National opioid pharmacotherapy statistics 2014

Summary Dependence on opioid drugs is associated with a range of health and social problems that affect individual drug users, their family and friends, and the wider public. This bulletin presents information on the clients receiving opioid pharmacotherapy treatment, the doctors prescribing opioid pharmacotherapy drugs, and the dosing points that clients attend to receive their medication. Over 48,000 Australians received pharmacotherapy treatment for their opioid dependence on a snapshot day in June 2014 The number of people receiving opioid pharmacotherapy treatment almost doubled between 1998 (from around 25,000) and 2014, but growth in client numbers slowed in recent years (growing by 0.5-2% a year between 2011 and 2014). Heroin is the most common opioid drug leading people to pharmacotherapy treatment Clients were nearly twice as likely to report heroin as an opioid drug of dependence as they were for all opioid pharmaceuticals combined, however this varied by jurisdiction. Methadone continued to be the drug most commonly prescribed; the form in which buprenorphine is prescribed is changing Around two-thirds  (67%) of clients received methadone in 2014, and this has been relatively stable since 2006. The remaining third (33%) received 1 of 2 forms of buprenorphine. Of these, the proportion receiving buprenorphine only has fallen (from 24% to 13%) while the proportion receiving buprenorphine combined with naloxone has risen (from 5% to 20%) over the same period. Naloxone is added to buprenorphine to deter its injection. Opioid pharmacotherapy clients are getting older on average In 2014, around two-thirds  (69%) of clients were aged 30-49, and this has been fairly consistent since 2006. However, from 2006 to 2014 the proportion of clients aged less than 30 more than halved (from 28% to 10%), and the proportion of clients aged 50 and over more than doubled (from 8% to 21%). These trends indicate an ageing population of clients in pharmacotherapy treatment. Males and Indigenous Australians are over-represented in pharmacotherapy treatment Around two-thirds (65%) of clients receiving pharmacotherapy in June 2014 were male. Where reported, 1 in 10 (10%) clients identified as Indigenous and Indigenous Australians were around 3 times as likely to have received pharmacotherapy treatment as non-Indigenous Australians. Prescriber numbers have increased, and most work in the private sector The number of prescribers of opioid pharmacotherapy rose by 31% since 2012 (from 1,768 to 2,319). In 2014, most prescribers treated 1-5 clients (39%), worked in the private sector (82%) and were authorised to prescribe more than 1 type of pharmacotherapy drug (74%). Most dosing points were located in pharmacies Most clients need to attend a dosing point regularly to take their opioid pharmacotherapy drug under supervision. In 2013-14 there were 2,432 dosing point sites in Australia, and 9 in 10 (89%) were located in pharmacies

Alcohol and other drug treatment services in Australia 2013–14

Alcohol and other drug treatment services across Australia provide a broad range of treatment services and support to people using drugs and to their families and friends. This report presents the information for 2013–14 about publicly funded alcohol and other drug treatment service agencies, the people they treat and the treatment provided. Summary Around 119,000 clients received over 180,000 treatment episodes from 795 publicly funded alcohol and other drug treatment agencies across Australia An estimated 118,741 clients received treatment in 2013–14. This equates to a rate of 509 clients per 100,000 people, or about 1 in 200 people in the general population. About 2 in 3 clients were male (67%) and 1 in 2 were aged 20–39 (54%). Despite only comprising 2.7% of the population, 1 in 7 (14%) clients were Aboriginal and Torres Strait Islander. Treatment agencies provided a total of 180,713 treatment episodes—an average of 1.5 episodes per client—and 4 in 5 (79%) episodes ended within 3 months. There has been a steady increase in the number of treatment episodes provided over the last 5 years (from 145,630 to 180,713), an increase of 24%. Between 2012–13 and 2013–14, the estimated number of clients who received treatment increased by 8%. Of those clients who received treatment in 2013–14, 22% also received treatment in 2012–13. The age profile of people receiving treatment suggests there is an ageing cohort of clients Over the 5 years to 2013–14, the proportion of treatment episodes for clients who were aged 20–29 fell from 29% to 27%, while the proportion for those aged 40 and over rose from 30% to 33%. Alcohol continues to be the most common drug leading clients to seek treatment but treatment for use of amphetamines is increasing Alcohol, cannabis, amphetamines and heroin  have remained the most common principal drugs of concern for clients since 2003–04. Nationally, alcohol was the most common principal drug of concern in 2013–14, accounting for 40% of episodes. For clients aged 30 and over, alcohol was the most common principal drug of concern, while for clients aged 10–29, cannabis was the most common. Since 2009–10, the proportion of episodes where alcohol was the most common principal drug of concern has decreased (from 48% to 40%), while the proportion of episodes for amphetamines have increased (from 7% to 17%). The number of episodes for clients injecting and smoking/inhaling amphetamines has also increased, with more than 6 times as many clients smoking/inhaling in 2013–14 as in 2009–10. Most clients have more than 1 drug of concern In more than half (54%) of treatment episodes, the client also reported additional drugs of concern. Just under a third (29%) had 1 additional drug of concern and 13% had 2 drugs. Nicotine and cannabis were the most common additional drugs of concern. Counselling continues to be the most common type of treatment Since 2003–04, the proportion of episodes for each main treatment type has remained fairly stable, with counselling, withdrawal management and assessment only being the most common types of treatment. Counselling continues to be the most common main treatment type provided for clients (2 in 5 episodes since 2003–04). &nbsp

