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Biomedical subjects

Helge Waal

Publications and source records attributed to Helge Waal.

12 recordsLinked to original sources
PubMed2006

Abstinence-orientated buprenorphine replacement therapy for young adults in out-patient counselling.

This study assessed treatment retention, compliance and completion of a 9-month buprenorphine replacement programme. In addition, changes in drug use and other relevant variables, as well as predictors of completion, were examined. Seventy-five opioid-dependent out-patients (mean age 26 years; 33% females) who aimed for opioid abstinence were enrolled into the study. Assessments were undertaken prior to buprenorphine induction and again at 3, 6 and 9 months. Forty patients (53%) completed the buprenorphine programme. At 9 months, 67 patients (87%) were still in counselling. Mean attendance rates for buprenorphine dosing and counselling sessions were 0.91 and 0.74, respectively. There were significant and persistent reductions in drug use during treatment with, however, a reversed tendency in the 9th month. Psychiatric problems escalated at 9 months, and three patients died during the detoxification phase. Completion was predicted by fewer previous treatment episodes. Detoxification from buprenorphine is associated with substantial psychological distress and an increased death risk. Buprenorphine replacement therapy should be continued until the patient chooses to leave, and close monitoring during the detoxification phase is essential.

Adult↗
PubMed2006

Naltrexone implants -- duration, tolerability and clinical usefulness. A pilot study.

Naltrexone blocks opioid effects effectively, but poor compliance limits the clinical usefulness in the treatment of opioid dependence. Long-acting implanted formulations might increase the clinical feasibility. Several implants have been produced, but few clinical reports have been published. This paper describes an open trial with an Australian implant. This implant is claimed to have duration of up to six months with double implants and acceptable levels of side effects. This was explored in the present pilot study with 13 opioid-dependent patients. By single implant of 1.8 g naltrexone the duration judged by naltrexone plasma levels above 1 ng/ml naltrexone was between 2 and 4 months. Double implants maintained such plasma levels for 5-6.5 months. Clinically, the implants appeared promising. Side effects were minimal. During the period with adequate plasma levels of naltrexone, use of opioids was absent and use of other psychoactive drugs reduced. At 1-year follow-up, the patients rated the implants highly positively.

Drug Implants↗
PubMed2005

From opioid maintenance to abstinence: a literature review.

It appears that the literature on agonist maintenance therapies for opioid dependence pays more attention to outcomes during, rather than after, treatment. This review aims to (a) estimate to what extent opioid abstinence can be expected from former maintenance patients, (b) examine possible relationships between patient and treatment characteristics and abstinence rates and (c) assess the need for research in the field of abstinence-orientated maintenance treatment in general, and time-limited buprenorphine maintenance treatment in particular. Database searches supplemented by cross-references resulted in 12 studies included in the review. The studies were mostly naturalistic follow-up studies of former methadone maintenance patients, authored by US researchers in the 1970s. Buprenorphine was used in only one of the studies, and then as a transition between methadone and abstinence. There were considerable variations in definition and assessment of abstinence. Pooled abstinence rates ranged from 22% to 86%. The single factor associated most frequently with abstinence was voluntary participation in detoxification programmes with eligibility criteria ('therapeutic detoxification'). When 'therapeutic detoxification' was compared to 'non-therapeutic detoxification' the pooled abstinence rates were 48% and 22%, respectively. Abstinence-orientated maintenance therapy may be suitable for a subgroup of patients, but there is a substantial need for research updates.

Buprenorphine↗
PubMed2004

[Routine ECG in methadone-assisted rehabilitation is wrong prioritization].

The Norwegian Medicines Agency has recently reported dose-dependent QT prolongation and occurrence of Torsades des pointes in patients treated with methadone; the agency recommends that an ECG is taken before induction to methadone. We have performed a literature search in Medline and Embase. QT prolongation in methadone therapy is dose-dependent and primarily seen with doses higher than those usually used in maintenance therapy and/or in cases with known risk factors. Routine ECG should not be recommended, but before starting therapy the physician should secure an adequate case history including information on any family history of cardiac disease and other risk factors. ECG is recommended when doses higher than 130 mg/day are used or the serum concentration level exceeds 1200 nmol/l. QTc prolongation above 470 msek should be reported to the authors.

Dose-Response Relationship, Drug↗
PubMed2004

[Methadone dose, treatment duration and heroin use in drug-assisted rehabilitation].

BACKGROUND: Medication-assisted rehabilitation is established as a nationwide treatment option for opioid addicts. MATERIAL AND METHOD: A pilot study using a recently developed evaluation inventory was conducted in the autumn of 2001. Data on 303 methadone patients from the eastern health region formed the basis of evaluation. RESULTS: The sample mean methadone dose was 111 mg, with a lower dosage level in Oslo than in the other counties. On average, the patients had been treated for 22.4 months. 125 (41%) patients had used non-prescribed opioids the last four weeks. Use of heroin was more prevalent among the Oslo patients (49%) than in the other counties (24%). Heroin use was significantly associated with geography, sex (higher prevalence among men) and methadone dose (higher prevalence at methadone doses < or = 105 mg). There was a negative relationship between treatment duration and use of heroin among the Oslo patients. INTERPRETATION: In an international perspective, this sample has a generally high dosage level, long treatment duration and good treatment outcomes. Heroin abstinence is more difficult to achieve in Oslo than in the rest of the region, especially in the early phases of treatment.

