Background Heroin dependence is associated with increased risk of the transmission of blood-borne viral (BBV) infections such as HIV, as a result of unsafe injecting practices. Opioid Substitution Treatment (OST) Programmes including Methadone Maintenance Treatment (MMT) programmes are a recommended way of addressing heroin dependence with the dual aims of reducing both heroin use and associated harms. However, OST programmes, particularly in prison settings, are often unavailable, in spite of large numbers of prisoners with heroin dependence and the high risk of HIV transmission in the prison setting. Little is currently known about the delivery of OST programmes within prison settings. A systematic literature review conducted within this study revealed that there are only a small number of studies from middle and lower-income countries and the perspectives of the range of stakeholders are often underrepresented. Aim and setting of this study This aim of this study was to understand the role of Methadone Maintenance Treatment (MMT) programmes within the context of HIV prevention programmes and to identify barriers and facilitators that influence the implementation, routine delivery and sustainability of methadone programmes in Indonesian prisons. Study design Three prison settings were selected as part of a qualitative case study. These comprised: a narcotics prison that provided methadone, a general prison that provided methadone, and a general prison, where there was no methadone programme. This allowed the exploration of multiple perspectives of prisoners and the diverse range of staff involved in the implementation of programmes. Interview and observational data were supplemented by data from medical case notes. Qualitative data underwent thematic analysis, with the help of framework analysis for data management. Principal findings This study found that there were many misconceptions about methadone programmes. HIV infection was not recognised as a problem and prison staff, healthcare staff and prisoners alike lacked understanding of the roles of methadone programmes. Prisoners participating in programmes were often stigmatised, while many prisoners believed methadone withdrawal was dangerous and could lead to death. These factors all contributed to low level participation, observed in both prisons with methadone programmes. Lack of confidentiality and associated stigmatisation as well as inappropriate assessment criteria also contributed to this, as did a lack of support systems. A reduction in international funding and a shift in national drug policy priorities away from the provision of methadone to drug-free Therapeutic Community (TC) programmes, together with a failure to embed methadone programmes within the daily prison routine currently pose challenges to effective implementation, delivery and programme sustainability. Conclusion Educating policy makers and practitioners could improve understanding of the roles of methadone programmes and increase support for programme delivery within prisons. It is therefore recommended that Indonesian government and prison policy focuses on ensuring effective delivery and sustainability of methadone programmes for people with heroin dependence in the prison setting.

Through changes in the code of statutes, SOSFS 2009:27 (M), opioid addicts are excluded since March 1 2010 from possibilities to be accepted for substitution treatment. Opiate addicts are solitary admitted for substitution treatment from that date. Opioid addicts are excluded admission for treatment regardless of the fact that they fulfil the ICD-10 diagnosis F.11.2, i.e. opioid/opiate addictive criteria. The alteration in the statutes was carried out in reference to the fact that evidence for this kind of treatment intended for opioid addicts was missing. Both groups i.e. opiate – and opioid addicts, are nevertheless experienced in clinical work , to have extensive problems with addiction, health, social situation along with the risk of premature death.     The purpose with this study is to identify what differences and/or similarities there are in background varieties and the severity of the problems  between the groups. This is conducted with the use of a population (n=127) with comparable background material, e.g. collected Addictions Severe Index- interviews, scientifically survey and compare background factors and the severity of the problems.      The main discovery in this study is that one can demonstrate great similarities between the groups regarding background as well as the severity of the problems. It is therefore of great interest, on a individual as well as a social oriented level, that pursued studies regarding diagnostic safety and on processes in substitution program are needed to generate further knowledge as a foundation for development of future care and changes in the code of statutes.

published_or_final_version / Sociology / Master / Master of Social Sciences

No description available.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

Background & Purpose: Opioid maintenance therapy (OMT) is an effective method of treating opioid addiction. Of incarcerated individuals in the U.S., 50-85% have a history of substance abuse, and >80% of inmates with opioid addiction history do not receive treatment. The purpose of this study was to explore individuals' experiences after being tapered from OMT upon incarceration. Methods: Interpretative phenomenological analysis (IPA) was employed using in-depth interviewing of 10 participants. Results: Analysis identified six themes that captured the essence of the participants' experiences. Implications & Conclusion: Losing OMT upon incarceration was described as an extremely stressful experience for many individuals, and may create issues for both inmates and facility staff. Further research is needed to discover ways in which to improve addiction treatment in prison.