A meta-analysis of pharmacotherapy for social anxiety disorder: an examination of efficacy, moderators, and mediators

INTRODUCTION: Social anxiety disorder (SAD) is among the most prevalent mental disorders, associated with impaired functioning and poor quality of life. Pharmacotherapy is the most widely utilized treatment option. The current study provides an updated meta-analytic review of the efficacy of pharmacotherapy and examines moderators and mediators of treatment efficacy. Areas Covered: A comprehensive search of the current literature yielded 52 randomized, pill placebo-controlled trials of pharmacotherapy for adults diagnosed with SAD. Data on potential mediators of treatment outcome were collected, as well as data necessary to calculate pooled correlation matrices to compute indirect effects. Expert Opinion: The overall effect size of pharmacotherapy for SAD is small to medium (Hedges' g = 0.41). Effect sizes were not moderated by age, sex, length of treatment, initial severity, risk of study bias, or publication year. Furthermore, reductions in symptoms mediated pharmacotherapy's effect on quality of life. Support was found for reverse mediation. Future directions may include sustained efforts to examine treatment mechanisms of pharmacotherapy using rigorous longitudinal methodology to better establish temporal precedence

Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study

Classical trigeminal neuralgia (CTN) is treated predominantly by pharmacotherapy but side effects and unsuccessful occurs. The current study was carried out to evaluate the therapeutic effect of combination of pharmacotherapy and lidocaine block. Thirteen patients with CTN managed with pharmacotherapy were recruited and assigned either to no additional treatment (Group I) or to additional analgesic block (Group II). The primary endpoint was the reduction in the frequency of pain episodes in a month assessed at 30 and 90 days. Comparisons of measurements of pain, general health and depression scales were secondary endpoints. The results from the follow-up visits at 30 and 90 days showed the Group II to have larger reduction in the frequency of pain and exhibited a bigger improvement in the scores of the pain, general health and depression scales. The results from this preliminary study suggest a clinical benefit of the combination of pharmacotherapy and lidocaine block

In vivo effects of eurycoma longifolia Jack (Tongkat Ali) extract on reproductive functions in the rat

An aqueous extract of Eurycoma longifolia (Tongkat Ali; TA) roots is traditionally used to enhance male sexuality. Because previous studies are limited to only few sperm parameters or testosterone concentration, this study investigated the in vivo effects of TA on body and organ weight as well as functional sperm parameters in terms of safety and efficacy in the management of male infertility. Forty-two male rats were divided into a control, low-dose (200 mg kg(-1) BW) and high-dose (800 mg kg(-1) BW) group (n = 14). Rats were force-fed for 14 days and then sacrificed. Total body and organ weights of the prostate, testes, epididymides, gastrocnemius muscle and the omentum were recorded. Moreover, testosterone concentration, sperm concentration, motility, velocity, vitality, acrosome reaction and mitochondrial membrane potential (MMP) were assessed. Whilst TA decreased BW by 5.7% (P = 0.0276) and omentum fat by 31.9% (P = 0.0496), no changes in organ weights were found for the prostate, testes and epididymides. Testosterone concentration increased by 30.2% (P = 0.0544). Muscle weight also increased, yet not significantly. Whilst sperm concentration, total and progressive motility and vitality increased significantly, MMP improved markedly (P = 0.0765) by 25.1%. Because no detrimental effect could be observed, TA appears safe for possible treatment of male infertility and ageing male problems.IS

