗效好，能明显延长探亲时间，减少吸毒冲动，觅药行为，无明显副作用。结论··：纳曲酮在抗复吸中有很好的运用前景。     

曲唑酮联合纳曲酮对海洛因依赖者防复吸的疗效

目的评估曲唑酮联合纳曲酮治疗海洛因依赖者防复吸的临床疗效及安全性。方法将160例海洛因依赖者随机分成两组,试验组和对照组各80例。两组患者均先经过东莨菪碱复合麻醉(杨氏1+1)脱毒治疗,待尿吗啡检测转阴性后,研究组给予曲唑酮(100²00 mg·d-1,bid)联合纳曲酮(50 mg·d-1,qd)治疗,对照组单纯给予纳曲酮治疗,住院治疗2周后维持治疗12个月。采用心理渴求量表(PCS)、稽延性戒断症状量表(PWSS)和纳曲酮维持率在出院时与维持治疗1、3、6、9、12个月后进行评分分析,用副反应症状量表(TESS)评价安全性。结果共135例完成全部研究,对照组67例,研究组68例。与出院时相比,两组治疗1、3、6、9、12个月的PCS得分及PWSS得分均下降(P<0.01)。治疗1、3、6个月时研究组的PCS和PWSS均低于对照组(P<0.05),9、12个月时两组组间无显著差异(P>0.05);研究组的纳曲酮维持率高于对照组,有非常显著差异(P<0.01)。两组不良反应轻微,研究组的TESS总分小于对照组(P<0.05或P<0.01);6个月后两组比较无显著差异(P>0.05)。结论曲唑酮能明显提高纳曲酮维持治疗的依从性。曲唑酮联合纳曲酮是一种安全、有效的预防海洛因依赖者复吸的治疗方案。     

国产盐酸纳曲酮对阿片类依赖脱毒治疗后预防复吸的疗效观察

本研究应用国产盐酸纳曲酮对３８例临床脱毒成功后的阿什类依赖者进行了８－１２月临床观察，结果表明：不同时间保持不复吸率明显高于既往操守率。服用纳曲酮保持时间与既往脱毒后操守时间比较明显延长。服用纳曲酮平均保持时间（１００．２±ｓ５５．８ｄ）、平均保持不复吸时间（２２８．９±ｓ９５．１ｄ）、停药后保持不复吸时间（１２８．７±ｓ９７．５ｄ）与本人既往脱毒后平均操守时间（７．５±ｓ２１．３ｄ）比较明显延长。不良反应主要发生在１周—１月内，以胃肠道反应、焦虑、睡眠障碍、易激惹等发生率高。研究表明：国产纳曲酮能明显降低复吸率，不良反应轻，用于脱毒后的巩固治疗有明显疗效。     

盐酸纳曲酮——海洛因依赖脱毒后防复吸辅助治疗药物

盐酸纳曲酮作为海洛因依赖脱毒治疗后预防复吸的一种辅助治疗药物，已在医疗戒毒领域获得广泛认同，应用日益广泛，取得明显效果。脱毒后的一年操守率由以往的１０％以下提高到４０％，若不断完善相应的心理辅导及环境净化，疗效可望进一步提高。我们广州江村医院戒毒所作...     

纳曲酮冲击疗法治疗海洛因依赖快速进入抗复吸的临床研究

目的:海洛因依赖者常规脱毒一周左右,一次性给予大量纳曲酮冲击治疗,达到快速进入抗复吸治疗,提高操守率.方法:实验组40例,均为男性,常规脱毒7天,一次性给予纳曲酮50 mg,辅以莨菪类药、氯丙嗪及镇静类药,使患者在睡眠中度过戒断期.心电监护,观察冲击治疗期及治疗后各项症状;比较治疗前后血常规、肝功能、肾功能、心电图改变情况.对照组40例,其性别、年龄、吸毒史、末周日滥用量与实验组基本一致,对两组均进行半年随访,比较两组操守率.结果:实验组入院至冲击治疗时间平均6.35天,一次性纳曲酮冲击成功率100%,冲击治疗期有P、R加快,BP升高,但均能顺利度过戒断期.冲击治疗清醒时间平均9.69 h,术后戒断症状、药物副反应轻,消除快.对心、肝、肾、血常规没有明显影响.半年操守率,实验组30%明显高于对照组0%.结论:该法疗效肯定,安全性高,依从性好,很有临床实用价值,值得临床推广应用.     

