slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The effect of alcohol co-dependence on the opioid withdrawal syndrome PowerPoint Presentation
Download Presentation
The effect of alcohol co-dependence on the opioid withdrawal syndrome

Loading in 2 Seconds...

play fullscreen
1 / 1

The effect of alcohol co-dependence on the opioid withdrawal syndrome - PowerPoint PPT Presentation


  • 202 Views
  • Uploaded on

Screening of new admissions during period of study (N = 35). Screening of existing database (N = 49). Opioid only dependent participants (N = 51). Opioid and alcohol co-dependent participants (N = 33). Informed consent obtained. WPH Admission Assessment (Modified MAP)

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The effect of alcohol co-dependence on the opioid withdrawal syndrome' - minnie


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Screening of new

admissions during period of

study (N = 35)

Screening of existing

database (N = 49)

Opioid only dependent

participants (N = 51)

Opioid and alcohol co-dependent

participants (N = 33)

Informed consent

obtained

WPH Admission Assessment (Modified MAP)

completed on day of admission

Daily SOWS completed throughout admission

The effect of alcohol co-dependence on the opioid withdrawal syndrome

Robyn J Akhurst and Jennifer A Bearn, Wickham Park House, Bethlem Royal Hospital, South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, BR3 3BX

Introduction

  • Opioid and alcohol co-dependence becoming more prevalent amongst opioid users1,2 – co-dependence complicates assessment and treatment of dependence3
  • Alcohol co-dependence has an adverse outcome on physical & mental health, social functioning and treatment outcomes4,5,6
  • Two distinct withdrawal syndromes with clinical and neurobiological overlap observed
  • No previous studies of the impact of alcohol co-dependence on opioid withdrawal syndrome (OWS) during in-patient detoxification

Results

  • 84 participants – 51 O and 33 OA, 83% male, more

OA White British (93.9% vs. 72.5%, p < 0.05)

  • OA scripted for and stabilised on higher methadone doses (Table 1)
  • OA were more chaotic in their drug use (Table 2)
  • OA had higher mean SOWS scores (12.1 vs. 9.1, p < 0.001) – especially on days 10, 11 & 16 (Figure 1). These days corresponded to when chlordiazepoxide and methadone detoxification schedules were completed

Discussion

  • Higher methadone doses support evidence of enhanced metabolism of methadone during chronic alcohol use9
  • Course of OW correlates well with previous findings10,11
  • Study translates neurobiological findings of enhanced excitatory neurotransmission during simultaneous withdrawal in animal studies to similar clinical effects in human participants12,13,14

Conclusion

  • First investigation of the impact of alcohol co-dependence on the OWS during in-patient detoxification - increased opioid withdrawals were noted in the alcohol co-dependent group
  • Concurrent detoxification from opioids and alcohol may therefore not be the optimal clinical management in co-dependent patients
  • Further studies are needed – using objective ratings, measures of psychological health, community treatment programmes, women drug users, ethnic minorities - to broaden the evidence base and assess the impact of alcohol co-dependence further

Aim

  • To determine the effect of alcohol co-dependence on the course and severity of the opioid withdrawal syndrome during in-patient medically assisted withdrawal
  • To determine the effect of alcohol co-dependence on compliance with treatment

Figure 1. Comparison of course of mean total SOWS scores between groups O and OA

Method

  • Combined prospective and retrospective study
  • Demographic information obtained from modified Maudsley Addiction Profile7
  • Daily Short Opioid Withdrawal Scales (SOWS)8 collected
  • Opiate only dependent group (O) detoxified from opioids (using methadone), opioid and alcohol co-dependent group (OA) concurrently detoxified from opioids (using methadone) and alcohol (using chlordiazepoxide)

References

1. Gossop, M et al., 2000. Journal of Substance Abuse Treatment, 19, p 45 – 50

2. Gossop, M, 2001. Addiction 96, p 677 – 678

3. Gossop, M, Marsden, J & Stewart, D, 2001. NTORS: After Five Years. The

National Treatment Study

4. Chatham, LR et al., 1997. Addictive Behaviours 22, p 69 – 80

5. Best, D et al., 1999. Journal of Substance Abuse 4, p 41 – 44

6. Gossop, M, Marsden, J & Stewart, D, 2002. Addiction 97(2), p 169 – 178

7. Marsden, J et al., 1998. The Maudsley Addiction Profile: a brief instrument

of treatment outcome. Development and User Manual

8. Gossop, M, 1990. Addictive Behaviours 15, p 487 – 490

9.Ottomanelli, G, 1999. Journal of Substance Abuse Treatment 16(2), p 113 –

121

10.Farrell, M, 1994. Addiction 89, p 1471 - 1475

11. Gossop, M, Bradley, B & Phillips, GT, 1984. Addictive Behaviours 12, p 1 –

6

12. Rasmussen, K et al., 1990. Journal of Neuroscience 10,p 2308 – 2317

13. Bayard, M et al., 2004. American Family Physician69, p1443 – 1450

14. Weiss, F and Porrino, LJ, 2002. Journal of Neuroscience 22, p 3332 - 3333

Table 1. Differences in methadone doses

OA O p-value

Scripted dose 52.9 39.2 0.05

Stabilisation dose 56.2 42.6 0.001

Table 2. Patterns of drug use

OA O p-value

Illicit opioid use 73.1% 48.6% 0.053

Previous overdose 57.6% 21.6% 0.001

Previous treatment

episodes 2.4 1.2 0.05

Acknowledgements

We are grateful to the patients and staff of Wickham Park House, Bethlem Royal Hospital for theirsupport.