The Use of Antihypertensive and Antiplatelet Drugs on Hospital Stroke Patients

Medicine is one of the most important part of the healing process, the restoration of health and prevention of disease. This study aims to describe the use of drugs, particularly antihypertensive and antiplatelet drugs in stroke patients hospitalized in PKU Muhammadiyah Hospital Bantul during December 2014-April 2015. This research is observational descriptive study. Data collection was done prospectively with a survey of stroke patients in inpatient Al-Insan and al-A'raaf wards in PKU Muhammadiyah Hospital Bantul during the specified period. During the study there were 61 stroke patients sampled in the study, of which 41 (67.2%) were geriatrics and 20 (32.8%) were not geriatrc. From the data, 28 (45.9%) patients did not receive antihypertensive drugs, only 33 (54,1%) patients received antihypertensive drug.The antihypertensive drugs type were given to patients were ACEI 9 (14.8%) and CCB 6 (9.8%), as well as combinations ACEI and CCB 7 (11.5%). Most patients did not receive antiplatelet 43 (70.5%), whereas patients receiving antiplatelet drugs most was the kind of aspirin 17 (27.9%). From the above data it can be concluded that the use of antihypertensive drugs in stroke patients in the inpatient ward in PKU Muhamaddiyah Hospital Bantul quite frequently used, while the use of antiplatelet drugs in these cases rarely used

Integrating Pharmacotherapy and Psychotherapy for Paediatric Bipolar Disorder: Translating Science to Service

Objective: For comprehensive management of paediatric bipolar disorder (PBD), it is imperative to combine psychopharmacotherapy with specific psychotherapy. This article proposes a model that incorporates (1) an overview of psychopathology, (2) a review of outcomes in psychopharmacotherapy trials, and (3) a summary of evidence-based forms of psychotherapy to complement pharmacotherapy. Results: The psychopathology of PBD is unique compared to that of adult bipolar disorder with prominent irritability, rapid cycling, high rates of co-morbid attention deficit hyperactivity disorder, mixed episodes and chronicity. Combination therapy with a second generation antipsychotic and a mood stabilizer is proving to be more effective than monotherapy with a mood stabilizer. Empirical findings for the support of family-focused, cognitive behavioral therapies with individual family or multifamily psychoeducation groups suggest that these psychosocial treatments are valuable complementary tools for clinicians who treat youths diagnosed with PBD. Conclusion: As pharmacotherapy and psychotherapy are most beneficial when applied together, the clinician’s understanding of the science behind these forms of treatment is likely to be of great value in effectively providing services to youths diagnosed with PBD

The Incidence and Risk Factor Analysis of Drug Induced Liver Injury (Dili) in a Surabaya Hospital

The research has been conducted on the incident and analysis of risk factors drug liver injury (DILI) in a Surabaya Hospital. The aim of this study was to determine the incident of DILI, know which drugs cause DILI, and see the association of risk factors to DILI. The research method was descriptive and analytical observational (prospective cohort). Danan-Benichou scale is a tool used to ascertain drugs that cause DILI. Based on data collected for 3 months, the population was 1202 patients. Samples fulfilling the inclusion and exclusion criteria were 310 patients, the risk drug group of DILI were 285 patients (11 DILI, 274 Non-DILI), and the non-risk drug group 25 patients (11 DILI, 14 Non-DILI). The incident of DILI was 3.55%. Drugs that cause DILI are ranitidine (4 cases), omeprazole (1 case), rifampicin (2 cases), meropenem (1 case), ciprofloxacin (1 case), methotrexate (1 case), and dexamethasone (1 case). Characteristic of patients with DILI (11 patients) are average age of 59.27 ± 15.54 years (23-73 years), belonging to high risk group (54.55%), male gender (81,82%), have moderate comorbid disease (54.55%), and are not comsumsing alcohol (100%). This research use logistic regression analysis through SPSS 17.0 program to see the relation of risk factor to DILI incident. The p results were obtained from sex (0,156), age (0,534), and comorbid isease (0,213)> α (0,05) which means gender, age, and comorbid disease do not significantly affect the incident of DILI

