Lecture 22

Lecture 22 - Lecture 22 - Treatment of Opiate Dependence...

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Lecture 22 - Treatment of Opiate Dependence Key Concepts Clinical Issues poor outcomes Lethality of heroin addiction (Hser et al., 2001) Early treatment modalities Lexington KY Results of Stimmel et al., 1977 Ultra-rapid detoxification Methadone Maintenance (MM) Treatment STUDENT PRESENTATION –– Heroin Assisted Treatment Camille Texier & Jordon Townsend
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Clinical Issues
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Retention in Outpatient Treatment at the MUHC Addictions Unit 0 20 40 60 80 100 0 20 40 60 80 100 120 140 160 180 Days of Follow Up % Remaining in Treatment BZDs Alcohol Cocaine Opiates (Paraherakis et al., 2000)
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Potential Lethality of Heroin Addiction Relatively small LD/ED ratio (about 12-15) Possible adverse effects from toxic substances “cut” with the heroin heroin use with other drugs such as cocaine Unstable levels of tolerance tied to environmental setting Possible respiratory depression from inhibition of the medulla Allergic reaction to a massive release of histamine For IVDUs there is an increased risk of HIV and/or hepatitis infections from shared and non-sterile needles Risky sex/prostitution
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A Grim Outlook Hser et al. 581 male heroin addicts followed from 1962 1964 to 1996 1997. At follow-up, 284 were dead and 242 were interviewed (mean age at interview = 57 yr). Of the 242, 20 percent tested positive for heroin (with additional 10 percent urine refusal and 14 percent incarceration, urinalysis unavailable). 22 percent drank daily and most had used illicit drugs in last year (heroin 40 %, marijuana 35%, cocaine 20%, crack 10%, amphetamines 12%) High rates of physical and mental health problems as well as criminal justice system involvement
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From Hser et al., 2001
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Treatment of Opiate Dependence Detoxification Switch to longer acting drug (e.g. methadone). Taper drug dosage on an inpatient or outpatient basis, depending on
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This note was uploaded on 04/26/2011 for the course PSYT 301 taught by Professor Kathryngill during the Winter '11 term at McGill.

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Lecture 22 - Lecture 22 - Treatment of Opiate Dependence...

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