ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472225

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractStarting at the latter part of the nineteenth century and through the early twentieth century, events are reviewed to provide a sense of the climate and setting in which early methadone research was conducted. The discovery of methadone by the Germans in the later stages of World War II is described. At that time, methadone was not recognized to be a narcotic analgesic. The first report of the properties of methadone published in the United States in 1947 is summarized, and its early use in the treatment of the opioid abstinence syndrome is noted. However, the utility of methadone as a maintenance drug was not recognized unti1 14 years later. Despite strong resistance from the U.S. Bureau of Narcotics, research progressed from the recognition of the unique properties of methadone to substantial clinical application. Finally, methadone is placed in a current context describing a second wave of acceptance based not solely on the reduction of crime but on the prevention of the spread of AIDS.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472226

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472227

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472228

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472229

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractThe relationship between public policy and scientific investigation is explored by a review of the experience with methadone maintenance treatment for narcotic addiction. The implementation of a widespread treatment effort in Hong Kong in the 1970s is contrasted with recent policies in regard to methadone treatment expansion in the United States. In neither case did research fmdings form the basis for public policy. In Hong Kong, rapid expansion of methadone treatment was initiated before scientific evidence was available to support this course, and in the United States treatment expansion has been rejected despite extensive evidence of its utility and safety. Decisions by government officials and health care providers, as in the case of addiction treatment, may be influenced more by philosophy and intuition than by scientific evidence. Scientists must recognize and address this reality if they are to play a meaningful role in shaping public health policy.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472230

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractThe neurobiology of drug addiction is being clarified. Research is revealing the anatomic pathways of primary drug reinforcement (reward) in the brain and the molecular architecture of the receptors on which addictive drugs act All addictive drugs mimic (or occasionally block) the actions of some neurotransmitter; in the case of heroin or methadone an endogenous opioid, probablyβ-endorphin. The ground work is being laid for understanding Dole and Nyswander's“metabolic disease”concept as a concrete neurochemical abnormality of the endogenous opioid system. Thus, a stronger basis is developing for regarding methadone maintenance as a means of replacing a neurohormonal deficiency. Three practical conclusions that can be drawn from this model are: (1) methadone dosage must be adequate (never less than 50–80 mg); (2) it should be more widely accepted that some patients may require lifelong methadone maintenance; and (3) longer-acting, better stabilizing methadone congeners, such as LAAM and its metabolites, should be brought into general use.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472231

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractAdrenal gland metabolism is markedly altered in heroin addicts. During day-time hours, the addict may suffer corticoid deficiency of the addisonian type, and in the evening, an excess of the cushingoid type. The high plasma levels of cortisol that are found in the evening in addicts antagonize endogenous opioids in a manner similar to naloxone. In the present study, 72% of the heroin addicts who sought treatment demonstrated reduced adrenal cortisol reserve. Effective immune and stress responses are dependent on adrenal cortisol reserve. This finding provides an explanation for the heroin addict's vulnerability to AIDS and other infectious diseases. One of methadone's greatest attributes is that it helps normalize adrenal metabolism. Clinical methods to at least partially correct adrenal metabolism may enhance current opioid addiction treatment modalities.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472232

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractOpioid addiction treatment consists of a broad range of treatment modalities, with each playing a valuable role within the overall network of treatment alternatives. Therapeutic communities are often the treatment of choice for addicts who are under legal contingencies and amenable to a rigorous process of life-style change. Methadone maintenance offers the most widely available treatment and is a modality that is compatible with the needs of many injecting heroin users. Outpatient drug-free models offer structure and support to detoxified opioid addicts and nonaddicted opioid abusers. New pharmacotherapies, including clonidine, LAAM, naltrexone and buprenorphine, provide promise for addressing the needs of many opioid abusers who are not currently accessing the treatment system. Furthermore, the treatment system could be better utilized if treatment planning was based more on the needs of the addict than on the ideological bias of the clinician; training efforts could be useful in facilitating change in clinician attitudes.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472233

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractThe doctor-patient interaction in the methadone maintenance treatment clinic is qualitatively different from general medical settings. The patient presents with a specific request for treatment of opioid dependence, most often having already selected the methadone treatment modality, and the initial contact is centered around obtaining methadone. Addiction and needle use increase susceptibility to life-threatening illnesses, such as syphilis, endocarditis, tuberculosis, and AIDS. The physician is working with counselors, nurses, therapists and 12-Step programs, incorporating the best of the medical, psychodynamic, behavioral, and recovery models into treatment. Federal and state governments also control and regulate methadone treatment Given this complex picture, the basic techniques of methadone maintenance treatment are reviewed, including the intake examination, the annual examination, dose adjustment, withdrawal from methadone maintenance, management of pregnant patients, dual diagnosis patients, and severely ill or medically disabled patients.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10472234

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor