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Open-label maintenance study with buprenorphine in pregnant opiate addicts
17.5Addiction
$340
The onset of clinical NAS symptoms was earliest in babies delivered by mothers maintained on slow-release morphine with a mean onset of 33.2 hours post delivery, followed by neonates exposed to buprenorphine (34.3 hours after delivery) and neonates exposed to methadone (57.5 hours after delivery). With regard to dtwation of NAS the three treatment groups differed significantly (~2 = 16.935; p = 0.000). This global significance is primarily due to the very short withdrawal duration of 1.3 days in babies delivered by mothers maintained on buprenorphine. Conclusion: Opioid maintenance therapy with methadone, slowrelease morphine and buprenorphine is safe and efficacious in pregnant women and their fetus. A short treatment duration of the infants implies a short separation from the mother, therefore emphasis should be put on further research of maintenance agents that result in a less prolonged NAS in addition to good retention and low concomitant consumption.
References [1] Fischer, G., Etzersdorfer, G., Eder, H., Jagsch, R., Langer, M. & Weninger, M. (1998). BuprenorphineMaintenance in Pregnant Opiate Addicts. European Addiction Research, 4, S 1: 32-36. [2] Fischer, G., Eder, H., Jagsch, R., Lenkia, C., Habeler, A., Aschauer, H.N. & Kasper, S. (1998). Maintenance therapy with synthetic opioids within a multidisciplinary program - A stabilizing necessity for pregnant opioid dependent women. Archives of Womens Mental Health, 1:109-116. [3] Fischer, G., Jagsch, R., Eder, H., Gombas, W., Etzersdorfer, P., SchinidlMohl, K., Schatten, C., Weninger, M. & Aschauer, H. (1999). Comparison of methadone and slow-release morphine maintenance in pregnant addicts. Addiction, 94 (2): 231-239.
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Open-label maintenance study with buprenorphine in pregnant opiate addicts
G. Fischer 1, H. Eder 1, R. Jagsch 2, A. Peternell 1, M. Weninger3, M. Langer4, H.N. Aschauer 1. t Dept. of General Psychiatry; 21nst. of Psy-
chology; 3Dept. of Neonatology; *Dept. of Gynecology & Obstetrics, University of Vienna, Austria Aims: To assess the maternal and fetal safety and neonatal abstinence syndrome (NAS) in neonates born to buprenorphine maintained mothers. Design: Open-label, flexible dosing, inpatient induction with outpatient maintenance. Setting: The study was conducted at the university of Vienna pregnancy and drug addiction program. Participants: Fifteen opioid dependent pregnant women. Intervention: Sublingual buprenorphine tablets and oxazepam for sedation during induction. Measurements: Patient self-report on nicotin consumption (Fagerstrrm Scale), addiction severity index (ASI), blood chemistries, urine toxicology, CTG, sonogram, mammal withdrawal (Wang scale) and neonatal withdrawal symptomatology (Finnegan Scale.) and birth outcome measures. Findings: All subjects were opioid, nicotine and cannabis dependent. Buprenorphine was well tolerated during pregnancy as assessed by self report (Wang Score < 4) and effectiveas measured by urine toxicology (91% opioid negativ). All maternal, fetal and neonatal safety laboratory measures were within normal limits or not of clinical significance. Mean birth outcome measures including: gestional age at delivery (39.6 weeks; SD 4- 1.5), Apgar scores (1 min = 8.9, SD + 0.6; 5 min = 9.9, SD 40.3; and 10 min = 10, SD 4- 0), birth weight (3049 grams; SD ± 346), length (49.8 cm; SD 4- 1.9) and head circumference (34.1 cm; SD 41.8) were within normal limits. Fifiteen healthy neonates were born with absent, mild (without treatment), and moderate (with treatment) NAS in eight, four and three cases, respectively. The two main symptoms of withdrawal were tremor and hyperreflexia. Conclusions: Buprenorphine is safe and efficacious in opioid dependent pregnant women and their children. The partial opiate agonist profile (high affinity with low intrinsic activity at the mu receptor) of buprenorphine may account for the mild NAS observed in the neonates. No positive correlation in regard to mean daily dose at delivery and intensity of NAS was detected. Double-blind, double-dummy studies need to be undertaken to confirm our observation.
