Studiens syfte är att undersöka hur behandlingspersonal vid en opiatmottagning i en stor stad i Sverige ser på substitutionsbehandling och vilken betydelse behandlingsformen har för klientgruppen. Studien baseras på fyra kvalitativa semistrukturerade intervjuer med personal som har olika professioner (kurator, sjuksköterska, läkare samt psykolog) vid en för studien relevant behandlingsenhet. För att analysera det inkomna materialet har följande fem teorier använts: biologiska teorier, systemteorier, stämplingsteori, behavioristiska teorier samt psykodynamiska teorier/anknytningsteori. Resultaten visar att personalen överlag har en liknande syn på bakgrunden till ett drogmissbruk då samtliga anser att orsaken beror på både genetiska och sociala faktorer. Personalen anser även att behandlingsenhetens klienter är i behov av kemiskt framställda opiater (buprenorfin eller metadon) för att kunna bryta med sitt drogmissbruk, detta då det bidrar till att klienterna kan börja fokusera på andra livsområden utöver droganvändandet. Vidare visar resultaten att personalen anser att behandlingens längd varierar från individ till individ. Gruppen opiatberoende anses vara en resurskrävande grupp och önskemål finns gällande bättre samarbete med – för klienten – relevanta myndigheter. Sammanfattningsvis anser personalen att klienterna – genom behandlingen – får hjälp att uppnå ett drogfritt liv, bli en del av samhället, känna sig tillfreds med sig själva; genom detta får klienterna ett bättre och mer stabilt liv. / The purpose of this study is to examine how personnel working at a opiate substitution treatment clinic in a large city in Sweden view the treatment method and how important they reckon that the treatment is for the clientele. The study is based on four qualitative semi-structured interviews with a professional team that consists of counsellor, nurse, doctor and psychologist. To analyze the data the following five theories have been used: biological theories, system theories, labeling theory, behavioristic theories and psychodynamic theories/attachment theory. The results show that the professional team generally have a similar view on the background variables of drug addiction as they generally believe it depends on genetic and social factors. The main consensus of the team is that the clients are in need of chemically manufactured opiates (buprenorphine or methadone) to end their drug addiction because it helps the clients to focus on other areas, besides drugs, in their lives. The results also show that the team believe that the length of the treatment varies from individual to individual. Opiate addicts are considered to be a resource-demanding group and the team would like a better co-operation with relevant authorities. In conclusion the personnel believe that the clients – with help from the treatment method – can reach a life without drugs, become a part of the society and feel satisfied with themselves; with this the clients get a better and more stabile life.

A. Marudinaite. The evaluation of metadone maintenance treatment program process in Lithuania: Master Thesis // supervisor prof. Žilvinas Padaiga; Department of Social Medicine, Kaunas University of Medicine. – Kaunas, 2005 – 59 p. Objective: To evaluate methadone maintenance treatment program process in Lithuania. Methods: The analysis was based on instruments developed or adapted by the World Health Organization (WHO): Treatment services review, Checklist for Service Description, Checklist on service quality, Staff attitude and Satisfaction Questionnaire, Schedules for the Assessment of Standards of Care, and Treatment Perception Questionnaire. 50 patients from Vilnius, 20 from Kaunas and 30 from Klaipeda Centers for Addictive Disorders have been questioned, as well as focus groups, comprised of program personnel, patients, external experts, and community representatives. Results: the literature review revealed the factors influencing the process of methadone maintenance treatment (MMT) program: quantity and quality of services; consultations of psychologists to both patients, their relatives and social workers, as well as medical help; adequate methadone dose (it is usually 60 – 100 mg/day); take home privileges, which improve patients motivation; control urine tests, which deter patients from drug usage. The MMT in Lithuania review indicates that treatment accessibility for drug users is very limited geographically. MMT is run only in five largest Lithuanian cities:... [to full text]

Prescription opioid use is highly prevalent and may be replacing heroin as the predominant illicit opioid that is used. Little is known about specific prescription opioid use characteristics, or issues faced by these individuals in treatment. The major aims of the two studies comprising this thesis were: 1) to systematically and quantitatively assess different occasions of use for the prescription opioid hydromorphone; and 2) to evaluate how current substance use and psychiatric symptoms may be related in a population of prescription opioid users enrolled in a low-threshold Methadone Maintenance Treatment (MMT) program. Eighty-two participants from a low-threshold MMT program in Halifax, Nova Scotia were interviewed regarding their lifetime and current substance use, specific past occasions of hydromorphone use, and current psychiatric symptoms. A subsample of 26 participants was interviewed a second time, one day later, to assess reliability of participants’ self-report on the above-mentioned study measures. It was found that many variables were reliably reported between the two interviews by the subsample. With regards to the first major thesis aim, hydromorphone was found to be a prevalent, highly-favoured prescription opioid in the sample. Characteristics of initial, but not later, hydromorphone use varied by prescription status at initiation. Later use of hydromorphone shared many characteristics previously documented with heroin. With regards to the second major thesis aim, participants reported high rates of current substance use and psychiatric symptoms. Current substance use and psychiatric symptoms appeared to be related; notably, non-prescribed benzodiazepine use predicted depression and anxiety symptoms, and general anxiety predicted non-prescribed benzodiazepine use. In summary, while the results may not be representative of all prescription opioid users, or MMT clients, the thesis presented novel findings with a unique and vulnerable population. The findings supplement the existing literature in terms of describing how prescription opioids may be used during specific occasions, and in describing psychiatric and substance use issues faced by prescription opioid users enrolled in low-threshold MMT in Nova Scotia.

