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Ilkka Ojanpera - One of the best experts on this subject based on the ideXlab platform.
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Polydrug Abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine
WOS, 2017Co-Authors: Pertti Heikman, Leea Hellevi Muhonen, Ilkka OjanperaAbstract:Polydrug Abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT). However, improved laboratory diagnostics is required to reveal Polydrug Abuse in its current scope. Furthermore, there are few studies focusing on the relationship between Polydrug Abuse and adequacy of the dose of OMT medicine. This study aimed to evaluate the Polydrug Abuse among opioid-dependent patients receiving OMT with inadequate (Group IA) and adequate (Group A) doses of OMT medicine as experienced by the patients. Craving for opioids and withdrawal symptoms were evaluated as indicators of the adequacy rating. This is a retrospective register-based study of 60 OMT patients on either methadone or sublingual buprenorphine/naloxone medication, whose Polydrug Abuse was studied from urine samples by means of a comprehensive high-resolution mass spectrometry method. Inadequate doses of the OMT medicines were associated with higher subjective withdrawal scores and craving for opioids. Six groups of Abused substances (benzodiazepines, amphetamines, opioids, cannabis, new psychoactive substances, and non-prescribed psychotropic medicines) were found among OMT patients. Group IA patients showed significantly more Abuse of benzodiazepines and amphetamines than the Group A patients. All the new psychoactive substances and most of the non-prescribed psychotropic medicines were detected from the Group IA patients. There was no difference in the doses of the OMT medicine between Groups IA and A patients. Polydrug Abuse, detected by definitive laboratory methods, was widespread and more common among Group IA than Group A patients, emphasizing the requirement for individual OMT medicine dose adjustment.
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new psychoactive substances as part of Polydrug Abuse within opioid maintenance treatment revealed by comprehensive high resolution mass spectrometric urine drug screening
Human Psychopharmacology-clinical and Experimental, 2016Co-Authors: Pertti Heikman, Mira Sundstrom, Anna Pelander, Ilkka OjanperaAbstract:Objective At present, Polydrug Abuse comprises, besides traditional illicit drugs, new psychoactive substances (NPS) and non-prescribed psychotropic medicines (N-PPM). Polydrug Abuse was comprehensively evaluated among opioid-dependent patients undergoing opioid maintenance treatment (OMT). Methods Two hundred consecutively collected urine samples from 82 OMT patients (52 male) treated with methadone or buprenorphine-naloxone medication were studied using a liquid chromatography/time-of-flight mass spectrometry screening method. The method enables simultaneous detection of hundreds of Abused substances covering the traditional drugs of Abuse and many NPS as well as N-PPM. Results Ninety-two (45.8%) samples were positive for the Abused substances. Benzodiazepines (29.0%), amphetamines (19.5%), cannabinoids (17.0%), NPS (13.0%), N-PPM (9.0%), and opioids (9.0%) were detected in different combinations. The simultaneous occurrence of up to three groups of Abused substances was common (40.0%), and in one sample, all six groups were found. The stimulant NPS alpha-pyrrolidinovalerophenone was found in 10.0% and the sedative N-PPM pregabalin in 4.0% of the samples. The patients were seldom aware of what particular NPS they had Abused. Conclusions A widespread occurrence of Abused substances beyond the ordinary was revealed. Identifying these patients is essential as Polydrug Abuse is a safety risk to the patient and may cause attrition from OMT. Copyright © 2016 John Wiley & Sons, Ltd.
Nancy M Petry - One of the best experts on this subject based on the ideXlab platform.
