Psychosocial and treatment correlates of opiate free success in a clinical review of a naltrexone implant program

Background: There is on-going controversy in relation to the efficacy of naltrexone used for the treatment of heroin addiction, and the important covariates of that success. We were also interested to review our experience with two depot forms of implantable naltrexone. Methods: A retrospective review of patients' charts was undertaken, patients were recalled by telephone and by letter, and urine drug screen samples were collected. Opiate free success (OFS) was the parameter of interest. Three groups were defined. The first two were treated in the previous 12 months and comprised "implant" and "tablet" patients. A third group was "historical" comprising those treated orally in the preceding 12 months. Results: There were 102, 113 and 161 patients in each group respectively. Groups were matched for age, sex, and dose of heroin used, but not financial status or social support. The overall follow-up rate was 82%. The Kaplan Meier 12 month OFS were 82%, 58% and 52% respectively. 12 post-treatment variables were independently associated with treatment retention. In a Cox proportional hazard multivariate model social support, the number of detoxification episodes, post-treatment employment, the use of multiple implant episodes and spiritual belief were significantly related to OFS. Conclusion: Consistent with the voluminous international literature clinically useful retention rates can be achieved with naltrexone, which may be improved by implants and particularly serial implants, repeat detoxification, meticulous clinical follow-up, and social support. As depot formulations of naltrexone become increasingly available such results can guide their clinical deployment, improve treatment outcomes, and enlarge the policy options for an exciting non-addictive pharmacotherapy for opiate addiction

Koorlankga wer wiern: Indigenous young people and spirituality

The colonial enterprise has been instrumental in attempting to silence and destroy Indigenous expressions of spirituality. At the same time there has been much reliance upon Indigenous forms of knowing, Indigenous men and women of high degree, and the labor and guidance of young people. Today Indigenous spiritualities have been greatly impacted on by Christianity, western epistemology, and modern expressions of spirit. However, many Indigenous young people have been shaped by a renaissance of culture, language, and expressions of identity. There is also evidence that Indigenous young people are having an influence on the spiritual lives and practices of others through their involvement in the church, the school, cultural revival, language regeneration, sport, and the arts. This chapter will focus upon spirituality and the lives of Indigenous young people. It will include a background discussion of historical influences on tradition and culture. This will include an examination of the connection between spirituality, traditional Indigenous ontology, Christianity, and modern social and cultural forms. The chapter will also show that these two broad traditions have shaped the experience of spirituality for young people. In turn it will also explore how modern expressions and reconfigurations of Indigenous young people’s spirituality are also influencing and shaping the worlds of others