Addiction Rehab: Low Incidence of HCV Amongst Prisoners in Scotland.

Low incidence of HCV amongst prisoners in Scotland.

Filed under: Addiction Rehab

Addiction. 2013 Jan 8;
Taylor A, Munro A, Allen E, Dunleavy K, Cameron S, Miller L, Hickman M

AIMS: To estimate HCV incidence and HCV risk among Scottish prisoners DESIGN: National sero-behavioural survey; dried blood spots were collected in order to identify recent HCV infections (i.e. HCV antibody negative and HCV PCR positive) SETTING: All 14 closed prisons in Scotland PARTICIPANTS: 5187 prisoners responded to the survey (79% of available prisoners on survey days) comprising 5076 individuals (after removing incomplete returns and participants surveyed in more than one prison); 95% men, 32% (1625) reported an injecting history (PWID) and median sentence of 9.5 months. HCV antibody samples were available for 4904 participants; there was sufficient sera for HCV PCR for 3165 participants, of which 2446 had been in prison for at least 75 days. MEASUREMENTS: The estimate of in-prison recent infections is based on prisoners incarcerated for a sufficient period, i.e. at least 75 days, so that recent infections could be attributed to prison. FINDINGS: Overall HCV prevalence was 19%; 53% amongst people who reported an injecting history and 3% amongst other prisoners. 3 recent infections likely acquired in prison were detected. None of the cases reported injecting during their current sentence or any other potential exposure. Estimated incidence was 0.6 to 0.9% overall and 3.0 to 4.3% among PWID (assuming all infections acquired through injecting). 57% (929) of PWID were receiving opiate substitution treatment (OST) at the time of the survey. 2.5% of all prisoners and 8% of PWID reported injecting during their current period of incarceration. CONCLUSION: The low incidence of HCV infections in Scottish prisons is due most likely to the low occurrence of in-prison injecting and high coverage of OST. Low HCV risk can be achieved in prisons without necessarily introducing needle exchange programmes but close monitoring of risk behaviours is essential. If risk increases, provision of needle exchange should be considered.
HubMed – addiction

 

Micromorphological changes in cardiac tissue of drug-related deaths with emphasis on chronic illicit opioid abuse.

Filed under: Addiction Rehab

Addiction. 2013 Jan 8;
Seltenhammer MH, Marchart K, Paula P, Kordina N, Klupp N, Schneider B, Fitzl C, Risser DU

AIMS: The main intention of this retrospective study was to investigate whether chronic illicit drug abuse, especially the intravenous use of opioids (heroin) could potentially trigger the development of myocardial fibrosis in drug addicts. DESIGN: A retrospective case-control study using myocardial tissue samples from both drug-related deaths (DRD) with verifiable opioid abuse and non-drug-related deaths in the same age group was performed. SETTING: Department of Forensic Medicine, Medical University of Vienna, Austria (1993 – 1994). PARTICIPANTS: Myocardial specimens were retrieved from 76 deceased intravenous opioid users and compared to those of 23 deceased non-drug users. MEASUREMENTS: Drug quantification was carried out using EMIT (enzyme-multiplied immunoassay technique), followed by GC/MS (gas chromatography-mass spectrometry, MAT 112(®) ), and analysed using the Integrator 3390A by Hewlett Packard(®) and LABCOM.1 computer (MSS-G.G.). The amount of fibrous connective tissue (FCT) in the myocardium was determined by using the morphometric software LUCIA Net Version 1.16.2(©) , Laboratory Imaging, with NIS Elements 3.0(®) . FINDINGS: Drug analysis revealed that 67.11% were poly-drug users and the same proportion was classified as heroin addicts (6-monoacetylmorphine, 6-MAM) – 32.89% were users of pure heroin. In 76.32% of DRD cases, codeine was detected. Only 2.63% consumed cocaine. The mean morphine concentrations were 389.03 ng/g in the cerebellum and 275.52 ng/g in the medulla oblongata respectively. Morphometric analysis exhibited a strong correlation between DRD and myocardial fibrosis. The mean proportion of FCT content in the drug group was 7.6% (females: 6.30%; males: 7.91%) in contrast to 5.2% (females: 4.45%; males: 5.50%) in the control group, indicating a significant difference (p=0.0012), and a significant difference in the amount of FCT between females and males (p=0.0383). There was no significant interaction of age and FCT (p=0.8472). CONCLUSIONS: There is a long-term risk of cardiac dysfunction following chronic illicit drug abuse with opioids as a principal component. Regular cardiological examination of patients receiving substitution treatment with morphine is strongly recommended.
HubMed – addiction

 

Tobacco Dependence Diagnosis and Treatment in Veterans Health Administration Residential Substance Use Disorder Treatment Programs.

Filed under: Addiction Rehab

Addiction. 2013 Jan 8;
Gifford E, Tavakoli S, Wang R, Hagedorn HJ, Hamlett-Berry KW

AIMS: To explore tobacco dependence (TD) diagnosis and treatment utilization, and identify predictors of nicotine replacement therapy (NRT), among Veterans with substance use disorders (SUDs) enrolled in Veterans Health Administration (VHA) SUD residential treatment programs (SRTPs). DESIGN: Retrospective cohort study. SETTING: VHA SRTPs, which treat Veterans with SUD and multiple severe psychosocial deficits, from 1 October 2009 to 31 September 2010. Participants: Identified tobacco users among Veterans with SUD treated in SRTPs during fiscal year 2010 (FY10). MEASUREMENTS: Rates of documented TD diagnosis and pharmacotherapy were assessed nationally, regionally, and by facility. Patient-level predictors of NRT were examined using a mixed-effects logistic regression model with facility as a random effect. Findings: 12,097 of the 15,320 Veterans in SRTPs in FY10 (79%) were identified as likely tobacco users. Among these, 33% had a documented TD diagnosis, 34% were treated with pharmacotherapy, and only 11% were both diagnosed and treated for TD while in SRTP. NRT was more common among patients with a current documented TD diagnosis, recent history of TD treatment, comorbid mental health disorder, age 55 years or younger, and identified as White. CONCLUSIONS: Most Veterans in Veterans Health Administration substance use disorders residential treatment programs appear to use tobacco, yet only one in ten receives a documented ICD-9 tobacco dependence diagnosis and pharmacotherapy while in substance use disorders residential treatment program.
HubMed – addiction

 


 

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