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a behavioral economic analysis of Polydrug Abuse in alcoholics asymmetrical substitution of alcohol and cocaine
Drug and Alcohol Dependence, 2001Co-Authors: Nancy M PetryAbstract:Economic concepts can be used to assess how drug prices affect consumption patterns. Increases in price for a commodity typically result in reductions in consumption. Demand is considered elastic if decreases in consumption are proportionally greater than increases in price, and inelastic if they are proportionally smaller than rises in price. The price of one commodity can also affect consumption of others. Commodities can function as substitutes, complements or independents, and these concepts refer to increases, decreases, or no change in the consumption of one item as the price of another increases. This study evaluated the effects of drug prices on hypothetical drug-purchasing decisions in 53 alcohol Abusers. Experiments 1, 2, and 3 examined how alcohol, cocaine, and Valium prices, respectively, influenced purchases of alcohol, cocaine, Valium, heroin, marijuana and nicotine. As price of alcohol rose in Experiment 1, alcohol purchases decreased and demand for alcohol was inelastic. Cocaine was a complement to alcohol, but other drugs purchases were independent of alcohol prices. In Experiment 2, demand for cocaine was elastic as its price increased. Alcohol was a substitute for cocaine, but other drug purchases did not change significantly. In Experiment 3, demand for Valium was elastic as its price rose, and all other drug purchases were independent of Valium prices. Hypothetical choices were reliable between and within subjects and associated with urinalysis results and lifetime histories of drug Abuse. These results suggest that, among alcohol Abusers, cocaine is a complement to alcohol, but alcohol is a substitute for cocaine.
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the effects of housing costs on Polydrug Abuse patterns a comparison of heroin cocaine and alcohol Abusers
Experimental and Clinical Psychopharmacology, 2001Co-Authors: Nancy M PetryAbstract:This study evaluated how price of housing affects hypothetical purchasing decisions. Participants (26 heroin, 28 cocaine, and 15 alcohol Abusers, and 25 controls) were exposed to 4 conditions in which they "purchased" drugs, food, housing, and entertainment. Whereas income remained constant, housing prices varied across conditions. Except for 23% of heroin Abusers, participants purchased housing regardless of cost, so that income increased as housing cost decreased. Demand for food was income inelastic, whereas demand for entertainment was income elastic. Each group showed income elastic demand for their drug of choice. Hypothetical choices were reliable; drug choices were correlated with urinalysis results, and willingness to forgo housing in the simulation was correlated with time spent homeless in real life. This study shows that changes in housing prices may affect choices for drug and nondrug reinforcers.
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Polydrug Abuse in heroin addicts a behavioral economic analysis
Addiction, 1998Co-Authors: Nancy M Petry, Warren K BickelAbstract:A bstract A im . To assess how price and income affect hypothetical drug-purchasing decisions of Polydrug Abusers undergoing treatment for heroin addiction . Participants, design and setting. Forty subjects participated in experiments in which they hypothetically "purchased" drugs as price or income varied . Intervention. Experiment 1 examined effects of heroin price on purchases of heroin, valium, cocaine, marijuana and alcohol. Experiment 2 examined the effects of both heroin and valium prices on purchases of these drugs. In both these experiments, income remained constant. Experiment 3 examined the effects of increasing income on drug choices, with drug prices constant . Findings. As price of heroin rose in Experiment 1, heroin purchases decreased. Reductions in heroin purchases were proportionally less than price increases, demonstrating inelastic demand for heroin. Valium and cocaine purchases increased as heroin price rose, and cross-price elasticity coefficients indicated that these drugs substituted for heroin. In Experiment 2, demand for both heroin and valium was inelastic. Valium substituted for heroin, but heroin purchases were independent of valium prices, suggesting an asymmetrical substitution effect. Marijuana and alcohol purchases were independent of valium price, but both these drugs substituted for heroin. In Experiment 3 demand for heroin and cocaine was income elastic, with purchases rising in greater proportion than income. Marijuana, alcohol and valium purchases did not vary with income, demonstrating that demand for these drugs was income inelastic. Hypothetical choices were reliable both between and within subjects. Moreover, drug choices in this hypothetical situation were correlated with urinalysis results, demonstrating initial validity of this methodology . C onclusions. This methodology may be useful for understanding the phenomenon of Polydrug Abuse .