海洛因依赖者纳曲酮治疗中合并心理行为治疗的疗效分析

海洛因依赖者一个月的复吸率95%左右,纳曲酮治疗有预防复吸的作用。我院在对海洛因依赖者纳曲酮治疗中同时加强心理行为治疗,取得了较明显的疗效。1临床资料:病例为2001年7月至2003年3月,自愿戒毒治疗的68例均符合CCMD-3海洛因依赖者的诊断标准。其中男性54例,女性14例。年龄为18～42岁,平均26±2岁,平均吸毒时间4±1年。每次吸毒量为0.5～2g。采用的纳曲酮治疗量为30～50mg/日。2方法:海洛因依赖病人在纳曲酮治疗的同时根据病人的心理渴求早期加强心理行为治疗。主要采用的方法为系统脱敏、暴露疗法,并加强其认知的矫正。具体做法是针对…     

Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men

BACKGROUND: Methamphetamine-dependent gay and bisexual men (GBM) are at high risk for HIV transmission, largely due to drug-associated sexual risk behaviors. This project evaluated the efficacy of four behavioral drug abuse treatments for reducing methamphetamine use and sexual risk behaviors among this population. METHODS: In this randomized controlled trial, 162 methamphetamine-dependent (SCID-verified) GBM in Los Angeles County were randomly assigned to one of four treatment conditions for 16 weeks: standard cognitive behavioral therapy (CBT, n=40), contingency management (CM, n=42), combined cognitive behavioral therapy and contingency management (CBT+CM, n=40), and a culturally tailored cognitive behavioral therapy (GCBT, n=40). Stimulant use was assessed thrice-weekly during treatment using urine drug screens (48 measures). Sexual risk behaviors were monitored monthly (four measures). Follow-up assessments were conducted at 6 (80.0%) and 12 months (79.9%). RESULTS: Statistically significant differences in retention (F(3,158)=3.78, p<.02), in longest period of consecutive urine samples negative for methamphetamine metabolites (F(3,158)=11.80, p<.001), and in the Treatment Effectiveness Score were observed by condition during treatment (F(3,158)=7.35, p<.001) with post hoc analyses showing the CM and CBT+CM conditions to perform better than standard CBT. GEE modeling results showed GCBT significantly reduced unprotected receptive anal intercourse (URAI) during the first 4 weeks of treatment (X2=6.75, p<.01). During treatment between-group differences disappeared at follow-up with overall reductions in outcomes sustained to 1-year. CONCLUSIONS: Among high-risk methamphetamine-dependent GBM, drug abuse treatments produced significant reductions in methamphetamine use and sexual risk behaviors. Drug abuse treatments merit consideration as a primary HIV prevention strategy for this population.     

Explanations for methamphetamine use among gay and bisexual men in New York City

Qualitative interview data from Project Tina, a formative investigation of methamphetamine use among gay and bisexual men in New York City, were used to explore the reasons men use methamphetamine. Interviews were conducted with 48 active methamphetamine users, and coding revealed that a majority of the men used the substance to enhance sexual experiences. However, usage was also related to physical needs, emotional needs, and socialization. Differential explanations were noted across participant HIV serostatus, age, and race/ethnicity. HIV seropositive men indicated significantly greater use of methamphetamine for sexual reasons, as did older respondents. HIV seronegative participants reported significantly greater use of the drug for social reasons, as did younger men. White participants were significantly more likely to use the drug for physical reasons compared to other men. These data suggest that methamphetamine use is multifaceted. Treatment programs should consider individual differences and motivations for drug use in tailoring programs.     

Body dissatisfaction and methamphetamine use among HIV-positive gay and bisexual men: a pilot study

Methamphetamine use is strongly associated with risky sex and increased reports of HIV and other sexually transmitted infections among gay and bisexual men (GBM) who attend dance/circuit parties. The psychological mechanisms underlying methamphetamine use in this subculture, however, remain unclear. These exploratory findings are from a 2004 dataset measuring body dissatisfaction and drug use among 42 HIV-positive GBM in South Florida who attended at least one bar/club/circuit party within 3 months of participating. A multivariate regression model revealed that body dissatisfaction accounted for a small but significant amount of variance in methamphetamine use. Treatment implications and recommendations for future research are discussed.     

Levels of methamphetamine use and addiction among gay,bisexual, and other men who have sex with men

Methamphetamine (MA) and poly-drug use among gay, bisexual, and other men who have sex with men (MSM) may be linked to risky sexual behaviors and the subsequent transmission of the human immunodeficiency virus. The goal of this analysis was to examine, quantify, and describe lifetime use of MA as well as MA use in the past year in relation to other substances by means of a standardized diagnostic tool, and along key socio-demographic variables. Data for this analysis were gathered from the screening assessment of a larger cross-sectional study examining MA use and psychosocial states in a sample of 215 MSM in New York City. Based on criteria set forth by the Mini International Neuropsychiatric Inventory, clinical dependence to MA was shown in 78% of participants. Of this group, over 70% were codependent on other substances, including cocaine and Ecstasy. Further, 95% of Black MSM reported MA use in the past year, of which 97% were classified as dependent. These findings suggest that MA continues to be used at significant rates among MSM and often in conjunction with other substances, and is increasingly used and abused by ethnic and racial minority MSM. Findings suggest the need for programs to address multiple drug dependence and in relation to co-occurring health problems.     