A dor aguda pós-operatória tem suscitado grande interesse por seu potencial risco de cronicidade caso não seja adequadamente tratada, podendo piorar a recuperação e a qualidade de vida do paciente. Este estudo comparativo foi realizado de maneira prospectiva, aleatória e encoberta para se avaliar os efeitos sedativos, analgésicos e na resposta inflamatória da administração de metadona ou tramadol. Foram incluídos 28 cães com ruptura de ligamento cruzado e submetidos a osteotomias corretivas, distribuídos em três grupos: TRA - 4 mg/kg de tramadol; MET0,5 - 0,5 mg/kg de metadona e MET0,7 - 0,7 mg/kg de metadona, administrados por via intramuscular na medicação pré-anestésica (MPA). A indução da anestesia foi realizada com propofol e os animais foram intubados e mantidos com isofluorano em oxigênio a 100%. Parâmetros fisiológicos (frequências cardíaca, respiratória e pressão arterial) foram avaliados nos dados momentos: TBL (basal), T1 (uma hora após a MPA), T2 (duas horas após, transcirúrgico), T4 (quatro horas após, pós-cirúrgico), T6 (seis horas após) e T24 (24 horas após). Escores de sedação e dor foram avaliados por escalas em TBL, T1, T4, T6 e T24. Coletas de sangue para mensuração de IL-6 foram realizadas em TBL, T1, T6 e T24. Animais apresentando escores na escala análoga visual maiores que 4, na escala de Glasgow maiores que 5 ou na escala de Colorado maiores que 2, recebiam analgesia complementar com o fármaco do grupo em que foram alocados. Utilizou-se análise de variância para medidas repetidas (ANOVA) com pós teste de Tukey para análise estatística dos parâmetros fisiológicos. Escores de dor e sedação foram comparados entre diferentes momentos por teste de Friedman, seguido de teste de Tukey. Os grupos foram comparados em um mesmo momento, por teste não-paramétrico Kruskal-Wallis, seguido de teste post hoc de Dunn. Valores de p<0,05 expressam diferença significativa. Não houve diferença entre os grupos com relação a idade, peso e sexo, além de tempos de cirurgia e extubação. Os valores de frequência cardíaca, respiratória e pressão arterial mantiveram-se dentro dos parâmetros aceitáveis nas condições avaliadas, havendo redução nos valores em T2 nos grupos MET0,5 e MET 0,7 com relação ao TBL. Para os escores na escala análoga visual, dentro do grupo TRA houve aumento significativo em T4 comparado a TBL, T1 e T24 e entre T1 e T6 (p<0,001). No grupo MET0,5, houve aumento significativo de T1 para T4 (p<0,001). Os grupos TRA e MET0,5 apresentaram médias±DP mais altas (3,4±2,5 e 2,5±2,6, respectivamente) que MET0,7 (1,1±1,5) em T4. Na escala de dor de Glasgow, em MET0,5, houve aumento significativo no momento T4 com relação aos momentos T6 e T24 (p<0,001). No grupo MET0,7, houve aumento significativo no momento T4 para TBL e T24 (p<0,001). Houve maior necessidade de resgate no grupo TRA (quatro animais em T4 e dois em T6), contudo após um incremento na dose do fármaco, obteve-se controle adequado da dor. Não foram observadas diferenças estatísticas significativas quanto ao grau de sedação, escala de Colorado e interleucinas séricas entre os grupos e momentos avaliados. A metadona e o tramadol foram eficazes em promover analgesia pós-operatória quando administrados antes do procedimento cirúrgico e suas doses ajustadas no resgate analgésico. Ambos parecem ter tido efeito sobre a liberação de IL-6, sugerindo modulação da resposta inflamatória aguda / Acute postoperative pain has aroused great interest because of their potential risk of chronification if not treated properly, may worsen the recovery and quality of life of the patient. This clinical trial was conducted in a prospective, randomized, double-blind comparison to evaluate the efficacy of methadone and tramadol as premedication in dogs. 28 animals with ruptured cruciate ligament undergoing corrective osteotomies were divided into three groups: TRA - received 4 mg/kg of tramadol; MET0.5 - received 0.5 mg/kg of methadone and MET0.7 - received 0.7 mg/kg of methadone intramuscularly. Anesthesia induction was performed with propofol and animals intubated for general anesthesia with isoflurane in 100% oxygen. Physiological parameters (heart and respiratory rate and blood pressure) were evaluated at specified times (in hours): TBL (baseline), T1, T2, T4, T6 and T24. Pain and sedation scores were described by use of visual analogue scale (VAS), composite modified Glasgow scale and Colorado scale at TBL, T1, T4, T6 and T24. Blood samples for measurement of IL-6 were performed in moments TBL, T1, T6 and T24. Statistical analysis was performed by ANOVA for repeated measurements. Pain and sedation scores were compared in different times by Friedman\'s test followed by Tukey test. Groups were compared by non-parametric Kruskal-Wallis test followed by post hoc Dunn\'s test. Values with p <0.05 were considered significant. There was no statistically significant difference among groups with respect to age, weight, gender, time of surgery and time for extubation. Heart rate, respiratory rate and blood pressure values were maintained within acceptable values and a reduction was observed in T2 in groups MET0.5 and MET0.7 in relation to TBL. Increases in VAS scores were observed in TRA in T4 compared to TBL, T1 and T24 and between T1 and T6 (p<0.001). In MET0.5 there was a significant increase in T4 when compared to T1 (p<0.001). Groups TRA and MET0.5 showed higher mean±SD values (3.4±2.5 and 2.5±2.6, respectively) than MET0.7 (1.1±1.5) in T4. In Glasgow pains scale, there was significant increase in T4 when compared to T6 and T24 (p<0.001). In MET0.7, T4 showed higher scores than TBL and T24 (p<0.001). TRA showed greater demand of rescue analgesia (four animals in T4 and two in T6), however after a dose adjustment pain was controlled. There were no statistically significant differences in degree of sedation, Colorado acute pain scale and serum interleukin among groups and time points assessed. Both drugs were effective in promoting postoperative analgesia when administered prior to surgical procedure and the doses adjusted according to demand. The drugs appear to have an effect on the release of IL-6, suggesting acute inflammatory response modulation

