Alkoholin kulutuksen vaihtelut ja alkoholiin liittyviä ongelmia Liettuassa

Summary: Fluctuation of alcohol consumption and prevalence of alcohol-related harm in Lithuania

Pakaitinis priklausomybės nuo opioidų gydymas ir gyvenimo kokybės įvertinimas

Quality of life measurements are increasingly incorporated into trials of pharmaceuticals. This can be applied to a wide range of medical areas including drug-addiction maintenance treatment programs. Maintenance treatment has been demonstrated to be an effective treatment for opioid addiction but still lacks quality of life specific measures to measure the maintenance program effects and until now there have been only few attempts to assess the impact of opioid dependence and its treatment on the drug-addicted patients’ quality of life. The aim of this article is to describe quality of life concept, measurement instruments, selection criteria and its applicability in the drug addiction maintenance studies

Outpatient methadone maintenance treatment program Quality of life and health of opioid-dependent persons in Lithuania

Background. The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being. Objective. Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived health of opioid-dependent persons in Lithuania. Methods. A total of 102 opioid-dependent patients were recruited in the study. A prospective follow-up study design was used. To assess quality of life, the WHOQOL-BREF 26-item version was used. The impact of methadone maintenance treatment on self-perceived health was assessed by Opiate Treatment Index (OTI). Results. Following 6 months of methadone maintenance treatment, significant improvements in physical (P=0.004), psychological (P=0.004), and environmental (P=0.048) components of quality of life were observed; no statistically significant improvements were found in social component of quality of life. Study participants reported lower rates of medical morbidity associated with injection (P<0.001), cardiorespiratory (P=0.034), musculoskeletal (P<0.001), neurological (P=0.013), gastrointestinal (P<0.001), and general health (P<0.001). Conclusions. Methadone maintenance treatment substantially reduces morbidity associated with opioid dependence and improves the quality of life of patients

Pakaitinio gydymo metadonu ambulatorinė programa Lietuvoje. Asmenų, sergančių priklausomybe opioidams, gyvenimo kokybė ir sveikata

Background. The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being. Objective. Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived health of opioid-dependent persons in Lithuania. Methods. A total of 102 opioid-dependent patients were recruited in the study. A prospective follow-up study design was used. To assess quality of life, the WHOQOL-BREF 26-item version was used. The impact of methadone maintenance treatment on self-perceived health was assessed by Opiate Treatment Index (OTI). Results. Following 6 months of methadone maintenance treatment, significant improvements in physical (P=0.004), psychological (P=0.004), and environmental (P=0.048) components of quality of life were observed; no statistically significant improvements were found in social component of quality of life. Study participants reported lower rates of medical morbidity associated with injection (P<0.001), cardiorespiratory (P=0.034), musculoskeletal (P<0.001), neurological (P=0.013), gastrointestinal (P<0.001), and general health (P<0.001). Conclusions. Methadone maintenance treatment substantially reduces morbidity associated with opioid dependence and improves the quality of life of patients

Economic efficiency of methadone maintenance and factors affecting it

Methadone maintenance is effective in reducing injection drug use, needle sharing, and the overall mortality associated with opiate abuse. Scientific literature describes that efficiency of methadone maintenance program depends on many factors. Our analysis is based on description of economic research methods and on factors affecting economic efficiency of methadone maintenance. Methods. Computerized Medline data base was searched by key words: “economic evaluation”, “cost–effectiveness”, “cost–utility”, “methadone”, “methadone dosage”, “ancillary services”, “treatment duration”. Review and analysis. Results. Methadone maintenance therapy has higher economic efficiency with 80–100 mg per day methadone dose. Doses lower than 40 mg per day are considered as inefficient. Some methadone programs limit treatment to 90 days or less, but such short treatment episodes are not likely to be cost-effective. Ancillary services are more cost–effective at the beginning of methadone maintenance program, than in the later stages of the program. Economic efficiency is higher when program involves more participants, than when more ancillary services are provided. Conclusions. Effectiveness of Methadone maintenance program affects methadone dosage policy, treatment duration and ancillary services

A prospective, randomized, multicenter acceptability and safety study of direct buprenorphine/naloxone induction in heroin-dependent individuals

Aims: To provide controlled data on direct induction with buprenorphine/naloxone (BNX) vs indirect buprenorphine (BPN)-to-BNX induction. Design: Phase 4, prospective, randomized, active-drug controlled, parallel-group trial consisting of a 2-day, double-blind, double-dummy induction phase followed by 26 days of open-label treatment with BNX. Setting: 19 sites in 10 European countries from March 2008 to December 2009. Participants: 187 opioid-dependent men and women ≥15 years of age. Measurements: The primary objective was assessment of patient response to direct and indirect BNX induction (proportion of patients receiving the scheduled 16-mg BNX dose on day 3 [i.e. first day post-induction]). Secondary assessments included illicit drug use, treatment retention and compliance, withdrawal scale scores, and safety. Findings: Patient response to direct- versus indirect-BNX induction was similar (direct 91.4% [85/93] versus indirect 90.4% [85/94]; 95%CI, -7.3%, 9.2%). Rapid dose induction (16 mg of buprenorphine equivalent on day 2) was acceptable and >70% of patients within each group completed treatment (day 28). There were no significant differences in secondary measures across groups. An average BNX maintenance dose of 15.3 mg across groups was associated with substantial reductions in illicit opioid use and no self-reported intravenous misuse. Treatment compliance and retention rates were similar (99% and 81%, respectively). Treatment-emergent adverse event rates were comparable: 75% vs 74% for direct- versus indirect-induction groups, respectively. Conclusions: Direct BNX induction was a safe and effective strategy for maintenance treatment of opioid dependence. Response to high-dose direct BNX induction appears to be similar to indirect BPN-to-BNX induction and was not associated with reports of intravenous BNX misuse