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a behavioral economic analysis of Polydrug Abuse in heroin addicts
National Bureau of Economic Research, 1998Co-Authors: Nancy M Petry, Warren K BickelAbstract:Polydrug Abuse is common among substance Abusers, but few empirical or theoretical methods accurately characterize this phenomenon. This chapter describes a simulation paradigm that was developed to apply a behavioral economic analysis to understanding Polydrug Abuse. Heroin Abusers 'purchased' drugs as the price of drugs or income varied. In Experiment 1, heroin price rose while prices of other drugs and income remained constant. Heroin purchases significantly decreased as heroin prices increased. As price of heroin rose, valium and cocaine purchases increased and cross-price elasticity coefficients indicated these drugs substituted for heroin. In Experiment 2, prices of both heroin and valium increased separately to determine symmetry of the substitution effect. While valium substituted for heroin, heroin purchases were independent of valium prices. Marijuana and alcohol purchases were independent of valium price, but both these drugs were weak substitutes for heroin. In Experiment 3, income rose while prices remained constant. At some changes in income, demand for heroin and cocaine was income elastic, with purchases rising in greater proportion than income. Marijuana, alcohol, and valium purchases did not vary significantly as a function of income. Choices in this simulation were reliable both between and within subjects. Moreover, drug choices in the simulation were correlated with drug use as determined by urinanalysis testing. These results are discussed in terms of the utility of a behavioral economics approach for characterizing Polydrug Abuse.
Guirguis Amira - One of the best experts on this subject based on the ideXlab platform.
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Focus on clozapine withdrawal- and misuse-related cases, as reported to the European Medicines Agency (EMA) pharmacovigilance database
'MDPI AG', 2020Co-Authors: Chiappini Stephania, Schifano Fabrizio, Corkery, John Martin, Guirguis AmiraAbstract:© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Background: Clozapine is of high clinical relevance for the management of both treatment-resistant schizophrenia and psychotic disturbances with concurrent drug misuse. Although the molecule presents with a range of well-known side-effects, its discontinuation/withdrawal syndrome has been only anecdotally described. Aims: the 2005–2018 European Medicines Agency (EMA) dataset of Adverse Drug Reactions (ADRs) was analyzed to identify and describe possible clozapine withdrawal-and misuse-/Abuse-/dependence-related issues. Method: A descriptive analysis of clozapine-related ADRs was performed when available, data on ADRs’ outcome, dosage, and possible concomitant drug(s) were considered. Results: Out of 11,847 clozapine-related ADRs, some 599 (5.05%) were related to misuse/Abuse/dependence/withdrawal issues, including 258 withdrawal-related (43.1%); 241 Abuse-related (40.2%); and 80 intentional product misuse-related (13.3%) ADRs. A small number of overdose-and suicide-related ADRs were reported as well. Clozapine was typically (69.2%) identified alone, and most (84.7%) fatalities/high-dosage intake instances were reported in association with a history of substance Abuse. Conclusions: Previous suggestions about the possibility of a clozapine discontinuation/withdrawal occurrence are here supported, but further studies are needed. However, the misuse/Abuse cases here identified might be difficult to interpret, given the lack of studies highlighting the possible recreational use of clozapine. The high-dosage intake, fatal outcomes and clozapine/Polydrug Abuse issues reported here may, however, be a reason for concern.Peer reviewe
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Focus on clozapine withdrawal- and misuse-related cases, as reported to the European Medicines Agency (EMA) pharmacovigilance database
'MDPI AG', 2020Co-Authors: Chiappini Stephania, Schifano Fabrizio, Corkery, John Martin, Guirguis AmiraAbstract:© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Background: Clozapine is of high clinical relevance for the management of both treatment-resistant schizophrenia and psychotic disturbances with concurrent drug misuse. Although the molecule presents with a range of well-known side-effects, its discontinuation/withdrawal syndrome has been only anecdotally described. Aims: the 2005–2018 European Medicines Agency (EMA) dataset of Adverse Drug Reactions (ADRs) was analyzed to identify and describe possible clozapine withdrawal-and misuse-/Abuse-/dependence-related issues. Method: A descriptive analysis of clozapine-related ADRs was performed when available, data on ADRs’ outcome, dosage, and possible concomitant drug(s) were considered. Results: Out of 11,847 clozapine-related ADRs, some 599 (5.05%) were related to misuse/Abuse/dependence/withdrawal issues, including 258 withdrawal-related (43.1%); 241 Abuse-related (40.2%); and 80 intentional product misuse-related (13.3%) ADRs. A small number of overdose-and suicide-related ADRs were reported as well. Clozapine was typically (69.2%) identified alone, and most (84.7%) fatalities/high-dosage intake instances were reported in association with a history of substance Abuse. Conclusions: Previous suggestions about the possibility of a clozapine discontinuation/withdrawal occurrence are here supported, but further studies are needed. However, the misuse/Abuse cases here identified might be difficult to interpret, given the lack of studies highlighting the possible recreational use of clozapine. The high-dosage intake, fatal outcomes and clozapine/Polydrug Abuse issues reported here may, however, be a reason for concern.Peer reviewedFinal Published versio
Pertti Heikman - One of the best experts on this subject based on the ideXlab platform.
