Academic literature on the topic 'Methadone maintenance Physiological effect'

Background: Morphine independent reduces the expression level of Brain-derived Neurotrophic Factor (BDNF) and Cyclic-AMP Response Element Binding protein (CREB). BDNF and CREB play a vital role in protecting and regulating the proper functioning of neurons. There has not been any study on the effect of methadone maintenance treatment and its comparison with morphine. Therefore, this study was conducted to examine the effect of methadone maintenance on the expression of BDNF and CREB genes in brain VTA of male morphine treated rats Methods: I Morphine independent reduces the expression level of Brain-derived Neurotrophic Factor (BDNF) and Cyclic-AMP Response Element Binding protein (CREB). BDNF and CREB play a vital role in protecting and regulating the proper functioning of neurons. There has not been any study on the effect of methadone maintenance treatment and its comparison with morphine. Therefore, this study was conducted to examine the effect of methadone maintenance on the expression of BDNF and CREB genes in brain VTA of male morphine treated rats Results: According to the findings of this study, similar to morphine treated group, methadone maintenance in morphine treated animals led to significant reduction in the expression of BDNF and CREB genes at VTA as well as BDNF serum level compared with control group. Conclusion: It was concluded that methadone, like morphine, causes significant reduction in the expression of BDNF and CREB genes in brain VTA area of rat as well as BDNF serum level compared with control group.

Abstract Objective The study objective was to identify the analgesic efficacy of three different pharmacological strategies in patients receiving methadone or buprenorphine as opioid agonist treatment (OAT). The three pharmacological approaches, a) increasing maintenance methadone/buprenorphine dose by 30%, b) adding oxycodone, or c) adding a single dose of gabapentin, were compared with a control condition of the participant’s usual OAT dose. Design A randomized, controlled, double-blinded, double-dummy, within-subject crossover study. Subjects Nine participants on stable doses of methadone and eight participants on stable doses of buprenorphine were recruited. Setting An outpatient opioid treatment clinic in inner city Sydney, Australia. Methods The cold pressor tolerance test was used to examine experimental pain threshold and tolerance. Ratings of subjective drug effects and safety measures (physiological and cognitive) were assessed. Results There was no difference in the primary outcome measures of pain thresholds or tolerance between the conditions examined. Interindividual variability was evident. Differences in some subjective measures were identified, including lower pain recall, lower “bad effects,” and higher global satisfaction in the additional methadone condition. In the buprenorphine arm, increased drug liking and “bad effects” were detected with oxycodone administration, while increased subjective intoxication was identified with gabapentin. Conclusions There was no evidence of an objective improvement in analgesia with any condition compared with control. Further research is required to optimize pain management strategies in this population.

In this study, the effect of four anaesthetic protocols that included the combination of xylazine (X) and ketamine (K) with acepromazine (A) and opioids (methadone (Me), morphine (Mo) or tramadol (T)) was evaluated in laboratory rats of both sexes. Ultrasonic vocalization (USV) was used as an indicator of pain during the recovery period. The objective was to evaluate the physiological parameters and the analgesic effect of each protocol to determine which protocol was the safest and fulfil the requirements of a balanced anaesthesia. The better protocols were the XKA protocol for both sexes and the XKMe protocol for females because the combinations achieve surgical plane of anaesthesia in rats. However, pain assessment during the formalin test revealed that rats anaesthetized with XKA produced more numbers of USV, suggesting that it is not a good protocol for the control of immediate postoperative pain. All protocols produced depression in body temperature and respiratory and heart rates, and had important effects, such as micturition and maintenance of open eyes. Only rats anaesthetized with XKA protocol did not present piloerection. These results demonstrated that good monitoring and care during anaesthesia must be included to prevent complications that compromise the life of the animal and to ensure a good recovery. The inclusion of analgesia in anaesthesia protocols must be used routinely, ensuring minimal presence of pain and thus more reliable results in the experimental procedures.