Combination of Tempeh and Carrot Prevent Atherosclerosis Wistar Rat: Indicated by Increase of Hdl and Total Antioxidant, Decrease Ldl, F2-isoprostan, and Il-6

Coronary heart disease (CHD) is the leading cause of death, either in developed and developing countries. The disease is stimulated by the present of atherosclerosis. This study aims to investigate supplementation of combined tempeh M-2 and carrot to prevent atherosclerosis wistar rat by increases HDL and TAC, decreases LDL, F2-Isoprostan, and IL-6. This was a true experimental study with the factorial completely randomized post-test only control group design. variables such as KN (standard feeding / pellets (50 g / kg bw / day), KP: pig lubrication: pellets (1: 9) (50 g / kg bw / day), T : lubrication pig: pellets (1: 9) with tempeh M -2 (20 g / kg bw / day), W: pig lubrication: pellets (1: 9) with carrots (20 g / kg bw / day), and TW: pig lubrication: pellets (1: 9) with tempeh M-2 (20 g / kg bw / day), and carrots (20 g / kg bw / day). Dependent variables in this study are serum HDL,serum TAC, LDL serum, urine F2-Isoprostan, and plasma IL-6 (with Elisa Method). Data were analyzed using the F test (two-way ANOVA), followed by LSD test. Descriptive research was also conducted in this study in order to find out the change of aortic histopathologic. The highest average levels of HDL, TAC contained on TW, which respectively amounted 68.640 ± 0.50 mg / dl, 1.454 ± 0.01 nM / mL. It showed highly significant differences (p<0.01) in the various treatments. TW treatment showed highly significant interaction effect (p<0.01) were observed for all parameters except for HDL. Average levels of LDL, F2- Isoprostan, and IL-6 lowest in the treatment TW, which respectively amounted 20.718 ± 1.33 mg / dl, 0.720 ± 0.065 ng / dl, 35.328 ± 1.000 pg/dl, showed highly significant differences (p<0.01) in the various treatments. It can be concluded that supplementation with a combination of tempeh M-2 with carrots give the best effect, can increases HDL and TAC, and can decreases LDL, F2-Isoprostan, IL-6 significantly, and may change the hystopathology structure of aorta from endotel dysfunction to become normal

Inhibitory effect on ovarian cancer ALDH+ stem-like cells by Disulfiram and Copper treatment through ALDH and ROS modulation

BACKGROUND: Disulfiram (DSF) is a drug used for treatment of alcoholism that has also displayed promising anti-cancer activity. It unfolds its effects by inhibiting the enzyme activity of aldehyde dehydrogenase (ALDH) isoforms. METHODS: MTT assay, spheroid formation, clonogenicity assay, qRT-PCR, and ALDH enzyme activity analysis were performed using ovarian cancer cell lines IGROV1, SKOV3 and SKOV3IP1. Cell cycle analyses and measurement of intracellular reactive oxygen species (ROS) were carried out by flow cytometry. ALDH+ and ALDH- cells were isolated by FACS sorting. RESULTS: ALDH activity was inhibited in ovarian cancer stem cells (the proportion of ALDH+ cells was reduced from 21.7% to 0.391%, 8.4% to 0%, 6.88% to 0.05% in cell lines IGROV1, SKOV3, and SKOV3IP1, respectively). DSF with or without the cofactor copper (Cu2+) exhibited cytotoxicity dose- and time-dependent and enhanced cisplatin-induced apoptosis. DSF + Cu2+ increased intracellular ROS levels triggering apoptosis of ovarian cancer stem cells (CSC). Significantly more colony and spheroid formation was observed in ALDH+ compared with ALDH- cells (P < 0.01). Moreover, ALDH+ cells were more resistant to cisplatin treatment compared with ALDH-cells (P < 0.05) and also exhibited a lower basal level of ROS. However, no significant difference in ROS accumulation nor in cellular viability was observed in ALDH + cells in comparison to ALDH- cells after pre-treatment with DSF (0.08 μM). CONCLUSION: Our findings provide evidence that DSF might be employed as a novel adjuvant chemotherapeutic agent in combination with cisplatin for treatment of ovarian cancer