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Includes copies of articles co-authored by the author during the preparation of this thesis. / Includes bibliographical references (leaves 334-376). / viii, 376 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Aims to increase understanding of the metabolism and disposition of methadone in humans, in particular in subjects receiving methadone maintenance treatment for opioid dependence, and to identify factors which may contribute to inter-subject variability in these processes, with respect to stereoselectivity / Thesis (Ph.D.)--Adelaide University, Dept. of Clinical and Experimental Pharmacology, 2001

Methadone is a long acting mu-opioid and is the most effective treatment for heroin addiction. However, opioids depress respiration and methadone maintenance treatment (MMT) patients have a higher mortality rate than the general population. Teichtahl et al conducted a pilot study and found 6 out of 10 MMT patients had central sleep apnea (CSA). But no definite conclusions were made regarding the prevalence and possible pathogenesis of CSA in the patients due to the small sample size and lack of blood toxicology data. The present project aims to confirm the preliminary results and further quantify the sleep disordered breathing (SDB) in stable MMT patients and to delineate the pathogenesis involved. (For complete abstract open document)

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Thesis (M. Sc.)--University of Canterbury, 2009. / Typescript (photocopy). Includes bibliographical references (leaves 102-122). Also available via the World Wide Web.

Orientador: José Antonio Marques / Banca: Paulo Sérgio Patto dos Santos / Banca: Priscila Viau Furtado / Banca: Angélica Trazzi Bento de Moraes / Banca: Newton Nunes / Resumo: A metadona é um opioide pouco utilizado na prática veterinária, sendo que existem ainda, questionamentos quanto ao seu uso. Dessa maneira, objetivou-se comparar o emprego da metadona, administrada por via intramuscular e intravenosa e seus efeitos sobre os parâmetros cardiorrespiratórios e profundidade anestésica em cadelas submetidas à ovariossalpingohisterectomia. Utilizaram-se 16 cadelas (103 kg), pré-medicadas com levomepromazina (0,5 mg/kg, IM). Transcorridos 20 minutos, a indução anestésica foi realizada com propofol (5 mg/kg, IV) e a manutenção com isofluorano. Após 10 minutos, os animais receberam metadona pelas vias IM (GIM) e IV (GIV), na dose de 0,3 mg/kg, diluídos em solução fisiológica (volume total=1ml/5kg). As mensurações das variáveis frequências cardíaca (FC) e respiratória (f), pressões arteriais (PAS, PAD e PAM), eletrocardiografia (ECG), temperatura esofágica (TE), pressão parcial de dióxido de carbono no final da expiração (EtCO2), saturação da oxihemoglobina (SpO2) e índice biespectral (BIS) iniciaram-se antes da administração do opioide (M0), 20 minutos após M0 (M1) e a cada 10 minutos (M2 a M5). As mensurações do cortisol foram obtidas em M0 (antes do opioide), M2, M5 (30, 60 minutos após a metadona), M6, M7 e M8 (1, 3 e 6 horas após OSH). A análise estatística utilizada foi a de Perfil, testes t, de Tuckey, e Kruskal-Wallis (5%). Foram observados tempos de extubação e recuperação maiores no GIV. Com relação à f, FC, PAM, TE, EtCO2, SpO2 e BIS não foram observadas diferenças significativas entre grupos e momentos. Não foi observada diferença entre grupos para os níveis de cortisol. Entre momentos, no GIM, as concentrações de cortisol em M0 foram menores do que em M7. Para a escala descritiva (escores) não foram observadas diferenças entre grupos e momentos / Abstract: Methadone is an opioid little used in veterinary practice, and there are still questions about its use.Thus, the aim of this study was to compare the effects of intramuscular (IMG) and intravenous (IVG) administration of methadone on cardiopulmonary parameters, biespectral index and analgesic requirements in female dogs submitted to ovariohysterectomy. Sixteen female dogs were used (10±3 kg), premedicated with levomepromazine (0,5 mg/kg, IM). After 20 minutes, propofol (5 mg/kg) was used for induction and the anesthesia was maintained with isoflurane. After 10 minutes, methadone at 0.3 mg/kg was administered intravenously in IVG and intramuscularly in IMG, diluted in physiological saline (total volume of 1ml/5kg). The initial measurement of heart ( HR) and respiratory rates (RR), arterial pressures (SAP, DAP and MAP), electrocardiogram (ECG), body temperature (BT), concentration of end-tidal carbon dioxide (PECO2), peripheral oxygen saturation (SpO2) and biespectral index (BIS) was performed immediately before the administration of opioid (M0), after 20 minutes (M1) and then at 10-minute intervals (M2, M3, M4 and M5). Serum cortisol concentrations (Sc) were measured at M0, M2, M5 (30 and 60 minutes after opioid, and 1(M6), 3 (M7) and 6 (M8) hours after the end of surgery. The statistical analysis used was profile and tests "t", Tuckey and Kruskal-Wallis (5%). Times of extubation and recovery were higher in IVG. HR, RR, APM, BT, PECO2, SpO2 and BIS did not differ significantly among times or between groups at any time. No differences were observed between groups for Sc. Between moments, in IMG, Sc at M0 were lower than at M7. For the descriptive scale (scores), no differences between groups or among times were observed / Doutor