Initiation into methamphetamine use for young gay and bisexual men

Research over the past 10 years has suggested that methamphetamine use has become a significant problem and is associated with risky sexual behaviors among gay and bisexual men. In order to better understand initiation into methamphetamine use among gay and bisexual men, qualitative analyses were performed on a sample of young gay and bisexual men (ages 18–29) in New York City. Participants were recruited as part of a larger study which used time–space sampling to enroll club-going young adults who indicated recent club drug (ecstasy, ketamine, GHB, methamphetamine, cocaine, and/or LSD) use. The data for this paper are derived from the qualitative interviews of 54 gay and bisexual male methamphetamine users. At initiation (1) methamphetamine was used in a social, non-sexual setting for a majority of the participants; (2) participants expressed limited knowledge of methamphetamine; and (3) many participants used cocaine as a basis for comparison when describing various effects of the drug. The understanding that at initiation methamphetamine was not solely used as a sexual enhancement for members of this community may enable health workers to more accurately target potential users when putting forth intervention efforts. Future research should aim to gain a better understanding into the role that methamphetamine plays in non-sexual contexts, particularly among gay and bisexual men who may not be part of the club “scene.” The relationship between attitudes towards methamphetamine and other drugs, particularly cocaine, among gay and bisexual men should be explored.     

Pharmacotherapeutic agents in the treatment of methamphetamine dependence

Introduction: Methamphetamine use is a serious public health concern in many countries and is second to cannabis as the most widely abused illicit drug in the world. Effective management for methamphetamine dependence remains elusive and the large majority of methamphetamine users relapse following treatment.

Areas covered: Progression in the understanding of the pharmacological basis of methamphetamine use has provided us with innovative opportunities to develop agents to treat dependence. The current review summarizes relevant literature on the neurobiological and clinical correlates associated with methamphetamine use. We then outline agents that have been explored for potential treatments in preclinical studies, human laboratory phase I and phase II trials over the last ten years.

Expert opinion: No agent has demonstrated a broad and strong effect in achieving MA abstinence in Phase II trials. Agents with novel therapeutic targets appear promising. Advancement in MA treatment, including translation into practice, faces several clinical challenges.     

Methamphetamine use among gay men across the UK

BackgroundConcerns about gay men's methamphetamine use reflect its physical and psychological harms, and association with sexual-risk behaviour and HIV infection. Existing research suggests gay men's use in the UK is low and may be largely confined to London.MethodsCross-sectional survey of convenience sample of UK gay men.ResultsMethamphetamine was used by a significant minority of gay men in London but also in other regions. Overall, use was highest among those men aged 30–49, HIV-positive and reporting sexual-risk behaviours.ConclusionMethamphetamine was used by a significant minority of gay men in and outside London. Targeted prevention and treatment services should be developed and evaluated.     

Priorities and practices of risk reduction among gay and bisexual men in Australia who use crystal methamphetamine for sex

Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling “out of control”, and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a “counterpublic health” underpinned by forms of “sex-based sociality”, which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex.     

A double-blind,placebo-controlled study of N-acetyl cysteine plus naltrexone for methamphetamine dependence

Reducing both glutamatergic and dopaminergic drive in the nucleus accumbens may offer complementary mechanisms by which to reduce drug cravings. This 8-week study sought to examine the efficacy of a combination of a glutamate modulator, N-acetyl cysteine (NAC), plus the opioid antagonist, naltrexone, compared to placebo in the treatment of methamphetamine dependence. Thirty-one subjects with methamphetamine dependence (mean age 36.8 ± 7.12 years; 29% female) were randomly assigned in a 1:1 fashion to NAC plus naltrexone or placebo and returned for one post-baseline visit. The Penn Craving Scale was the primary outcome measure. Self-report methamphetamine use frequency and urine toxicology were secondary measures. NAC plus naltrexone failed to demonstrate statistically significant differences from placebo on primary and secondary outcomes. The current study failed to demonstrate greater efficacy for NAC plus naltrexone compared to placebo. Given the small sample size, the statistical power to detect significant effects of active treatment versus placebo was limited. The question of whether a larger, well-powered sample would have detected differences between NAC plus naltrexone and placebo deserves further examination.