It is increasingly recognised that chronic exposure to opioids has been associated with neuropsychological impairment during both active use and following a period of abstinence. The overall objective of this thesis was to review the relevant prior literature in a systematic manner and subsequently to describe the effects of chronic exposure to prescribed and illicit opioids using an ambispective cohort study design. A systematic literature review was conducted to identify if chronic (defined as a period for more than 3 months) exposure to opioids (prescribed and/or illicit) was associated with measurable neuropsychological deficits. This review was conducted accordingly to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The results were subsequently described within three cognitive domains of intelligence, executive function and memory and learning. Out of a total of 905 articles extracted between 1964 and 2009, 49 articles were considered appropriate for selection and review. Studies of current and abstinent chronic opioid users (illicit heroin users, patients prescribed methadone for illicit opioid dependence and patients taking opioids as part of the management of chronic pain) have identified performance deficits in measures of executive functioning and memory. These have included impairments within the domains of cognitive and motor impulsivity, strategic planning, cognitive flexibility, attention and memory. However other studies found no clear deficits when comparing the performance of healthy controls. The literature suggested that these neuropsychological deficits may be subject to at least partial recovery following initiation of methadone or total withdrawal from any opioids.This review also highlighted several methodological issues that affect the reliability, validity and clinical relevance of the results obtained. Subsequently a two year ambispective cohort design study was conducted which tested representative opioid exposed participants and healthy controls. Cohorts of participants with validated histories of illicit heroin use (HEROIN, n=24), stabilised methadone maintenance (METHADONE, n=29), chronic opioid prescriptions for pain (CHRONIC PAIN, n=28) and controls (HEALTHY CONTROL, n=28) were recruited. The study was designed to test neuropsychological performance in the HEALTHY CONTROL and CHRONIC PAIN groups on one occasion; and for the HEROIN and METHADONE groups on three and two occasions respectively. The intention was to describe neuropsychological performance in the HEROIN group under conditions of stable illicit heroin use, in controlled opioid withdrawal and when subsequently stabilised on methadone. For the METHADONE group, participants were tested twice, six months apart, to test for changes induced by chronic exposure to methadone. Eligible, screened and consented individuals were tested on nine tests from the CANTAB test battery. Data were analysed using univariate or repeated measures ANCOVA with a between subjects factor of GROUP. Further a priori subgroup analyses were conducted using (1) a two-group factor reflecting DEPENDENCE status and (2) a two-group factor reflecting INJECTING status separately as between subject factors. The homogeneity of variance across groups in repeated-measures design ANCOVAs was assessed by the Mauchly Sphericity Test. NART, age in years, SIMD, total Fagerström score, years in education and past alcohol use in years were used as covariates. A significance level of p<0.01 was applied due to multiple testing, in addition to the post-hoc Bonferroni correction procedure. On the Cambridge Gambling Task (CGT), HEROIN users placed higher bets earlier and risked more. They also showed increased motor impulsivity, impaired strategic planning and visuospatial memory on the Affective Go-NoGo (AGN), Stockings of Cambridge (SOC), and Delayed Matching to Sample(DMS) respectively. METHADONE users deliberated longer and placed higher bets earlier on the CGT, but did not show a tendency to risk more. METHADONE users were also more inattentive and demonstrated poor strategic planning and visuospatial memory on the Spatial Span (SSP) task. The CHRONIC PAIN participants did not exhibit significant impairment in neuropsychological performance on all the CANTAB tasks. Participants from the HEROIN, METHADONE and CHRONIC PAIN groups did not present with impaired cognitive flexibility. Chronic opioid dependence is associated with neuropsychological impairment reflected in altered performance on measures of risk taking and strategic planning. These data support the hypothesis that these neuropsychological impairments reflect an underlying trait vulnerability to drug taking and/or dependence rather than an effect of chronic exposure to opioids. Notably, motor impulsivity and visuo-spatial memory in HEROIN users improved after three weeks stability with methadone. Methadone use seems to confer improvement in some aspects of neuropsychological performance following cessation of heroin and sustains other deficits during long term stable methadone treatment. Dependence and injecting status do not contribute to the causation or deterioration of the identified neuropsychological impairments. Further long term longitudinal studies to help elucidate cognitive endophenotypes responsible for the components in the initiation, continuation and deterioration of neuropsychological deficits present in an opioid dependent population is necessary.

In my senior year at ETSU I produced a documentary about opioid abuse in East Tennessee. In 2016, two local health care providers and a university collaborated on a project that would bring an opioid treatment center to Gray, Tennessee. The center includes a methadone clinic, an addition that piqued the concern of many citizens living in Gray. The film evaluates the concerns citizens had about the clinic and explores the issue of opioid abuse in East Tennessee.