Women have been the focus of a great deal of research on opiate addiction and treatment because their gender is assumed to matter for their experiences in the drug world. Much of this has focused on women's experiences as mothers and caregivers. While men are often included as subjects in research on opiate addiction and treatment, their experiences as gendered beings are rarely analyzed. This research foregrounds men's gendered experiences as fathers, family members, and partners while in methadone maintenance treatment. Using data from addiction history interviews with 33 opiate-dependent men recruited from a single methadone clinic in Arizona, I find that men assign considerable significance to their family relationships. The men interviewed report that their experiences as fathers, grandfathers, sons, grandsons, brothers, husbands, and boyfriends both motivate them to seek methadone treatment for opiate addiction, and cause stress that sometimes pushes them to use or relapse on opiates. Given the importance of these men's family relationships, I argue that the marginalized masculinity of impoverished, drug-dependent men includes an ethic of care. Additionally, I argue that counselors in methadone clinics should consider men in the context of their family relationships in order to provide better treatment to men struggling to recover from opiate addiction.

Opioid abuse and addiction affects more than 2.4 million people in the United States. Medication assisted treatment (MAT), in combination with counseling, is recognized as the most effective treatment for patients with opioid dependence and abuse. Although MAT is considered the most effective treatment, previous research has found clinically significant weight gain with methadone. The purpose of this study was to determine if hedonic eating behaviors, sugar cravings, and addictive like eating was related to weight gain in opioid addicted patients receiving methadone and buprenorphine/naloxone (Suboxone™). Hedonic eating behaviors were measured using three validated surveys. Following survey collection, a chart review was completed to determine weight changes over time. One hundred twenty surveys were completed and 113 were analyzed. No differences were found between the medication groups in terms of mean age, weight at entry, BMI at entry, race, sex, and Hepatitis C status. A subset of 39 participants was analyzed for weight changes during treatment. There were no differences in food addiction scores, hedonic eating behaviors, and food cravings between the medication groups. We found significant weight gain in patients receiving methadone and no weight changes for those receiving Suboxone™. Weight gain in methadone maintenance does not appear to be related to addictive like eating, food craving, or hedonic eating. This research suggests that weight gain seen in methadone maintenance for opioid addiction treatment is related to something other than hedonic eating behaviors. Clinically significant weight gain should be considered when prescribing methadone for opioid addiction.