BackgroundDrugs of dependence cause dopamine release in the rat striatum. Human neuroimaging studies have shown an increase in dopamine in the equivalent region in response to stimulants and other drugsAimsWe tested whether opioids provoke dopamine release and its relationship to the subjective experienceMethodIn two combined studies 14 heroin addicts on methadone maintenance treatment underwent two positron emission tomography brain scans of the dopamine system using [11C]-raclopride following an injection of placebo and either 50 mg intravenous diamorphine or 10 mg subcutaneous hydromorphone in a double-blind, random order designResultsBoth opioids produced marked subjective and physiological effects, but no measurable change in [11C]-raclopride bindingConclusionsThe absence of a dopamine response to opioid agonists contrasts with that found with stimulant drugs and suggests dopamine may not play the same role in addiction to opioids. This questions the role of dopamine in the subjective experience of heroin in opioid addicts

The authors followed a cohort of 610 opioid users for 1 year after admission to methadone maintenance. At the end of the year, 52% were on methadone and 48% were off methadone. Among subjects on methadone, days of intravenous drug use, crime, and needle-sharing decreased markedly from the month preceding admission to the month preceding the first anniversary of admission. Among subjects off methadone, days of these activities also decreased, but the decreases appeared in large part to be an effect of increased days of incarceration. Among those on methadone, days of productive activity increased markedly. Subjects with more years of intravenous drug use were more likely to be on methadone at the end of the year, and subjects under compulsory supervision were less likely to be on methadone. The findings confirm previous reports of decreased illicit opioid use, decreased crime, and decreased needle risk for infection with the human immunodeficiency virus among opioid users who remain on methadone.

IntroductionThe prevalence of smoking in patients under methadone maintenance therapy is high (85–98%). Most of these patients tend to quit smoking, but only a few of them receive treatment or referred to quit smoking. Recent study on aripiprazole, has been shown to reduce smoking.AimsThe aim of this study was to evaluate aripiprazole on smoking in patients under methadone maintenance therapy.Material and methodThis study was a double-blind intervention study. Patients under Methadone maintenance therapy in 22 Bahman Hospital randomly divided into two intervention and control group. First with the FTQ questionnaire, nicotine dependency assessed in all patients. Then, 6-week aripiprazole administered to intervention group. Data were analyzed by SPSS version 21.ResultsThe age range of patients was 67–25 years. Two groups were matched in demographic characteristics. Finally, mean number of FTQ questionnaire in case group before intervention was 8.9 ± 1.4 and after intervention was 8.4 ± 1.6. This difference was statistically significant (P = 0.0007).ConclusionThe study results show the aripiprazole effect in reducing the desire to smoke in patients under methadone maintenance therapy. The overall level of dependency on nicotine on the basis of test FTQ has decreased. By choosing aripiprazole as adjunctive therapy to quit smoking, by reducing the tendency of patients to smoking, can decrease cardiovascular complications and other problems caused by smoking and we can reduce the mortality rate of these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Opioid abuse costs affect the majority of the adult population in our society directly or indirectly. The current prevailing medical treatment for opioid addiction is methadone maintenance treatment (MMT). MMT reduces infectious disease spread, illicit drug use, criminal activity, and overdose potential. MMT is only as effective as the length of time a client remains active and compliant with the program. In previous studies, therapeutic alliance (TA) has been shown to positively influence the effectiveness of substance abuse treatment. However, a gap exists in research in regards to the impact of TA on the effectiveness of MMT outcomes. The theoretical framework of this study is based on therapeutic alliance, which guided an examination on whether therapeutic alliance (as measured by the Session Rating Scale) influenced MMT retention and compliance (drug screens and session attendance). Archival data from 264 clients receiving MMT for opioid dependence were reviewed from a nonprofit community-based agency in Arizona. Logistic regression results revealed that TA did not significantly affect retention or compliance. However, issues were noted such as how the SRS was administered, a lack of understanding by clients regarding scoring the SRS, and unique social desirability demands when clients are in MMT. The finding that TA alone did not significantly affect retention and compliance does not decrease the need to find effective means to improve MMT outcomes. Rather, the findings suggest a critical need to identify and utilize measures more appropriate for clients receiving MMT. In doing so, positive social change may be achieved by assisting clinical staff in developing a strong therapeutic alliance with MMT clients as they focus on problem solving as a joint venture when challenges in the recovery process arise.

Findings from various studies investigating treatment of severe addictions lead to the conclusion that coping skills training in group therapy is viable and addresses both the vulnerabilities and capacities of addicts. This study adapted coping skills training as treatment for use in groups, on cocaine using clients in a methadone maintenance treatment program. The customary education format was used in a control group and the effects on outcome of both treatments were analyzed. The groups were conducted in the methadone clinic. The participants were 46 clients admitted to the methadone treatment program, abusing and or dependent on cocaine. They all volunteered to participate in the study. Subjects who volunteered to be in the experimental group had no time constraints, no transportation problems and were all unemployed. Clients identified high-risk situations in which they would use cocaine and coping skills training modules were selected to address these specific needs.