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Polydrug Abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine
WOS, 2017Co-Authors: Pertti Heikman, Leea Hellevi Muhonen, Ilkka OjanperaAbstract:Polydrug Abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT). However, improved laboratory diagnostics is required to reveal Polydrug Abuse in its current scope. Furthermore, there are few studies focusing on the relationship between Polydrug Abuse and adequacy of the dose of OMT medicine. This study aimed to evaluate the Polydrug Abuse among opioid-dependent patients receiving OMT with inadequate (Group IA) and adequate (Group A) doses of OMT medicine as experienced by the patients. Craving for opioids and withdrawal symptoms were evaluated as indicators of the adequacy rating. This is a retrospective register-based study of 60 OMT patients on either methadone or sublingual buprenorphine/naloxone medication, whose Polydrug Abuse was studied from urine samples by means of a comprehensive high-resolution mass spectrometry method. Inadequate doses of the OMT medicines were associated with higher subjective withdrawal scores and craving for opioids. Six groups of Abused substances (benzodiazepines, amphetamines, opioids, cannabis, new psychoactive substances, and non-prescribed psychotropic medicines) were found among OMT patients. Group IA patients showed significantly more Abuse of benzodiazepines and amphetamines than the Group A patients. All the new psychoactive substances and most of the non-prescribed psychotropic medicines were detected from the Group IA patients. There was no difference in the doses of the OMT medicine between Groups IA and A patients. Polydrug Abuse, detected by definitive laboratory methods, was widespread and more common among Group IA than Group A patients, emphasizing the requirement for individual OMT medicine dose adjustment.
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new psychoactive substances as part of Polydrug Abuse within opioid maintenance treatment revealed by comprehensive high resolution mass spectrometric urine drug screening
Human Psychopharmacology-clinical and Experimental, 2016Co-Authors: Pertti Heikman, Mira Sundstrom, Anna Pelander, Ilkka OjanperaAbstract:Objective At present, Polydrug Abuse comprises, besides traditional illicit drugs, new psychoactive substances (NPS) and non-prescribed psychotropic medicines (N-PPM). Polydrug Abuse was comprehensively evaluated among opioid-dependent patients undergoing opioid maintenance treatment (OMT). Methods Two hundred consecutively collected urine samples from 82 OMT patients (52 male) treated with methadone or buprenorphine-naloxone medication were studied using a liquid chromatography/time-of-flight mass spectrometry screening method. The method enables simultaneous detection of hundreds of Abused substances covering the traditional drugs of Abuse and many NPS as well as N-PPM. Results Ninety-two (45.8%) samples were positive for the Abused substances. Benzodiazepines (29.0%), amphetamines (19.5%), cannabinoids (17.0%), NPS (13.0%), N-PPM (9.0%), and opioids (9.0%) were detected in different combinations. The simultaneous occurrence of up to three groups of Abused substances was common (40.0%), and in one sample, all six groups were found. The stimulant NPS alpha-pyrrolidinovalerophenone was found in 10.0% and the sedative N-PPM pregabalin in 4.0% of the samples. The patients were seldom aware of what particular NPS they had Abused. Conclusions A widespread occurrence of Abused substances beyond the ordinary was revealed. Identifying these patients is essential as Polydrug Abuse is a safety risk to the patient and may cause attrition from OMT. Copyright © 2016 John Wiley & Sons, Ltd.
Prabhakar Kocherlakota - One of the best experts on this subject based on the ideXlab platform.
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neonatal abstinence syndrome
Pediatrics, 2014Co-Authors: Prabhakar KocherlakotaAbstract:Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or Abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in Polydrug Abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.