References [1] Fischer, G., Eder, H., Jagsch, R., Lennkh, C., Habeler, A., Aschaner, H.N., Kasper, S. (1998) Maintenance therapy with sybthetic opiods within a multidisciplinary program - A stabilizing necessity for pregnant opioid dependent women. Archives of Womens Mental Health 1: 109-116 [2] Fischer, G., Jagsch, R., Eder, H., Gombas, W., Etzersdorfer, P., SchmidlMohl, K., Schatten, C., Weninger, M., Aschaner, H.N. (1999) Comparison of methadone and slow-release morphine maintenance in pregnant addicts. Addiction 94 (2), 231-239
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Licit and illicit substance use among delinquent and non-delinquent alcoholics: preliminary report
J. Liappas, E. Peppas, T. Paparrigopoulos, G.N. Christodoulou. Athens
University Medical school Department of Psychiatry, Eginition Hospital"ATHENA"program Athens, Greece Objective: The aim of this study is to investigate the differences in licit and illicit substance use between delinquent and non-delinquent Greek alcoholics. Material-Method: The sample consisted of 127 alcoholics; 29 delinquents and 98 non-delinquents. All subjects fulfilled the DSM-III-R criteria for alcohol abuse/dependence. Sociodemographic, psychological, behavioral characteristics criminal activities and licit and illicit substance use (13 classes of medical and non-medical substances) were investigated through a structured interview. For the statistical analysis the x 2 and Mann-Whitney U test were used. Results: The mean age of delinquent and non-delinquent alcoholics was 41.8 4- 11.1 and 42.2 4- 12.1 years respectively. The majority of subjects were males. The age at onset of alcohol use in delinquent and non-delinquent was 17.5 4- 7.1 and 21.5 4- 8.6 years respectively (p = 0.001). In the delinquent group delinquency was not related to arrests and convictions for drugs and activities against property. As far as criminal activities are concerned the delinquent group reported 6.3% arrests and 1.6% conviction respectively related to drugs and activities against property, while 23.6% and 1.1% respectively for crimes of violence and other reasons. Coexistent consumption of various psychoactive substances was 62.1% in the delinquent and 19.4% in the non-delinquent group (p = 0.015). Significant differences were observed in the lifetime prevalence between the delinquent and non-delinquent groups concerning their "experimentation" with various non prescribed psychoactive substances i. e. sedative BZD (p = 0.02), hypnotics (p = 0.0009), analgesics (p = 0.04), opium/opiates (p = 0.02), atropine - like drugs (0.000), cannabis (p = 0.000), cocaine (p = 0.04), heroin (p = 0.0007), hallucinogens (p = 0.002) and volatile - inhalants (p = 0.007). There was no difference in the consumption of antidepressants, barbiturates, amphetamines and alcohol between groups. Furthermore during the past year the delinquent group "experimented" with all classes of psychoactive drugs than nondelinquents but only experimentation with cannabis significant difference (p = 0.039). During the past month no statistical difference was found,, in the use between the two groups except for sedative BZD (p = 0.04). Conclusion: Delinquent alcoholics report "experimentation" with various psychoactive substances much more frequently than non-delinquent alcohol abusers. However, delinquency was not related to arrests and convictions for drugs and activities against property.