碩士
國立中正大學
犯罪防治研究所
99
In recent years, Taiwan has been giving Methadone maintenance therapy (MMT) for up to one year to drug addicts that have had relapse within five years and voluntarily received hospital evaluation as suitable for MMT. However, MMT seems less effective than that in other countries. A questionnaire is designed for collecting relative information for this research. The questionnaire collects data from drug addicts for analyzing efficacy of MMT and its relative factors in order to understand the effectiveness of MMT for drug addicts in Taiwan. 716 nonrandom cluster questionnaires are collected from drug addicts who have received or completed MMT in Taipei Prison, Hsinchu Prison, Taichung Prison, Yunling Prison, Tainan Prison, Taoyuan Women’s Prison, Taichung Women’s Prison, and Kaouhsiung Women’s Prison. The study reveals that the dosage used in MMT in Taiwan has been less than other countries but still has good efficacy. However the lack of funding for supplementary treatments such as psychological consulting, assistance for advisory and medical service has shown negative impact on MMT’s effectiveness. It is recommended that the government devotes more resources on the support system for MMT, including the subsidization aforementioned in order to provide greater help for drug addicts.

Discovered in 1999, ghrelin, is one of the peptides co-creating the hypothalamicgastrointestinal axis, otherwise known as the brain-gut axis. Ghrelin participates in many physiological processes and spectrum of its activity is still being discovered. This 28 amino acid peptide ‒ a product of the ghrl gene, was found in all vertebrates and is synthesized and secreted mainly from enteroendocrine X/A cells located in the gastric mucosa of the stomach. Expression of the ghrelin receptor has been found in many nuclei of the hypothalamus involved in appetite regulation. Therefore it’s presumed that ghrelin is one of the crucial hormones deciphering the energy status required for the maintenance of organism homeostasis. Ghrelin acts as a signal of starvation or energy insufficiency and its level in plasma is reduced after the meal. Neuropeptide Y (NPY) and agouti-related peptide (AgRP; NPY/AgRP) neurons located in the arcuate nucleus (ARC) area are the main target of ghrelin in the hypothalamus. This subpopulation of neurons is indispensable for inducing orexigenic action of ghrelin. Moreover ghrelin acting as a neurohormone, mainly in the hypothalamus area, plays an important role in the regulation of growth and reproduction processes. Indeed, ghrelin action on reproductive processes has been observed in the systemic effects exerted at both hypothalamus-pituitary and gonadal levels. Similarly the GH-releasing ghrelin action was observed both on the hypothalamus level and directly on the somatotrophic cells in the pituitary and this dose-related GH releasing activity was found in in vitro as well as in in vivo experiments. In recent years, numerous studies revealed that ghrelin potentially takes part in the treatment of diseases associated with serious disturbances in the organism energy balance and/or functioning of the gastrointestinal tract. It was underlined that ghrelin may be a hormone with a broad spectrum of therapeutic effect on obesity and anorexia nervosa, as well as may also have protective effect on neurodegenerative diseases, inflammatory disorders or functional changes in the body caused by cancers. In overall, ghrelin treatment has been tested in over 100 preclinical studies with healthy volunteers as well as patients with various types of cancer, eating disorders such as anorexia nervosa and bulimia nervosa. It was observed that ghrelin has an excellent clinical safety profile and emerging side effects occurred only in 3–10% of patients and did not constitute a sufficient premise to discontinue the therapy. In general, it can be concluded that ghrelin may be sufficiently used as a prescription drug.

The meniscus performs several functions for the maintenance of knee joint health, such as load transmission and joint stability. Meniscal lesions have been suggested as a precursor to the onset of osteoarthritis (OA)[1]. Such lesions often lead to surgical removal of the torn portion of the meniscus, increasing cartilage to cartilage contact area. Partial meniscectomies have been shown using finite element analysis and histology to lead to altered and increased mechanical loading on the remaining meniscus and underlying articular cartilage[2,3]. Consequently, pathological compressive strains of more than 15% have been shown to increase proteoglycan breakdown and meniscal matrix degradation[4]. Preliminary investigations in our laboratory have demonstrated an increase in interleukin-1α (IL-1α) gene expression of meniscal explants subjected to pathological levels of dynamic compressive strain [6,7]. This inflammatory cytokine has been attributed to apoptosis and matrix degradation[5]. However, gene expression measurements merely suggest possible matrix remodeling mechanisms and do not necessarily result in protein syntheses from which matrix changes occur. Therefore, the purpose of this study was to quantify protein synthesis of IL-1α in porcine meniscal implants after compressive strain exercises. It was hypothesized that, similar to mRNA expression, protein synthesis for pathologically loaded (0 or 20% dynamic strain) samples would be greater than samples loaded to physiological levels (10% strain).