Submitted by Jorge Silva (jorgelmsilva@ufrrj.br) on 2017-02-17T18:21:05Z No. of bitstreams: 1 2015 - Renato Le?o S? de Oliveira.pdf: 1042208 bytes, checksum: 36444539adfac13a4589cce19eb24182 (MD5) / Made available in DSpace on 2017-02-17T18:21:05Z (GMT). No. of bitstreams: 1 2015 - Renato Le?o S? de Oliveira.pdf: 1042208 bytes, checksum: 36444539adfac13a4589cce19eb24182 (MD5) Previous issue date: 2015-08-20 / This study was developed in the Veterinary Hospital from UFRRJ. Forty cats, from the neutering program of our institution, were enrolled in this study. Cats were classified as ASA I or II to be accepted. The aim of this study was to verify the influence of the induction rate on the propofol requirement. We also aimed to quantify the propofol sparing effect of methadone and the incidence of side effects in these situations. Animals were randomly assigned to one of two premedication groups, receiving acepromazine (0,05 mg.kg-1) associated with saline (0,03 mL.kg-1) or methadone (0,3 mg.kg-1). Sedation scores were assessed 15 and 30 minutes after premedication using two scales (SDS and VAS). After the sedation assessment, animals were divided randomly in two more groups: fast (5 mg.kg-1.min-) or slow (1,5 mg.kg-1.min-1) induction rate. Sedation scores did not differed between groups neither over time. Just a slight sedation could be observed in both groups. Cats that received induction slowly had significantly more excitement as side effect of propofol. We could not observe difference between methadone and saline on the incidence of side effects. In fast induction rate we could not observe incidence of any side effects. Cats premedicated with methadone that received fast induction rate needed 33% less propofol than those that received saline and fast induction rate. When compared with both groups in slow induction rate, the propofol sparing effect of methadone was 38% when compared with fast induction rate. There were no differences between treatments in slow induction rate. Our results show the benefit of using methadone associated with acepromazine when an adequate induction rate is used. In addition we demonstrate that overly slow induction rates can increase the incidence of side effects as well as increase the amount of anesthetics used do achieve induction. / O presente trabalho foi desenvolvido no setor de pequenos animais do Hospital Veterin?rio da UFRRJ. Foram utilizados 40 gatos provenientes do programa de controle de natalidade de c?es e gatos da institui??o. Os animais se enquadraram como ASA I ou II para serem inclu?dos no estudo. Seu objetivo foi mensurar o potencial da metadona em reduzir o requerimento de propofol para indu??o anest?sica em gatos. Al?m disso objetivou avaliar a incid?ncia de efeitos adversos durante esta indu??o e comparar o efeito de diferentes velocidades de administra??o do anest?sico sobre estas vari?veis. Os animais foram distribu?dos em dois grupos para administra??o da medica??o pr?-anest?sica, um grupo recebeu acepromazina (0,05 mg.kg-1) associada a metadona (0,3 mg.kg-1) e outro grupo recebeu a acepromazina associada a solu??o salina est?ril (0,03 mL.kg-1). Os animais tiveram seus escores de seda??o avaliados nos tempos 15 e 30 minutos ap?s a administra??o dos protocolos, atrav?s de duas escalas: uma escala descritiva simples e uma escala anal?gica visual. Posteriormente a avalia??o dos escores de seda??o os animais foram novamente divididos em dois grupos: com indu??o com propofol na velocidade de 5 mg.kg-1.min-1 ou na velocidade de 1,5 mg.kg-1.min-1. Os escores de seda??o n?o variaram significativamente entre os grupos nem ao longo do tempo em ambas as escalas, sendo poss?vel observar apenas uma leve tranquiliza??o nos animais em ambos os grupos. Os animais que receberam metadona apresentaram sinais de euforia. Os animais que receberam a indu??o na velocidade mais lenta apresentaram maior incid?ncia de efeitos adversos al?m de apresentarem maior requerimento anest?sico para indu??o, sem diferen?a entre os grupos pr?-tratados ou n?o com metadona. Nos grupos com indu??o mais r?pida n?o foram evidenciados efeitos colaterais. A indu??o com a velocidade mais r?pida se apresentou mais segura por ser quase isenta de efeitos adversos. Os animais pr?-tratados com metadona e induzidos com velocidade maior, apresentaram significativa redu??o no requerimento de propofol, sendo esta redu??o de 33% frente aos animais n?o tratados com metadona e induzidos na mesma velocidade e de 38% frente aos animais induzidos com velocidade mais lenta, sem diferen?a entre os tratamentos. Estes resultados demonstram o benef?cio da utiliza??o de analg?sicos opi?ides na medica??o pr?-anest?sica, al?m do efeito analg?sico, mas tamb?m reduzindo o requerimento de agentes indutores e consequentemente seus efeitos delet?rios. Da mesma maneira demonstrou-se que indu??es em velocidades excessivamente lentas se apresentam como formas delet?rias de utiliza??o do propofol como agente indutor, aumentando seu requerimento e a incid?ncia de efeitos adversos.

The consequences of drug use and benefits of methadone maintenance therapy (MMT) were investigated in a random sample of Maori and non- Maori injecting drug users in Christchurch, Aotearoa New Zealand. Eighty- five injecting drug users (IDUs) who had been on MMT for a mean time of 57 months were interviewed and followed up over an average 18 month period. Markov models were used to model cohorts of IDUs, changes in their health states and the effects of MMT and anti-viral therapy on morbidity and mortality. The savings in life from reductions in drug overdoses were used as the main outcome measure in cost-effectiveness analysis. Cost-utility and cost-benefit analysis were also used to provide additional information on the costs and outcomes of treatment. Comparisons were made between: (a) MMT alone; (b) MMT provided with conventional combination therapy for hepatitis C virus (HCV); and (c) MMT provided with anti-viral therapy with pegylated interferon. The monetary costs of drug use and benefits of MMT were similar for Maori and non-Maori. However, Markov modelling indicated that MMT is associated with greater savings in life for Maori than for non-Maori. Further, Maori IDUs identified the main personal costs of drug use as being loss of their children and loss of marriage or partners. Large reductions in use of opioids and benzodiazipines were reported at interview, compared with before starting MMT. The participants also reported large reductions in crime and stabilisation of their lifestyles. Improvements in the general health of IDUs om MMT were reported. However, 89% were positive for HCV infection, which was identified as the major physical health problem affecting IDUs in New Zealand. Few IDUs had received anti-viral therapy for HCV infections, despite having stabilised on MMT. This study investigated the benefits of providing anti-viral therapy for HCV to all patients meeting treatment criteria. The cost-effectiveness of MMT alone was estimated at $25,397 per life year saved (LYS) for non- Maori men and $25,035 for non-Maori women IDUs (costs and benefits discounted at 3%). The incremental effects of providing anti-viral therapy for HCV to all eligible patients were to save extra years of life, as well as to involve additional costs. The net effect was that anti-viral therapy could be provided, at a similar level of cost-effectiveness, to all patients who meet HCV treatment criteria. Cost-effectiveness could be improved if IDUs could be stabilised on MMT five years earlier at an average age of 26 instead of the current age of 31 years. The cost-effectiveness of treatment with pegylated interferon was similar to that for conventional combination therapy because there were incremental savings in life as well as increased treatment costs. Costs per LYS were estimated to be lower for Maori than for non-Maori, reflecting ethnic differences in mortality. Sensitivity analysis revealed that provision of MMT with anti-viral treatment remained cost-effective under varying assumptions of mortality, disease progression and compliance with treatment. the main problems that were not improved during MMT were continuing use of tobacco and cannabis, low participation in paid employment, only three participants had received specific treatment for their HCV infections. Cost-benefit analysis using a conservative approach showed a ratio of the benefits to the costs of MMT of 8:1. Benefits were demonstrated in terms of large reductions in crime. Benefit to cost ratios were similar for the different policy examined, as well as for both Maori and non-Maori IDUs.