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Attitudes of users, ex-users and professional workers about drug addiction phenomenon
J. Liappas, E. Mellos, P. Papavasiliou, G.N. Christodoulou. Athens
University Medical school Department of Psychiatry, Eginition Hospital, "ATHENA" program Athens, Greece This study aims at investigating the attitudes of a sample of users, exusers and professional workers, working in the field of substance abuse, towards the nature and the etiology of drug addiction phenomenon. A structured questionnaire were completed by a sample of 120 Greek users (U) and 84 ex-users (EU), randomly selected from the outpatient drug free drug addiction clinic of Athens University psychiatric unit. An
$340
The onset of clinical NAS symptoms was earliest in babies delivered by mothers maintained on slow-release morphine with a mean onset of 33.2 hours post delivery, followed by neonates exposed to buprenorphine (34.3 hours after delivery) and neonates exposed to methadone (57.5 hours after delivery). With regard to dtwation of NAS the three treatment groups differed significantly (~2 = 16.935; p = 0.000). This global significance is primarily due to the very short withdrawal duration of 1.3 days in babies delivered by mothers maintained on buprenorphine. Conclusion: Opioid maintenance therapy with methadone, slowrelease morphine and buprenorphine is safe and efficacious in pregnant women and their fetus. A short treatment duration of the infants implies a short separation from the mother, therefore emphasis should be put on further research of maintenance agents that result in a less prolonged NAS in addition to good retention and low concomitant consumption.
References [1] Fischer, G., Etzersdorfer, G., Eder, H., Jagsch, R., Langer, M. & Weninger, M. (1998). BuprenorphineMaintenance in Pregnant Opiate Addicts. European Addiction Research, 4, S 1: 32-36. [2] Fischer, G., Eder, H., Jagsch, R., Lenkia, C., Habeler, A., Aschauer, H.N. & Kasper, S. (1998). Maintenance therapy with synthetic opioids within a multidisciplinary program - A stabilizing necessity for pregnant opioid dependent women. Archives of Womens Mental Health, 1:109-116. [3] Fischer, G., Jagsch, R., Eder, H., Gombas, W., Etzersdorfer, P., SchinidlMohl, K., Schatten, C., Weninger, M. & Aschauer, H. (1999). Comparison of methadone and slow-release morphine maintenance in pregnant addicts. Addiction, 94 (2): 231-239.
•
Open-label maintenance study with buprenorphine in pregnant opiate addicts
G. Fischer 1, H. Eder 1, R. Jagsch 2, A. Peternell 1, M. Weninger3, M. Langer4, H.N. Aschauer 1. t Dept. of General Psychiatry; 21nst. of Psy-
chology; 3Dept. of Neonatology; *Dept. of Gynecology & Obstetrics, University of Vienna, Austria Aims: To assess the maternal and fetal safety and neonatal abstinence syndrome (NAS) in neonates born to buprenorphine maintained mothers. Design: Open-label, flexible dosing, inpatient induction with outpatient maintenance. Setting: The study was conducted at the university of Vienna pregnancy and drug addiction program. Participants: Fifteen opioid dependent pregnant women. Intervention: Sublingual buprenorphine tablets and oxazepam for sedation during induction. Measurements: Patient self-report on nicotin consumption (Fagerstrrm Scale), addiction severity index (ASI), blood chemistries, urine toxicology, CTG, sonogram, mammal withdrawal (Wang scale) and neonatal withdrawal symptomatology (Finnegan Scale.) and birth outcome measures. Findings: All subjects were opioid, nicotine and cannabis dependent. Buprenorphine was well tolerated during pregnancy as assessed by self report (Wang Score < 4) and effectiveas measured by urine toxicology (91% opioid negativ). All maternal, fetal and neonatal safety laboratory measures were within normal limits or not of clinical significance. Mean birth outcome measures including: gestional age at delivery (39.6 weeks; SD 4- 1.5), Apgar scores (1 min = 8.9, SD + 0.6; 5 min = 9.9, SD 40.3; and 10 min = 10, SD 4- 0), birth weight (3049 grams; SD ± 346), length (49.8 cm; SD 4- 1.9) and head circumference (34.1 cm; SD 41.8) were within normal limits. Fifiteen healthy neonates were born with absent, mild (without treatment), and moderate (with treatment) NAS in eight, four and three cases, respectively. The two main symptoms of withdrawal were tremor and hyperreflexia. Conclusions: Buprenorphine is safe and efficacious in opioid dependent pregnant women and their children. The partial opiate agonist profile (high affinity with low intrinsic activity at the mu receptor) of buprenorphine may account for the mild NAS observed in the neonates. No positive correlation in regard to mean daily dose at delivery and intensity of NAS was detected. Double-blind, double-dummy studies need to be undertaken to confirm our observation.