Adult↗
PubMed2004

Plasma concentrations during naltrexone implant treatment of opiate-dependent patients.

AIMS: To evaluate individual variations in plasma concentrations over time in patients with naltrexone implants. METHODS: Ten opioid-dependent patients received up to four implants. Plasma samples were collected regularly for the analyses of naltrexone and the metabolite beta-naltrexol. RESULTS: The median naltrexone C(max) was 12.3 (range 5.8-22.1) ng ml(-1), the median T(max) was 1 day (range 3 h to 35 days), and the median length of time that plasma concentrations were above 1 ng ml(-1) was 55 (range 30-80) days. Two patients reported heroin use without experiencing any effect. Tissue reactions were recorded in two patients after repeated implantation. CONCLUSION: Marked individual and intraindividual variations in naltrexone concentrations were observed. Further studies should be performed to evaluate the need for therapeutic drug monitoring during naltrexone implant treatment.

Adult↗
PubMed2003

[Naltrexone implants--a pilot project].

BACKGROUND: An increasing number of Norwegian heroin addicts have had naltrexone implants abroad without proper documentation. The authors established a joint project to study duration and safety. MATERIAL AND METHODS: Methodology to measure naltrexone in plasma was developed. 10 patients had 21 implants. Plasma samples were collected before, one and three hours after implantation, daily for one week, then weekly. Patient satisfaction, side effects and unwanted medical events were recorded. RESULTS: Patients had a protective level of naltrexone for 35-80 days. Side effects were few. Two patients had abstinence reactions caused by insufficient detoxification. Two patients had their repeat implants removed because of tissue reactions. One patient developed hepatitis C infection in the second week after implantation. One had transient increase in transaminases after heavy multi-drug use. The others were without signs of hepatic toxicity. INTERPRETATION: Use of implants secures a prolonged period of naltrexone protection. Implants are mostly well tolerated, but tissue reactions to repeat implants could be a problem. Evaluation of the patients should be thorough and the treatment integrated in a competent follow up.

Adult↗
PubMed2003

[Use of naltrexone in the treatment of young drug addicts].

BACKGROUND: The study explores the use of naltrexone as an adjuvant therapy for psychosocial treatment in a unit for young heroin addicts with frequent relapses. MATERIAL AND METHOD: Naltrexone was introduced through discussions in the therapeutic community. 16 patients elected to participate in a six-month trial. Side effects were recorded daily, then weekly, and patient reactions by weekly self-ratings. At end point patient and counsellor independently scored estimated utility. The group was followed up at four years. RESULTS AND INTERPRETATION: Staff and patients developed an increasing degree of consensus during the project. Naltrexone is a useful adjuvant therapy. Several short-term goals were reached; side effects were minimal. Four out of 16 patients completed the full six-month treatment. 11 patients judged the use of naltrexone as somewhat or very positive. Therapists judged naltrexone to be beneficiary for 10. At four years follow up, six patients were rehabilitated without illegal substance use and two were substantially improved. Four of these were, however, on methadone maintenance. Naltrexone is useful as an adjuvant therapy to increase therapeutic potency in comprehensive therapeutic units for heroin addicts. The long-term effects are limited. Therapeutic units for heroin addicts should integrate both agonists and antagonists in their psychosocial programs.

Adult↗
PubMed2003

[Naltrexone in the treatment of addiction].

BACKGROUND: Naltrexone is a well-known opioid antagonist that has attracted increased attention with respect to new techniques in detoxification, methods for improving compliance, and new indications. Naltrexone 50 mg Revia recently obtained registration in Norway as a pharmaceutical product. A review of its pharmacological properties and documentation of clinical use is merited. METHODS: Basic neurobiological descriptions are cited from review publications. In addition, Medline, Embase and the Cochrane library have been searched for evidence-based evaluations. RESULTS AND INTERPRETATION: The basic antagonist effect is proven beyond doubt. Clinical dosages give few and moderate side effects. The drug's two properties, blocking for exogenic opioid and modulating the endogenic opioid system, are both therapeutically useful. Its use in the treatment of heroin addiction is hampered by poor compliance; this might be improved by formulations with prolonged duration or by special therapeutic techniques. Usefulness in treatment of alcohol problems is documented but effect size is moderate and partly dependent on psychosocial therapeutic techniques. There is interesting but undocumented reports on usefulness with nicotine and cocaine addiction, with gambling problems, in impulsive behaviour and in several other areas.

Adult↗
PubMed2002

[Buprenorphine as maintenance treatment in rehabilitation of heroin addicts].

BACKGROUND: Buprenorphine is used for maintenance treatment of opiate abusers. METHOD: A literature review was carried out in order to describe buprenorphine's pharmacology, its clinical use in maintenance treatment, and its efficacy when compared to methadone. RESULTS: Buprenorphine is a partial agonist to the opiate mu-receptor and is therefore safer in overdose. The distress of abstinence is reduced compared to methadone. The potential for abuse is, however, considerable. Some patients may not be maintained well enough on buprenorphine. INTERPRETATION: Buprenorphine should be subject to the same considerations in maintenance treatment as methadone.

Buprenorphine↗