Misguided drug policy in the United States has led to many severe social and economic problems that have burgeoned over the past century. I analyzed heroin policy specifically, investigating new treatment methods and alternative decriminalization policies that would ameliorate some of these problems.

Thesis (Ph.D.) in Nursing--University of Maine, 2009. / Includes vita. Includes bibliographical references (leaves 134-152).

Hepatitis C (HCV) is an infectious disease of the liver which affects more than 250,000 Canadians; the majority of those living with the disease have experience with injection drug use. Treatment for HCV involves a strict protocol, has only a 50% success rate and has harsh side effects. Interest in HCV treatment among people who use drugs is high, but actual uptake of treatment remains low. The objective of this research was to explore the barriers to accessing HCV treatment for individuals who were accessing methadone. A mixed methods approach was used; a cross sectional survey and an in-depth interview were administered to clients of a methadone maintenance program. The two sets of data identified three main barriers to HCV treatment; stigma, the toxicity of treatment, and day-to-day struggles. Future research should be conducted to further explore how stigma guides decisions around HCV treatment, particularly in a methadone treatment setting.

Children born to methadone maintained mothers are at high risk of adverse socio-emotional and behavioural outcomes. However, existing studies inadequately report the extent of maternal methadone and other drug use, focus on a narrow range of outcomes, and have given little consideration to the possible impact of child protection and placement experiences. As part of a prospective longitudinal study, mothers of 53 methadone-exposed (ME) children and 54 non-exposed comparison children were interviewed at four time-points from term to the child turning 4.5-years. Detailed information about infant clinical, maternal and family background characteristics was recorded. The nature of all child out-of-home placements was reported at regular intervals using life history calendar methods. At 4.5 years, all caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and were interviewed using the Developmental and Well-Being Assessment (DAWBA) to examine the extent of child socio-emotional and behavioural adjustment problems as well as risk for a range of clinical disorders. By age 4.5 years, ME children were rated by their caregivers as having higher levels of emotional (p = .01), peer-relationship (p = .01), hyperactivity/inattention (p = .01), conduct (p = .01) and total problems (p = .01) than comparison children on the SDQ. Between-groups differences persisted for conduct problems (p = .003) and total difficulties (p = .006) even after controlling for a range of covariates associated with maternal methadone maintenance therapy, including single motherhood, maternal educational achievement, family socioeconomic status (SES), and other drug use in pregnancy. On the DAWBA, children in the ME group were also significantly more at risk than comparison children for externalising disorders spanning ADHD (p = .02), hyperkinesis (p =.01), oppositional defiant disorder (p < .001), and conduct disorder (p = .007). Examination of all study children‟s family situation at 3-monthly intervals over the first 4.5-years revealed that 43% of children in the ME group had experienced at least one foster care placement (range: 1 – 7). In contrast, no comparison children had any placement experience (p < .01). Within the methadone group, maternal risk factors that predicted the likelihood of child placement included maternal methadone dose in pregnancy (p <.01), SES (p = .03), maternal depression (p <.01) and the extent of tobacco (p = .01) and illicit substance use while pregnant (p = .05). ME children exposed to placement showed some increased risk for internalising disorders such as separation anxiety disorder (p = .35) and specific phobia disorder (p = .35), whereas ME children remaining in their biological mothers‟ care tended to have an increased risk for externalising disorders such as ADHD, hyperkinesis and oppositional defiant disorder, although these differences did not reach statistical significance (ps < .05). Child placement did not appear to be independently contributing to the later mental health risks for ME children, at least to age 4.5-years. Rather, a very similar set of maternal psychosocial risk factors were associated with both out-of-home placement and child adjustment problems, thus highlighting the importance of socio-environmental adversity leading to both child removal from parental care and externalising behaviour problems. Further longer-term follow-up of ME children will be important to fully understand the emerging relationships between out-of-home care and the mental health outcomes of ME children. These study findings have important clinical and public health implications. First, the increased risk for socio-emotional and behavioural adjustment problems and disorder as observed among the ME group suggests that appropriate clinical support is needed to address the problems experienced by these children, with the preschool years being a timely opportunity for early targeted interventions. Second, given that high risk ME children are also a population likely to encounter considerable early environmental instability, public healthcare protocols should be introduced to meet the specific developmental needs of young ME children as they transition through and adjust to the placement process.

