1/6. A case study of employment case management with chronically unemployed methadone maintained clients.employment interventions implemented in drug treatment programs have been marginally successful, but few interventions have been found to address the needs of chronically unemployed clients. employment case management (ECM) is a comprehensive employment intervention strategy designed to motivate chronically unemployed persons to engage in work, assist in job placement, and provide post employment support through workforce integration, while maintaining progress in drug treatment. This clinical case study reports on a convenience sample of 10 chronically unemployed methadone maintained clients who voluntarily enrolled in the ECM project. Clients received individual ECM services for a period of 26 weeks. Clients were assessed at two- and eight-month follow-up intervals. Nine of the 10 clients were employed at the two-month follow-up assessment and six maintained employment at the eight-month follow-up. Moreover, three clients were able to successfully transition from welfare to competitive private sector employment. Preliminary data suggest that ECM may be an effective intervention strategy to help chronically unemployed methadone clients obtain and maintain employment. Qualitatively, clients reported that post employment intervention services such as motivational counseling, problem solving, and employer advocacy helped sustain employment.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
2/6. Usefulness of multi-parameter opiate analysis in hair of drug users and victims of fatal poisonings.The results of a multi-parameter analysis of opiates in the hair of drug users and victims of fatal poisonings with these xenobiotics have been presented. The analysis was carried out with the use of liquid chromatography coupled with mass spectrometry (LC-MS). The article discusses the monitoring of the drug users' adherence to pharmacotherapy and the usefulness of hair analysis for medico-legal purposes. The authors evaluate the differences in the contents of particular opiates in the hair as related to the origin of a sample (untreated drug user, drug user in the course of treatment, victim of fatal poisoning). The report presents differences between the Polish and American profiles of abuse, providing confirmation that a great part of drug users undergoing methadone treatment do not abstain from opiates and/or amphetamine, the latter as a rule being very often taken with opiates.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
3/6. pemoline for the treatment of cocaine dependence in methadone-maintained patients.The authors conducted an open-label trial of pemoline, a dopaminergic CNS stimulant, for the treatment of cocaine addiction in methadone-maintained patients. Ten patients who met DSM-III-R criteria for cocaine dependence participated in an eight-week study. Findings showed that 50% of patients were discontinued from the study due to complaints of side-effects. patients who completed treatment submitted 79% positive urine toxicology screens over the course of the study. patients who dropped out tended to submit fewer cocaine-positive urine screens than treatment completers. In view of suggestions that dopaminergic agents in the treatment of addictions may be enhanced when combined with serotonergic agents, a single-case study of pemoline plus fenfluramine is also reported. Except for one urine sample, all of this patient's urine screens were positive for cocaine. Although findings from these studies do not support the effectiveness of pemoline for the treatment of cocaine abuse in methadone-maintained patients, conclusions must be qualified by the lack of a control group.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |
4/6. methadone distribution and excretion into breast milk of clients in a methadone maintenance programme.AIMS: methadone is widely used in maintenance programs for opioid-dependent subjects. The aims of the study were to quantify the distribution and excretion of methadone in human milk during the early postnatal period and to investigate exposure of breast fed infants to the drug. methods: blood and milk samples were obtained from 12 breast feeding women who were taking methadone in daily doses ranging from 20-80 mg (0.3-1.14 mg kg-1). blood was also obtained from eight of their infants. methadone concentration in these samples was quantified by h.p.l.c. The infants were observed for withdrawal symptoms. RESULTS: The mean (95% CI) milk/plasma ratio was 0.44 (0.24-0.64). Exposure of the infants, calculated assuming an average milk intake of 0.15 l kg-1 day-1 and a bioavailability of 100% was 17.4 (10.8-24) microg kg-1 day-1. The mean infant dose expressed as a percentage of the maternal dose was 2.79 (2.07-3.51)%. methadone concentrations in seven infants were below the limit of detection for the h.p.l.c. assay procedure, while one infant had a plasma methadone concentration of 6.5 microg l-1. infant exposure to methadone via human milk was insufficient to prevent the development of a neonatal abstinence syndrome which was seen in seven (64%) infants. No adverse effects attributable to methadone in milk were seen. CONCLUSIONS: We conclude that exposure of breast fed infants to methadone taken by their mothers is minimal and that women in methadone maintenance programs should not be discouraged from breast feeding because of this exposure.- - - - - - - - - - ranking = 2keywords = sample (Clic here for more details about this article) |
5/6. Fatal opiates overdose. Toxicological identification of various metabolites in a blood sample by GC-MS after silylation.A fatal opiates overdose, where ethylmorphine, hydrocodone, dihydrocodeine and codeine were consumed concomitantly, is reported. This case report may contribute to data on fatal blood concentrations of drugs with rare incidence. The relative retention times in capillary gas chromatography and full mass spectra of various opiates in their silylated forms, detected together in one sample, may serve as a helpful analytical reference for clinical and forensic toxicologists.- - - - - - - - - - ranking = 5keywords = sample (Clic here for more details about this article) |
6/6. Six deaths linked to concomitant use of buprenorphine and benzodiazepines.AIMS: buprenorphine at high dosage became available in 1996 for substitution treatment in france. This drug is considered particularly safe and has become widely available in general medical practice. We investigated the possible implication of a buprenorphine-benzodiazepine association in six deaths of known abusers. DESIGN: Full investigation of cause of death was conducted for six drug abusers. SETTING: The deaths occurred in two regions of france (Auvergne and Lorraine). Assays were carried out by the Institut de Medecine Legale at Strasbourg, france, one of the few French laboratories equipped to assay buprenorphine. MEASUREMENT: First, the blood and urine underwent triple exhaustive screening. Secondly, buprenorphine and norbuprenorphine were analysed in all the autopsy samples by HPLC/MS. FINDINGS: Benzodiazepine-buprenorphine associations were found in every case; no other substances that could account for the death were found. The tissue concentrations were markedly higher than the blood levels. CONCLUSION: If the number of deaths linked to such drug misuse proves high, it may be necessary to review how buprenorphine is dispensed.- - - - - - - - - - ranking = 1keywords = sample (Clic here for more details about this article) |