Naltrexone for alcohol-dependent patients

Background Clinical trials have shown that naltrexone 50mg/day reduces alcohol consumption and relapse rates in alcohol dependents. Aim To investigate the efficacy of 50mg/day dose of naltrexone in the maintenance of alcohol-dependent subjects over a 36-week treatment period. Methods Subjects were randomised into two equal groups, consisting of 116 male alcohol-dependent patients who met the DSM-IV criteria for alcohol dependence and were seeking treatment. The participants received naltrexone or placebo at a dose of 50mg/day and were treated in an outpatient clinic, offering a weekly 0.5-hour individual counselling session. Days retained in treatment were measured. Results Forty-one participants (35.3%) completed the 36-week study. Completion rates by group were 44.8% for the 50mg naltrexone group and 25.9% for the placebo group (_x2=4.56, DF=1, 2-sided significance=0.033). Conclusion The results support the efficacy and safety of naltrexone for outpatient treatment of alcohol-dependent individuals in Iran.     

Methadone versus buprenorphine maintenance for the treatment of heroin-dependent outpatients

The aim of this study was to assess the efficacy of methadone compared with buprenorphine maintenance therapy in heroin-dependent patients over a treatment period of 18 weeks. Subjects were randomized to receive either methadone or buprenorphine in a comparative double-blind study and consisted of 164 heroin-dependent male patients who met the DSM-IV criteria for heroin dependence and were seeking treatment. The 164 subjects included 41 patients in 1-mg, 41 patients in 3-mg, and 41 patients in 8-mg dosage group of buprenorphine, and also 41 patients in the 30-mg dosage group of methadone. The mean age was 31.4 years for total buprenorphine group and 33.7 years for methadone group (the mean age differences in 4 groups were not statistically significant). Subjects received buprenorphine at a dose of 1, 3, or 8 mg per day or methadone at a dose of 30 mg per day and were treated in an urban outpatient clinic, offering a 1-hour weekly individual counseling session. Days retained in treatment were measured. Completion rates by buprenorphine dosage group were 29.3% for the 1-mg dose group, 46.3% for the 3-mg dose group, 68.3% for the 8-mg dose group, and 61% for the 30-mg methadone dose group. Retention in the 8-mg dose group was significantly better than in the 1-mg dose group (p=.00041) and in the 3-mg dose group (p=.045); other comparison (1 mg dose with 3 mg dose) was not significant. Methadone group was significantly better than 1mg buprenorphine dose group (p=.004), but was not significantly different from 3 mg buprenorphine dose group (p=.18) or 8 mg buprenorphine dose group (p=.49). The results support the efficacy of buprenorphine for outpatient treatment of heroin dependence and seem to indicate that the highest dose (8 mg) of buprenorphine was the best of the three doses of buprenorphine, and also support the superiority of 30 mg of methadone compared to 1 mg dose of buprenorphine for Iranian heroin-dependent patients to increase their retention in treatment.     

Controlled trial of maintenance treatment of intravenous buprenorphine dependence

Background Buprenorphine dependence is a relatively novel addiction. Aims To compare the treatment outcome in three groups over 12-weeks of treatment. Methods Two hundred and four intravenous (IV)-buprenorphine-dependent patients were randomised into three groups. Subjects received 50mg oral methadone tablet, or 5mg sublingual buprenorphine tablet, or 50mg oral naltrexone, and a weekly 30-minute clinical counselling session. Results The majority (80%) had a history of opium or heroin dependency before they were introduced to IV buprenorphine. The main source of buprenorphine for misusers was street sale (91%). The mean duration of buprenorphine dependence was 1.9 years and the mean dose per day was 3.9 ampoules (1 ampoule contains 0.3mg of buprenorphine in 1ml). Overall 59% of the patients completed the 12-week study. Retention in the 50mg methadone group was significantly better than the 5mg dose buprenorphine group (p=0.001) and the 50mg dose naltrexone group (p=0.000). Retention in the 5mg buprenorphine group was significantly better than the 50mg naltrexone dose group (p=0.000). Conclusions These results support the efficacy and safety of oral methadone and sublingual buprenorphine tablets for injection buprenorphine-dependent patients.     

Adult supraglottitis subsequent to smoking crack cocaine

Supraglottitis is one possible complication of smoking crack cocaine. From 1992 through 2001, our institution treated nine patients for thermal supraglottitis secondary to crack cocaine inhalation. In this article, we describe two of these cases, and we briefly review what is known about this entity and the mechanism of injury. We also provide our recommendations for management.     

Rocking sexualities: Iranian migrants' views on sexuality

The purpose of this article is to put forward a theoretical discussion about Islamic views of sexuality and by means of an example show how Iranian immigrants in Sweden view sexuality and sexual culture. Building on theories that compare individualistic and holistic ways of thinking, the article seeks to elucidate the impact of basic cultural qualities on the formation of sexualities. The conclusion of the article is that the encounter with the Swedish way of thinking and the Swedish sexual culture seems to have influenced Iranian migrants' views on the nature of the relationship between couples and sexual decision making within the relationship. Exposed to an individualistic ideology and lifestyle in Sweden, Iranian migrants show a clear tendency to revise their previous holistic way of thinking, especially in regard to sexuality: the traditional, authoritarian, patriarchal sexual relationship among Iranian migrants in Sweden is giving way to more egalitarian relationships, and a relatively strong tendency towards a similarity of views between the sexes regarding sexuality can be observed. The most important change that could be observed in regard to the respondents in the study is probably an increased individualism.     

Modulation of synaptic transmission by nociceptin/orphanin FQ and nocistatin in the spinal cord dorsal horn of mutant mice lacking the nociceptin/orphanin FQ receptor

Nociceptin/orphanin FQ (N/OFQ) and nocistatin (NST) are two neuropeptides derived from the same precursor protein that exhibit opposing effects on spinal neurotransmission and nociception. Here, we have used whole-cell, patch-clamp recordings from visually identified neurons in spinal cord dorsal horn slices of genetically modified mice to investigate the role of the N/OFQ receptor (N/OFQ-R) in the modulatory action of both peptides on excitatory glutamatergic and inhibitory glycinergic and gamma-aminobutyric acid (GABA)-ergic synaptic transmission. In wild-type mice, N/OFQ selectively suppressed excitatory transmission in a concentration-dependent manner but left inhibitory synaptic transmission unaffected. In contrast, NST reduced only inhibitory but not alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor-mediated excitatory synaptic transmission. N/OFQ-mediated inhibition of excitatory transmission was completely absent in N/OFQ-R receptor-deficient (N/OFQ-R(-/-)) mice and significantly reduced in heterozygous (N/OFQ-R(+/-)) mice, whereas the action of NST on inhibitory neurotransmission was completely retained. To test for the relevance of these results for spinal nociception, we investigated the effects of intrathecally injected N/OFQ in the mouse formalin test, an animal model of tonic pain. N/OFQ (3 nmol/mouse) induced significant antinociception in wild-type mice, but had no antinociceptive effects in N/OFQ-R(-/-) mice. These results indicate that the inhibitory action of N/OFQ on excitatory glutamatergic synaptic transmission and its spinal antinociceptive action are mediated via the N/OFQ receptor, whereas the action of NST is independent of this receptor.