Opioid dependence is a complex and persistent disorder with a high mortality rate and severe impact on health and social situation. It is associated with much harm, including the transmission of blood-borne bacterial and viral infections, self-harm, traumatic injury and drug overdose. All of these harms carry a risk of death, and accordingly, mortality rates in opioid-dependent people are many times higher than those in the general population of the same age and sex. One of the more commonly used strategies for reducing the risks of opioid dependence is the provision of maintenance treatment. In Australia, available maintenance treatments include methadone, buprenorphine, oral naltrexone, and the unregistered sustained-release formulation of naltrexone, naltrexone implants. This thesis reports on a range of data collections and study designs to investigate the levels, predictors and causes of mortality in opioid-dependent persons entering methadone, buprenorphine and naltrexone maintenance treatment in Australia. The studies used data linkage to examine mortality rates and causes of death in a longitudinal cohort of the early entrants to the NSW methadone program, examined the predictors of mortality (particularly the impact of methadone and buprenorphine treatment) using survival analysis in a longitudinal cohort study, compared national mortality rates between methadone, buprenorphine and naltrexone maintenance treatments in a cross-sectional analytic study, and used a small case series of coronial cases to examine whether death from opioid overdose was possible in a recipient of a naltrexone implant. This thesis demonstrates that mortality rates as a whole and from particular causes of death are many times higher in Australian opioid-dependent subjects than the general population, exposure to methadone or buprenorphine maintenance treatment significantly reduced mortality in a sample of opioid-dependent subjects, naltrexone treatment appears to have higher mortality than both methadone and buprenorphine maintenance treatments, and fatal opioid overdose while in receipt of sustained-release naltrexone treatment is possible. These results support longer retention in and repeated access to methadone and buprenorphine maintenance treatments in order to reduce mortality in opioid-dependent people, and greater regulation of the access to and more rigorous monitoring of the mortality associated with oral and sustained-release naltrexone maintenance treatments.

Opioid dependence is a complex and persistent disorder with a high mortality rate and severe impact on health and social situation. It is associated with much harm, including the transmission of blood-borne bacterial and viral infections, self-harm, traumatic injury and drug overdose. All of these harms carry a risk of death, and accordingly, mortality rates in opioid-dependent people are many times higher than those in the general population of the same age and sex. One of the more commonly used strategies for reducing the risks of opioid dependence is the provision of maintenance treatment. In Australia, available maintenance treatments include methadone, buprenorphine, oral naltrexone, and the unregistered sustained-release formulation of naltrexone, naltrexone implants. This thesis reports on a range of data collections and study designs to investigate the levels, predictors and causes of mortality in opioid-dependent persons entering methadone, buprenorphine and naltrexone maintenance treatment in Australia. The studies used data linkage to examine mortality rates and causes of death in a longitudinal cohort of the early entrants to the NSW methadone program, examined the predictors of mortality (particularly the impact of methadone and buprenorphine treatment) using survival analysis in a longitudinal cohort study, compared national mortality rates between methadone, buprenorphine and naltrexone maintenance treatments in a cross-sectional analytic study, and used a small case series of coronial cases to examine whether death from opioid overdose was possible in a recipient of a naltrexone implant. This thesis demonstrates that mortality rates as a whole and from particular causes of death are many times higher in Australian opioid-dependent subjects than the general population, exposure to methadone or buprenorphine maintenance treatment significantly reduced mortality in a sample of opioid-dependent subjects, naltrexone treatment appears to have higher mortality than both methadone and buprenorphine maintenance treatments, and fatal opioid overdose while in receipt of sustained-release naltrexone treatment is possible. These results support longer retention in and repeated access to methadone and buprenorphine maintenance treatments in order to reduce mortality in opioid-dependent people, and greater regulation of the access to and more rigorous monitoring of the mortality associated with oral and sustained-release naltrexone maintenance treatments.