The concept of food as medicine is not new. The use of foods to prevent and/or treat certain diseases can be found in ancient drawings and writings. The most famous statement came from Hippocrates, who said “Let food be thy medicine.” It is the position of the Academy of Nutrition and Dietetics to recognize that although all foods provide some level of physiological function, the term, “functional foods” is defined as whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet regularly at effective levels based on significant standards of evidence. The most prominent results indicated that high total intake of fruits and vegetables, and some of their specific subgroups including berries, citrus, and green leafy vegetables, may promote higher levels of optimism and self-efficacy, as well as reduce the level of psychological distress, ambiguity, and cancer fatalism, and protect against depressive symptoms. Flavonoids are a class of organic polyphenolic compounds found in varying concentrations in plant-based whole foods such as berries, tea, cocoa, soybeans, and grains. Recent studies suggest that flavonoids can be beneficial to both cognitive and physiological health. As such, long term chronic supplementation with flavonoids has been investigated extensively, particularly concerning cognitive ageing and related neurodegenerative disorders. Less attention has been given to the acute effect of flavonoids on cognitive outcomes, within the immediate 0–6 h post ingestion. Therefore, the general recommendation to consume at least 5 portions of fruit and vegetables a day may be beneficial also for mental health. Immediate cognitive enhancement is often desirable in academic and work environments, such as during an exam or assessment. Besides, support a positive role for the nutrients EPA, DHA, magnesium, alpha-tocopherol, and folic acid, either alone or in combination with drugs, in the preservation of normal brain function and mental well-being. In this study, the effects of consumption of some functions on mood, cognitive function and mental health were investigated. Scientific findings support the combination of micro and macronutrients in a balanced and varied diet along with a healthy lifestyle for the maintenance of normal brain function, improvement of mental abilities, concentration, memory and alertness. Food components actively participate in the generation of nerve impulses by influencing neurotransmitters that activate different parts of the brain, thereby regulating our mental abilities, emotions and mood.

The involvement of calcium and phospholipid in the activation of Factor X to Xa by Factor IXa and Factor VIII has been well documented. Although we and others have shown that maintenance of physiological concentrations of calcium has a positive effect on the stability of Factor VIII in plasma, calcium’s role in the structure and function of Factor VIII remains to be fully elucidated. To this end, we examined the effect of calcium on the stability of highly purified Factor VIII. Homogeneous Factor VIII (specific activity approximately 5,200 U/mg) was prepared from heparinized blood using a six-step purification procedure including cryoprecipitation, polyethylene glycol precipitation, Affi-Gel Blue, Aminohexyl, polyelectrolyte E5 and immunoaffinity chromatography. This yielded a single chain high molecular weight species of approximately 260,000. The protein was tested for stability using the one stage assay over 6h of incubation at 4°C in buffers containing 0 mM, 5 mM, and 10 mM CaCl2. Addition of 5 mM and 10 mM CaCl2 to desalted, purified Factor VIII resulted in an immediate 12% (for 5 mM CaCl2) and 23% (for 10 mM CaCl2), enhancement of procoagulant activity compared to samples containing no added calcium. The calculated half-life (T1/2) of activity of Factor VIII in buffers containing no added calcium was 3.8h, whereas the Tl/2 for preparations incubated in the presence of 5 mM and 10 mM CaCl2 were increased to 5h and 5.5h respectively. Although the addition of calcium improved the recovery of activity over the first 0.5h of incubation, at later times the rate of decay in the calcium containing preparations was similar to Factor VIII preparations without added calcium. Our results suggest that removal of calcium from the microenvironment of purified Factor VIII by desalting, results in an immediate loss of procoagulant activity, which can be partially restored within the first 0.5h following readdition of calcium. The decay in Factor VIII activity observed at later times in the 0 mM, 5 mM and 10 mM CaCl2 containing buffers likely reflects calcium-independent denaturation of the protein.