Resumo: Apesar de doses relativamente elevadas de opioides produzirem maior intensidade de efeito analgésico, tais doses também estão associadas a efeitos adversos que podem limitar seu emprego em equinos. No presente estudo, hipotetizou-se que uma dose baixa de metadona (0,2 mg/kg), a qual não produz analgesia consistente quando administrada isoladamente em modelos de dor experimental, potencializaria a analgesia induzida pela detomidina, sem resultar em efeitos adversos como excitação/depressão cardiorrespiratória importante ou potencializar a hipomotilidade intestinal induzida pelo agonista α2-adrenérgico. Seis equinos (415 ± 20 kg) receberam dois tratamentos intravenosos com intervalo mínimo de uma semana em um delineamento aleatorizado duplo-cego: 0,01 mg/kg de detomidina administrada isoladamente (tratamento DET) ou em associação a 0,2 mg/kg de metadona (tratamento DET/MET). A analgesia foi avaliada através dos limiares nociceptivos térmico (LNT) e elétrico (LNE). O LNT consistiu no tempo para retirada do membro torácico em resposta à lâmpada de projeção de calor aplicada sobre a banda coronária. O LNE consistiu na voltagem (aplicada via eletrodos sobre a banda coronária) mais elevada capaz de induzir a retirada do membro torácico. A sedação foi avaliada pela distância queixo-solo e pelo interesse por alimento (feno de alfafa). A analgesia, sedação e parâmetros cardiorrespiratórios (eletrocardiografia, pressão arterial e gasometria arterial) foram avaliados antes e durante 120 min após os a administração dos tratamentos. Os escores de auscultação intestinal foram determinados durante 12 horas após a administração dos tratamentos. Tanto o LNE como o LNT se elevaram significativamente em relação aos valores basais durante 15 min após a DET. No tratamento DET/MET, a administração dos fármacos resultou em elevação significativamente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Although relativelly high doses of opioids result in greater analgesic effect, these doses also cause adverse effects that may limit its clinical usefullness in horses. In the present study it was hipothesized that a dose of methadone that does not induce a consistent analgesic effect when administered alone (0.2 mg/kg) in experimental pain models would potentialize detomidine's analgesic effect without resulting in adverse side effects such as excitation / important cardiorespiratory depression or potentialization of the intestinal hypomotility induced by the alpha-2 agonist. A total of six horses (415 ± 20 kg) received 2 intravenous treatments in a randomized double-blinded study design: 0.01 mg/kg of detomidine administered alone (DET treatment) or combined with 0.2 mg/kg of methadone (DET/MET treatment). The analgesia was evaluated by assessing the thermal (TNT) and electrical nociceptive thresholds (ENT). The TNT was assessed by measuring time for limb withdrawal (thoracic limb) in response to a heat projection lamp applied to the coronary band. The ENT was recorded as the highest voltage (applied via electrodes placed in the coronary band of the thoracic limb) that induced limb withdrawal. Sedation was assessed by the chin-to-floor distance and by the interest for food (alfalfa hay). The nociceptive testing, sedation and cardiorespiratory data (electrocardiography, direct arterial pressures, and arterial blood gases) were recorded before and during 120 minutes after drug injection. The intestinal auscultation scores were recorded for 12 hours after treatment administration.Both the ENT and the TNT significantly increased from baseline during 15 minutes after DET. In the DET/MET treatment, drug injection resulted in significantly greater and more prolonged (30 minutes increases in ENT and TNT in comparison to the DET treatment. The chin-to-floor distance was significantly... (Complete abstract click electronic access below) / Orientador: Francisco José Teixeira Neto / Coorientador: Stelio Pacca Loureiro Luna / Banca: Leonardo Gobbo Braz / Banca: Denise Tabachi Fantoni / Mestre