Enlarged cerebrospinal fluid spaces in opiate-dependent male patients: A stereological CT study

Computed tomography was performed in 9 male patients with a diagnosis of opiate dependence and in 9 age-matched psychiatric controls (neurotic depression). Patients with a history or diagnosis of another substance dependence (alcohol, cocaine, cannabis) were excluded from the study. The volumes of internal and external components of cerebrospinal fluid (CSF) were measured with a point-counting stereological method. Analysis of variance with age as a covariate revealed a significant enlargement of external and external CSF spaces in male patients with opiate dependence. There was no significant correlation between the length of opiate dependence and the volumes of internal and external CSF spaces. The present results suggest that opiate dependence is associated with structural brain alterations. However, the relationship between opiate dependence and structural brain changes is complex and still not well understood

A Guide to Prescribing Sufficient Post Surgical Quantities of Opiate Pain Medications

Purpose: To examine opiate pain medication prescription and consumption after surgical procedures at VCU Medical Center

Death by Dealer: When Addicts Overdose, Should Dealers Be Charged with Murder?

The nation is currently in the throes of an epidemic of opiate addiction. More Americans now die from fatal opiate overdoses than from automobile accidents every year -- and the problem is especially pronounced in white suburban, exurban, and rural communities.One fascinating by product of the whiteness of this new crisis has been the emergence of a more humane vocabulary for understanding -- and combating -- drug addiction. As a headline in the New York Times had it, in battling heroin addiction, "White Families Seek Gentler War on Drugs." When the Obama administration committed, recently, to allocate over $1 billion in new funding to address opiate addiction, officials referred to the problem as an epidemic, signaling that the acute social problems related to this type of chemical dependence should be regarded first and foremost as a public health crisis, rather than a law enforcement crisis.As a new addiction crisis sweeps the country, and as presidential candidates from both parties call for greater compassion and more comprehensive treatment options for addicts, there is another intriguing development that has received little media attention or policy debate: a widespread push for harsher sentences for drug dealers, rather than addicts. As addicts die in increasing numbers due to overdoses related to heroin and prescription opiate use abuse, prosecutors in communities across the country have been looking for new ways to hold people responsible for those deaths. Whether they are reviving old statutes, aggressively interpreting the ambit of existing law, or advancing tough new legislation at the state level, prosecutors in at least a dozen jurisdictions are pursuing charges against the dealers who sell drugs that cause overdoses, and they are looking to hold these dealers responsible not simply for drug sales, but for murder

Opiate Drug Seeking and Addiction: The Influence of Sucrose Consumption on the Acquisition and Expression of Morphine-induced Conditioned Place Preferences (CPP)

Sucrose intake may lead to changes in brain and behavior similar to the effects of abused drugs. For example, sucrose may agonize endogenous opiate systems and modulate opiate-seeking behavior. Previous research reported equivocal outcomes where sucrose may either enhance (i.e., cross-sensitization) or attenuate (i.e., cross-tolerance) drug seeking as measured by morphine-induced CPP. The present experiment extends from past work and evaluated the impact of sucrose administered prior to place conditioning. Additionally, unique groups received sucrose prior to tests for CPP to measure sucrose influences on CPP expression. Sprague-Dawley rats (n=24) were assigned to sucrose (15% w/v) or water pre-exposure conditions. Subsequently, subjects received morphine place conditioning where morphine (10mg/kg) was administered on the initially non-preferred side of the apparatus. Three post-tests were conducted and, prior to each test, animals within each pre-exposure group (sucrose or water) received either sucrose or water. Factorial ANOVA was used to analyze data. Results showed robust morphine-induced CPP. Although animals in the sucrose pre-exposure condition displayed enhanced CPP, the outcomes were not statistically significant. The present findings support the value of CPP techniques to measure opiate drug-seeking behavior. Future work may discover the sufficient conditions for detecting sucrose cross-sensitization of morphine CPP

Measuring the impact of the Capital Card®, a novel form of contingency management, on substance misuse treatment outcomes:A retrospective evaluation

Background The Capital Card, developed by WDP, is a digital innovation which acts as a form of contingency management, and aims to significantly improve service user outcomes. WDP is a substance misuse treatment provider commissioned by local authorities across the UK to support service users and their families affected by addiction. The Capital Card, much like commercial loyalty cards, uses a simple earn-spend points system which incentivises and rewards service users for engaging with services e.g. by attending key work sessions, Blood Borne Virus appointments or group-work sessions. The Spend activities available to service users are designed to improve overall wellbeing and build social and recovery capital, and include activities such as educational classes, fitness classes, driving lessons, and cinema tickets. Methods and findings We compared successful completion rates of 1,545 service users accessing one of WDP’s London based community services over a two-year period; before and after the Capital Card was introduced. Client demographics (age, sex and primary substance) were controlled for during the analysis. Once client demographics were controlled for, analysis showed that clients with a Capital Card were 1.5 times more likely to successfully complete treatment than those who had not had the Capital Card (OR = 1.507, 95% CI = 1.194 to 1.902). Conclusions The results of this initial evaluation are of particular interest to commissioners and policy makers as it indicates that the Capital Card can be used effectively as a form of contingency management to enhance recovery outcomes for service users engaging in community-based substance misuse services

The experience of long-term opiate maintenance treatment and reported barriers to recovery: A qualitative systematic review

Background/Aim: To inform understanding of the experience of long-term opiate maintenance and identify barriers to recovery. Methods: A qualitative systematic review. Results: 14 studies in 17 papers, mainly from the USA (65%), met inclusion criteria, involving 1,088 participants. Studies focused on methadone prescribing. Participants reported stability; however, many disliked methadone. Barriers to full recovery were primarily ‘inward focused'. Conclusion: This is the first review of qualitative literature on long-term maintenance, finding that universal service improvements could be made to address reported barriers to recovery, including involving ex-users as positive role models, and increasing access to psychological support. Treatment policies combining harm minimisation and abstinence-orientated approaches may best support individualised recovery

Opioid Exposed Mothers and Infants in Delaware: Clinical and Legal Considerations

Drug use is on the rise in Delaware, as demonstrated by the continued increase in infants born with neonatal abstinence syndrome. Thoughful, evidence based, and coordinated approaches are necessary to impact this problem. There is solid evidence that mothers and infants who remain together have improved outcomes. Professional medical and nursing societies are unanimous in support of non-punitive approaches to care. Medical Professionals, legislators, and society in general would benefit from ongoing education on the addiction disease process in order to best care for the increasing number of mother/baby dyads with neonatal abstinence syndrome