Research objectives were: 1) To study the effect of diet energy density, level of exercise, thermal conditions and reproductive state on cardiovascular function as it relates to oxygen (O2) mobilization. 2) To validate the use of heart rate (HR) to predict energy expenditure (EE) of ruminants, by measuring and calculating the energy balance components at different productive and reproductive states. 3) To validate the use of HR to identify changes in the metabolizable energy (ME) and ME intake (MEI) of grazing ruminants. Background: The development of an effective method for the measurement of EE is essential for understanding the management of both grazing and confined feedlot animals. The use of HR as a method of estimating EE in free-ranging large ruminants has been limited by the availability of suitable field monitoring equipment and by the absence of empirical understanding of the relationship between cardiac function and metabolic rate. Recent developments in microelectronics provide a good opportunity to use small HR devices to monitor free-range animals. The estimation of O2 uptake (VO2) of animals from their HR has to be based upon a consistent relationship between HR and VO2. The question as to whether, or to what extent, feeding level, environmental conditions and reproductive state affect such a relationship is still unanswered. Studies on the basic physiology of O2 mobilization (in USA) and field and feedlot-based investigations (in Israel) covered a , variety of conditions in order to investigate the possibilities of using HR to estimate EE. In USA the physiological studies conducted using animals with implanted flow probes, show that: I) although stroke volume decreases during intense exercise, VO2 per one heart beat per kgBW0.75 (O2 Pulse, O2P) actually increases and measurement of EE by HR and constant O2P may underestimate VO2unless the slope of the regression relating to heart rate and VO2 is also determined, 2) alterations in VO2 associated with the level of feeding and the effects of feeding itself have no effect on O2P, 3) both pregnancy and lactation may increase blood volume, especially lactation; but they have no effect on O2P, 4) ambient temperature in the range of 15 to 25°C in the resting animal has no effect on O2P, and 5) severe heat stress, induced by exercise, elevates body temperature to a sufficient extent that 14% of cardiac output may be required to dissipate the heat generated by exercise rather than for O2 transport. However, this is an unusual situation and its affect on EE estimation in a freely grazing animal, especially when heart rate is monitored over several days, is minor. In Israel three experiments were carried out in the hot summer to define changes in O2P attributable to changes in the time of day or In the heat load. The animals used were lambs and young calves in the growing phase and highly yielding dairy cows. In the growing animals the time of day, or the heat load, affected HR and VO2, but had no effect on O2P. On the other hand, the O2P measured in lactating cows was affected by the heat load; this is similar to the finding in the USA study of sheep. Energy balance trials were conducted to compare MEI recovery by the retained energy (RE) and by EE as measured by HR and O2P. The trial hypothesis was that if HR reliably estimated EE, the MEI proportion to (EE+RE) would not be significantly different from 1.0. Beef cows along a year of their reproductive cycle and growing lambs were used. The MEI recoveries of both trials were not significantly different from 1.0, 1.062+0.026 and 0.957+0.024 respectively. The cows' reproductive state did not affect the O2P, which is similar to the finding in the USA study. Pasture ME content and animal variables such as HR, VO2, O2P and EE of cows on grazing and in confinement were measured throughout three years under twenty-nine combinations of herbage quality and cows' reproductive state. In twelve grazing states, individual faecal output (FO) was measured and MEI was calculated. Regression analyses of the EE and RE dependent on MEI were highly significant (P<0.001). The predicted values of EE at zero intake (78 kcal/kgBW0.75), were similar to those estimated by NRC (1984). The EE at maintenance condition of the grazing cows (EE=MEI, 125 kcal/kgBW0.75) which are in the range of 96.1 to 125.5 as presented by NRC (1996 pp 6-7) for beef cows. Average daily HR and EE were significantly increased by lactation, P<0.001 and P<0.02 respectively. Grazing ME significantly increased HR and EE, P<0.001 and P<0.00l respectively. In contradiction to the finding in confined ewes and cows, the O2P of the grazing cows was significantly affected by the combined treatments (P<0.00l ); this effect was significantly related to the diet ME (P<0.00l ) and consequently to the MEI (P<0.03). Grazing significantly increased O2P compared to confinement. So, when EE of grazing animals during a certain season of the year is estimated using the HR method, the O2P must be re measured whenever grazing ME changes. A high correlation (R2>0.96) of group average EE and of HR dependency on MEI was also found in confined cows, which were fed six different diets and in growing lambs on three diets. In conclusion, the studies conducted in USA and in Israel investigated in depth the physiological mechanisms of cardiovascular and O2 mobilization, and went on to investigate a wide variety of ruminant species, ages, reproductive states, diets ME, time of intake and time of day, and compared these variables under grazing and confinement conditions. From these combined studies we can conclude that EE can be determined from HR measurements during several days, multiplied by O2P measured over a short period of time (10-15 min). The study showed that RE could be determined during the growing phase without slaughtering. In the near future the development microelectronic devices will enable wide use of the HR method to determine EE and energy balance. It will open new scopes of physiological and agricultural research with minimizes strain on animals. The method also has a high potential as a tool for herd management.