References [1] Fischer, G., Eder, H., Jagsch, R., Lennkh, C., Habeler, A., Aschaner, H.N., Kasper, S. (1998) Maintenance therapy with sybthetic opiods within a multidisciplinary program - A stabilizing necessity for pregnant opioid dependent women. Archives of Womens Mental Health 1: 109-116 [2] Fischer, G., Jagsch, R., Eder, H., Gombas, W., Etzersdorfer, P., SchmidlMohl, K., Schatten, C., Weninger, M., Aschaner, H.N. (1999) Comparison of methadone and slow-release morphine maintenance in pregnant addicts. Addiction 94 (2), 231-239
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Licit and illicit substance use among delinquent and non-delinquent alcoholics: preliminary report
J. Liappas, E. Peppas, T. Paparrigopoulos, G.N. Christodoulou. Athens
University Medical school Department of Psychiatry, Eginition Hospital"ATHENA"program Athens, Greece Objective: The aim of this study is to investigate the differences in licit and illicit substance use between delinquent and non-delinquent Greek alcoholics. Material-Method: The sample consisted of 127 alcoholics; 29 delinquents and 98 non-delinquents. All subjects fulfilled the DSM-III-R criteria for alcohol abuse/dependence. Sociodemographic, psychological, behavioral characteristics criminal activities and licit and illicit substance use (13 classes of medical and non-medical substances) were investigated through a structured interview. For the statistical analysis the x 2 and Mann-Whitney U test were used. Results: The mean age of delinquent and non-delinquent alcoholics was 41.8 4- 11.1 and 42.2 4- 12.1 years respectively. The majority of subjects were males. The age at onset of alcohol use in delinquent and non-delinquent was 17.5 4- 7.1 and 21.5 4- 8.6 years respectively (p = 0.001). In the delinquent group delinquency was not related to arrests and convictions for drugs and activities against property. As far as criminal activities are concerned the delinquent group reported 6.3% arrests and 1.6% conviction respectively related to drugs and activities against property, while 23.6% and 1.1% respectively for crimes of violence and other reasons. Coexistent consumption of various psychoactive substances was 62.1% in the delinquent and 19.4% in the non-delinquent group (p = 0.015). Significant differences were observed in the lifetime prevalence between the delinquent and non-delinquent groups concerning their "experimentation" with various non prescribed psychoactive substances i. e. sedative BZD (p = 0.02), hypnotics (p = 0.0009), analgesics (p = 0.04), opium/opiates (p = 0.02), atropine - like drugs (0.000), cannabis (p = 0.000), cocaine (p = 0.04), heroin (p = 0.0007), hallucinogens (p = 0.002) and volatile - inhalants (p = 0.007). There was no difference in the consumption of antidepressants, barbiturates, amphetamines and alcohol between groups. Furthermore during the past year the delinquent group "experimented" with all classes of psychoactive drugs than nondelinquents but only experimentation with cannabis significant difference (p = 0.039). During the past month no statistical difference was found,, in the use between the two groups except for sedative BZD (p = 0.04). Conclusion: Delinquent alcoholics report "experimentation" with various psychoactive substances much more frequently than non-delinquent alcohol abusers. However, delinquency was not related to arrests and convictions for drugs and activities against property.
•
Attitudes of users, ex-users and professional workers about drug addiction phenomenon
J. Liappas, E. Mellos, P. Papavasiliou, G.N. Christodoulou. Athens
University Medical school Department of Psychiatry, Eginition Hospital, "ATHENA" program Athens, Greece This study aims at investigating the attitudes of a sample of users, exusers and professional workers, working in the field of substance abuse, towards the nature and the etiology of drug addiction phenomenon. A structured questionnaire were completed by a sample of 120 Greek users (U) and 84 ex-users (EU), randomly selected from the outpatient drug free drug addiction clinic of Athens University psychiatric unit. An