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PubMed1988

Suicidality among opioid addicts: 2.5 year follow-up.

During a 2.5-yr follow-up of 263 opioid addicts, suicidality was examined as a predictor of outcome and as an outcome to be predicted among initially nonsuicidal addicts. Suicidality predicted poor medical, psychosocial, and substance abuse outcomes, but fewer legal problems during follow-up. Among the 218 initially nonsuicidal opioid addicts, subsequent suicidality was not associated with a history of drug overdoses, and psychosocial factors predictive of future suicidality differed from factors associated with a history of overdoses. Factors associated with overdoses included alcoholism, poor social adjustment, and legal problems, while depression, neuroticism, and family problems predicted suicidality during the subsequent 2.5 yr.

Female↗
PubMed1964

HEROIN ADDICTS.

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Heroin↗
PubMed1995

NMDA antagonist properties of the putative antiaddictive drug, ibogaine.

Both anecdotal reports in humans and preclinical studies indicate that ibogaine interrupts addiction to a variety of abused substances including alcohol, opiates, nicotine and stimulants. Based on the similarity of these therapeutic claims to recent preclinical studies demonstrating that N-methyl-D-aspartate (NMDA) antagonists attenuate addiction-related phenomena, we examined the NMDA antagonist properties of ibogaine. Pharmacologically relevant concentrations of ibogaine produce a voltage-dependent block of NMDA receptors in hippocampal cultures (Ki, 2.3 microM at -60 mV). Consistent with this observation, ibogaine competitively inhibits [3H]1-[1-(2-thienyl)-cyclohexyl]piperidine binding to rat forebrain homogenates (Ki, 1.5 microM) and blocks glutamate-induced cell death in neuronal cultures (IC50, 4.5 microM). Moreover, at doses previously reported to interfere with drug-seeking behaviors, ibogaine substitutes as a discriminative stimulus (ED50, 64.9 mg/kg) in mice trained to discriminate the prototypic voltage-dependent NMDA antagonist, dizocilpine (0.17 mg/kg), from saline. Consistent with previous reports, ibogaine reduced naloxone-precipitated jumping in morphine-dependent mice (ED50, 72 mg/kg). Although pretreatment with glycine did not affect naloxone-precipitated jumping in morphine-dependent mice, it abolished the ability of ibogaine to block naloxone-precipitated jumping. Taken together, these findings link the NMDA antagonist actions of ibogaine to a putative "antiaddictive" property of this alkaloid, its ability to reduce the expression of morphine dependence.

Animals↗
PubMed2005

Medical illness and comorbidities in drug users: implications for addiction pharmacotherapy treatment.

Providing effective medical care to those with substance use disorders can be a challenge to clinicians. In this article, we briefly summarize issues that occur frequently in the medical treatment of substance users. The focus of this article is twofold. The first is to briefly summarize common co-occurring medical illnesses in those manifesting substance use disorders with an emphasis on issues related to providing effective treatment for these diseases in this population. Using specific examples of frequently occurring comorbid medical illness in substance users, including infectious diseases (hepatitis C and HIV disease), sexually transmitted diseases, and pregnancy as examples, the complexities of medical care for this population is demonstrated. Second, this article addresses some of the difficulties encountered in pharmacotherapy aimed specifically at treatment of substance use disorders. For example, difficulties in managing concomitant opiate therapy in those requiring medications for medical illness that may have strong and adverse interactions with opiates are addressed. Adverse events reported for some substance use disorder pharmacotherapies are also highlighted. We conclude with a brief review of models of care that have been effective in addressing the needs of this challenging population that can provide additional means for enhancing the clinical care of substance users.

Antiviral Agents↗
PubMed1993

Developing educational programmes for nurses that meet today's addiction challenges.

Since undergraduate curricula have in the past offered little substance abuse content, bold and innovative educational programmes are necessary to prepare nurses for the addiction challenges of the 1990s. The University of Kansas and the American Nurses' Foundation (ANF) recently addressed the problem when they were jointly funded by the John W. and Effie E. Speas Memorial Trust to present an alcohol and other drug education project targeted to nurses practicing in the local community. 60 nurses in key clinical settings were given an opportunity to receive general information about substance abuse through two, 2-day workshops. The purposes of the project were; (1) to plan and develop materials for an alcohol and other drug abuse (AODA) curriculum for practicing nurses in a variety of clinical areas; (2) to assess the effectiveness of the programme through on-site and post-workshop participant evaluations; (3) and to refine the curriculum and materials according to evaluation data. Results indicated that participants' knowledge of AODA was significantly increased by the workshop. Attitudes also changed in two areas, permissiveness and belief in treatment interventions. Decreased permissiveness toward substance abuse persisted 3 months after the workshop indicating this may be a lasting change. The conclusion is that education can lead to a change in knowledge and attitudes toward substance abuse.

Curriculum↗
PubMed2002

Correlates of HIV transmission risk factors and considerations for interventions in homeless, chemically addicted and mentally ill patients.

A study was conducted to ascertain correlates of HIV high risk behaviors and attitudes toward HIV. A questionnaire was administered to 103 men living in a modified therapeutic community (TC) for homeless, chemically addicted and mentally ill men. The psychiatric diagnoses of the sample population included psychotic disorders (48%), depressive disorders (36%), and bipolar disorders (16%). Forty-two percent reported that their primary substance of abuse was cocaine and another 40% named alcohol as the substance to which they were most addicted. Two logistic regression analyses were conducted, one with needle sharing as the outcome measure and one with endorsement of the need for lifestyle changes to reduce risk of HIV transmission. Cocaine users were 3.4 times more likely to have shared needles than the rest of the sample. Patients who had a history of sexually transmitted diseases (STDs) were 17 times more likely to endorse the need for lifestyle changes. The level of HIV transmission knowledge was unrelated to HIV risk behaviors or attitudes.

Adolescent↗