Exploring the Association between Cannabis Use and Testosterone Levels in Men Receiving Methadone Maintenance Treatment

Cannabis and opioids are substances that affect reproductive health. Opioids suppress testosterone and studies have shown that cannabis may increase testosterone. However, there is minimal research describing the endocrine effects of concurrent cannabis and opioid use. We hypothesize that cannabis use improves opioid-induced testosterone suppression. To test this hypothesis, we used cross-sectional data from a prospective cohort study including 122 men enrolled in methadone maintenance treatment (MMT). We measured serum testosterone with an enzyme-linked immunosorbent assay at study enrolment. Urine drug screens were collected for 15 months and identified 52.5% of participants (n = 64) as cannabis users. The association between cannabis use and testosterone level was examined using regression models with serum testosterone as the dependent variable. In our multivariable regression, methadone dose was associated with lower serum testosterone (β = −0.003, 95% CI-0.005, −0.001, p = 0.003). However, neither cannabis use as a dichotomous variable nor the percentage of cannabis-positive urine drug screens were significantly associated with serum testosterone (β = 0.143, 95% CI −0.110, 0.396, p = 0.266, and β = 0.002, 95% CI > −0.001, 0.005, p = 0.116, respectively). Therefore, it does not appear that cannabis has an association with testosterone levels in men on MMT

Neuropsychological Impact of West Nile Virus Infection: An Extensive Neuropsychiatric Assessment of 49 Cases in Canada.

West Nile virus emerged as an important human pathogen in North America and continues to pose a risk to public health. It can cause a highly variable range of clinical manifestations ranging from asymptomatic to severe illness. Neuroinvasive disease due to West Nile virus can lead to long-term neurological deficits and psychological impairment. However, these deficits have not been well described. The objective of this study was to characterize the neuropsychological manifestations of West Nile virus infection with a focus on neuroinvasive status and time since infection.Patients from Ontario Canada with a diagnosis of neuroinvasive disease (meningitis, encephalitis, or acute flaccid paralysis) and non-neuroinvasive disease who had participated in a cohort study were enrolled. Clinical and laboratory were collected, as well as demographics and medical history. Cognitive functioning was assessed using a comprehensive battery of neuropsychological tests.Data from 49 individuals (32 with West Nile fever and 17 with West Nile neuroinvasive disease) were included in the present cross-sectional analysis. Patterns of neuropsychological impairment were comparable across participants with both neuroinvasive and non-neuroinvasive West Nile virus infection on all cognitive measures. Neuropsychiatric impairment was also observed more frequently at two to four years post-infection compared to earlier stages of illness.Our data provide objective evidence for cognitive difficulties among patients who were infected with West Nile virus; these deficits appear to manifest regardless of severity of West Nile virus infection (West Nile fever vs. West Nile neuroinvasive disease), and are more prevalent with increasing illness duration (2-4 years vs. 1 month). Data from this study will help inform patients and healthcare providers about the expected course of recovery, as well as the need to implement effective treatment strategies that include neuropsychological interventions

Impact of <i>ABCB1</i> and <i>CYP2B6</i> Genetic Polymorphisms on Methadone Metabolism, Dose and Treatment Response in Patients with Opioid Addiction: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Genetic variability may influence methadone metabolism, dose requirements, and risk of relapse.</p><p>Objectives</p><p>To determine whether the <i>CYP2B6*6</i> or <i>ABCB1</i> (rs1045642) polymorphisms are associated with variation in methadone response (plasma concentration, dose, or response to treatment).</p><p>Methods</p><p>Two independent reviewers searched Medline, EMBASE, CINAHL, PsycINFO, and Web of Science databases. We included studies that reported methadone plasma concentration, methadone response, or methadone dose in relation to the <i>CYP2B6*6</i> or <i>ABCB1</i> polymorphisms.</p><p>Results</p><p>We screened 182 articles and extracted 7 articles for inclusion in the meta-analysis. Considerable agreement was observed between the two independent raters on the title (kappa, 0.82), abstract (kappa, 0.43), and full text screening (kappa, 0.43). Trough (R) methadone plasma concentration was significantly higher in <i>CYP2B6*6</i> homozygous carriers when compared to non-carriers (standardized mean difference [SMD] = 0.53, 95% confidence interval [CI], 0.05–1.00, p = 0.03) with minimal heterogeneity (I² = 0%). Similarly, trough (S) methadone plasma concentration was higher in homozygous carriers of the *6 haplotype when compared to non-carriers, (SMD = 1.44, 95% CI 0.27–2.61, p = 0.02) however significant heterogeneity was observed (I² = 69%). Carriers of the <i>CYP2B6*6</i> haplotype were not found to be significantly different from non-carriers with respect to dose or response to treatment. We found no significant association between the <i>ABCB1</i> polymorphism and the trough (R), (S) plasma concentrations, methadone dose, or methadone response.</p><p>Conclusion</p><p>Although the number of studies included and sample size were modest, this is the first meta analysis to show participants homozygous for the <i>CYP2B6*6</i> genotype have higher trough (R) and (S) methadone plasma concentrations, suggesting that methadone metabolism is significantly slower in *6 homozygous carriers.</p></div

“Don’t Judge a Book by Its Cover”: A Qualitative Study of Methadone Patients’ Experiences of Stigma

Introduction: Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT. Methods: Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes. Results: In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies. Discussion and Conclusion: Stigma is a widespread and serious issue that adversely affects MMT patients’ quality of life and treatment. More efforts are needed to combat MMT-related stigma