Methadone maintenance treatment, criminality and overdose‐related deaths: An ecological study, 1983-1999

Background: Methadone maintenance treatments (MMTs) are the commonest substitution treatments offered to opiate addiction in Switzerland, in order to reduce criminal behaviour, infectious disease transmission and overdose death. Method: To investigate the relationship between the increase in the number of methadone maintenance treatments, criminal activity of addicts and overdose‐related deaths, an ecological study was undertaken in the Canton of Geneva, from 1983 to 1999. Results: The regular and extensive increase in the number of MMTs is not significantly associated, during the 1983-1999 period, with a fall either in drug addict incarcerations or in overdose‐related deaths. However, a slight decrease is observed in the number of imprisoned opiate addicts since 1994, and a marked decrease is seen in overdose deaths from 1997 on. An important and stable number of these deaths is due to methadone itself. Conclusion: Public health objectives to diminish delinquency and overdose deaths cannot solely be fulfilled by extensive use of MMTs. A positive result could appear when access to MMT is highly favoured. This hypothesis must be proved correct by observational studies conducted on a general populatio

Neurobiology of suicide: do biomarkers exist?

Clinical risk factors have a low predictive value on suicide. This may explain the increasing interest in potential neurobiological correlates and specific heritable markers of suicide vulnerability. This review aims to present the current neurobiological findings that have been shown to be implicated in suicide completers and to discuss how postmortem studies may be useful in characterizing these individuals. Data on the role of the main neurobiological systems in suicidality, such as the neurotransmitter families, hypothalamic-pituitary-adrenal axis, neurotrophic factors, and polyamines, are exposed at the different biochemical, genetic, and epigenetic levels. Some neuroanatomic and neuropathological aspects as well as their in vivo morphological and functional neuroimaging correlates are also described. Except for the serotoninergic system, particularly with respect to the polymorphism of the gene coding for the serotonin transporter (5-HTTLPR) and brain-derived neurotrophic factor, data did not converge to produce a univocal consensus. The possible limitations of currently published studies are discussed, as well as the scope for long-term prospective studies

Assistance au suicide : expérience et débats en Suisse

La législation suisse en matière d’assistance au suicide étant relativement permissive, cette pratique est essentiellement régie, lorsqu’elle implique un médecin, par des directives médico-éthiques. L’assistance au suicide (acte pratiqué par le patient) doit être différenciée de l’euthanasie active directe (acte pratiqué par le médecin), qui elle est pénalement réprimée en Suisse. Trois associations principales pratiquent des assistances au suicide, avec la particularité, pour Dignitas uniquement, d’entrer en matière même si le patient n’est pas domicilié sur territoire helvétique. Il a été discuté au niveau politique de limiter, voire interdire la pratique de l’assistance au suicide par des organisations. En 2011, le Conseil fédéral a renoncé à une telle limitation ; le risque aurait été une pratique « sauvage » d’assistances au suicide par des médecins indépendants, sans supervision et risquant d’échapper à tout contrôle. Tout décès par assistance au suicide fait l’objet d’une enquête par la justice, avec examen médico-légal du corps et vérification des indications médicales justifiant une entrée en matière du médecin ayant prescrit le pentobarbital. Le nombre d’assistances au suicide pratiquées en Suisse a constamment augmenté au cours de la dernière décennie, ne comptant toutefois toujours que pour une minime proportion des décès (0,48 %). En Suisse romande, une progression est constatée quant à la proportion de patients ayant recours à une assistance au suicide dans le contexte de souffrances physiques et/ou psychiques en lien avec des polypathologies invalidantes liées à l’âge, vraisemblablement en relation avec l’augmentation de l’espérance de vie et l’amélioration des traitements curatifs. Dans ce contexte, l’association Exit Suisse romande a, depuis 2014, spécifiquement mentionné ce critère dans les exigences pour une entrée en matière

Upregulation of IRAS/nischarin (I1-imidazoline receptor), a regulatory protein of μ-opioid receptor trafficking, in postmortem prefrontal cortex of long-term opiate and mixed opiate/cocaine abusers

Imidazoline receptor antisera-selected (IRAS)/nischarin, a putative I1-imidazoline receptor, has recently been shown to regulate μ-opioid receptor (OR) trafficking and resensitisation. To study a possible involvement of this μ-OR regulator in opiate dependence, the present study assessed by Western blot analysis the contents of IRAS/nischarin and μ-OR in total homogenates and subcellular preparations of postmortem human prefrontal cortex (PFC/BA9) of long-term opiate and mixed opiate/cocaine abusers as well as of matched healthy control subjects. In the PFC/BA9 of long-term opiate/cocaine abusers (all subjects together) IRAS/nischarin content was increased (+67%, p < 0.01, n = 11) when compared with matched controls (n = 10). Similar increases were found for the subgroups of opiate (+72%, n = 6) and mixed opiate/cocaine (+61%, n = 5) abusers. IRAS/nischarin immunocontents were also found increased in subcellular membrane preparations (+61%, p < 0.05, n = 10) of PFC/BA9 from opiate addicts. In the same brain samples, the levels of μ-OR were not different to those in control subjects. Based on the increased contents in brains of opiate abusers and the reported function as μ-OR regulator, IRAS/nischarin could represent a new promising target for treatment of opiate use disorder

Female Child and Adolescent Sexual Abuse Cases Reported at the Geneva University Hospitals Between 2006 and 2014: A Retrospective Study

To provide an objective quantification of the demographic characteristics and clinical findings related to female child and adolescent sexual abuse cases reported at the Geneva University Hospitals