Journal of addictive diseases
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Injection drug users (IDUs) are at increased risk for HIV, viral hepatitis, and tuberculosis, and making up more than a quarter of the incarcerated population in the United States. Methadone maintenance treatment of opiate addiction is highly effective at reducing drug use, drug-related criminal activity, and risk of HIV transmission. Recently released inmates are at particularly high risk for overdose and disease transmission. Linkage to methadone treatment immediately upon release from incarceration is a promising opportunity to combat disease transmission, facilitate reentry into the community, and reduce recidivism.
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Surveys of physicians' attitudes regarding the therapeutic value of marijuana are rare. Drawing on a national sample of family physicians, general internists, obstetrician-gynecologists, psychiatrists, and addiction specialists, 960 (adjusted response rate 66%) offered opinions about the legal prescription of marijuana as medical therapy. ⋯ Non-moralistic attitudes toward substance use were significantly associated with support for physician prescription, as was internal medicine and obstetrics-gynecology specialization. Physicians are, in general, less supportive than the general American public regarding the use of medical marijuana.
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Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. ⋯ Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more opioids (730 mg vs. 364 mg; P = .04) expressed as morphine equivalents than those with negative toxicology and were more likely to continue using opiates at the end of the 3rd, 4th, 5th, and 6th month after discharge. Patients hospitalized for high-energy fractures with positive admission toxicology are at risk for prolonged opiate use during the initial six months following discharge.
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Comparative Study
Physicians practicing in methadone treatment programs: who are they and what do they do?
This study examines the characteristics and roles of physicians practicing in methadone maintenance treatment programs (MTPs). ⋯ Physicians' treatment practices play a major role in overall treatment, treatment retention, and outcomes. Physicians at for-profit and large urban MTPs reported spending the most time in direct patient contact.
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OxyContin is a controlled-released form of oxycodone indicated for the management of moderate to severe pain. OxyContin diversion and abuse has become a major problem in certain areas of the United States, particularly rural areas and Appalachia. This study undertakes an 18-month retrospective chart review at a private freestanding psychiatric facility to develop a profile of OxyContin addicts seeking treatment. ⋯ One hundred and eighty seven of these individuals were dependent on OxyContin, using an average dose of 184 milligrams of OxyContin per day. The OxyContin dependent individuals tended to show a progression from p.o. use to either snorting or i.v. use. The author concludes that a sociocultural understanding is needed to better treat these addicts as is improved communication between the pain treatment community and the addiction treatment community.