Posts Tagged ‘Chinese opioid treatment programs’

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I just got my copy of the most recent issue of the Journal of Addiction Medicine, my favorite medical journal. It was filled with interesting articles. Here are highlights from a few articles.

One study found that vitamin D supplementation improved cognitive functions and mental health status of patients in methadone maintenance treatment in Iran.

The incidence of opioid use disorder is rising in Iran, with opium as the most common drug, followed by opium ashes, illicit methadone, heroin and morphine. This article, by Ghaderi, et al., said about 1.2 million Iranians have opioid use disorder, giving a prevalence about three times what is found worldwide. About half a million people in Iran are now in treatment with methadone and buprenorphine.

The author of the study wanted to see if vitamin D supplementation improved cognitive function in patients in methadone maintenance treatment. Several past studies showed higher incidence of cognitive deficits in patients undergoing treatment for opioid use disorder, and other studies have shown lower Vitamin D levels in patients on methadone maintenance programs compared to controls not on methadone treatment.  Also, previous studies have shown that low vitamin D levels are associated with impaired mental function and mental health disorders.

The authors of this present study have done past studies that demonstrated vitamin D administration helped patients with major depression, improving depressive symptoms.

However, the authors acknowledge that a meta-analysis study by Gowda et al., 2015, plus two other meta-analyses, showed no significant reduction in depression scoring after vitamin D administration.

This study was done to add to the literature around vitamin D supplementation in people susceptible to having lower vitamin D levels, who were also diagnosed with opioid use disorder and in treatment with methadone maintenance.

This was a randomized, double-blinded, placebo-controlled study, so the design was good. However, not many patients participated in this trial. Out of the screening of 425 prospective trial subjects, only 90 were interested in participating in the study. Those ninety subjects were reduced to 70 after twenty didn’t meet inclusion criteria.

These 70 people were randomized to either placebo or vitamin D treatment. Oral supplements were the only form of vitamin D that was counted; for obvious reasons, it would be quite difficult to quantify the amount of vitamin D that each subject got from sun exposure. The test subjects were compliant with taking their dose of either vitamin D or placebo, and the group of subjects on vitamin D had significantly higher vitamin D levels after twenty-four weeks of supplementation compared to subjects in the placebo group.

The vitamin D group had improved mental function. Specifically, this group performed better on a test known as the Iowa Gambling Test, which is a test designed to simulate real-life decision- making abilities. They also had better verbal fluency, logic and memory scoring. Results of the study showed improved depression scoring but no effect on anxiety test scoring.

How intriguing this is! I advise my patients with poor nutritional habits to take a one a day multivitamin, which should have all the vitamin D most people require. Vitamin D is one of the stored vitamins (along with vitamins A, E and K) so it is possible to get too much of a good thing, but routine supplemental doses are helpful for many people.

The study was interesting, but hardly conclusive. The study was relatively small, and most patients opted out of participation, for some reason. A larger study would give results more statistical power.

For now, I’ll keep recommending daily multivitamins in patients with unhealthy dietary habits, which includes vitamin D.

 

Another article was a study of job satisfaction of medical providers at methadone maintenance programs in China. Knowing next to nothing about methadone maintenance in China, I didn’t realize China has had methadone maintenance treatment available for the past twenty years. To be sure, that’s not long, compared to many other nations, but I was pleased to read of their programs.

The article, by Chen et al., said there were nearly eight hundred treatment programs in China as of the end of 2015, treating over 167,000 patients.

At Chinese methadone maintenance programs, doctors see these patients and do physical exams, some counseling, and prescribe methadone. Those patients (called clients in this article) take their prescriptions to pharmacists, and nurses then administer the medication and observe their dosing.

Some of the Chinese opioid treatment programs offer other services, like testing for sexually transmitted diseases, social support counseling, or employment skills training.

This present study was done in order to explore factors relating to job satisfaction among these medical professionals. Previous studies found challenges to medical personnel working at opioid treatment programs including worry about their safety, low pay, large workload, and negative attitudes toward methadone maintenance treatment in general in China.

Ten methadone maintenance programs were included in this study, and they were all located in urban areas. The average number of patients treated at the programs was 114, so these were relatively small programs compared to what we usually see in the U.S. There were only seven to fifteen employees total at these programs, and the study was only open to medical staff members, meaning doctors, nurses, or pharmacists. Only seventy-six subjects were included in this study.

The subjects were asked questions about their demographics and work history, about their job satisfaction, about perceived institutional support, and about perceived stigma due to working with drug users.

The results showed that low job satisfaction was associated with working at a program that was associated with the Centers for Disease Control, high perceived stigma due to working with drug users, prior experience outside of infectious disease areas, and perceived low institutional support.

Several of the findings make sense, but why was program association with the CDC negatively correlated with job satisfaction? As it turns out, physicians and nurses who work at these programs are largely contract employees. These workers tend to have lower pay and benefits and are asked to work more on weekends and holidays. They also may perceive less job security.

As for the other findings, the article says that in China there’s a belief that heroin users congregate at methadone maintenance programs, making them dangerous places. Some workers felt their personal security was at risk and that they may be exposed to infectious diseases by working with this patient population.

I think some medical workers in U.S. programs feel the same way. I don’t know of any statistics showing that this is the case; exposure to infectious diseases can happen in any medical field. I don’t feel my personal security is at risk where I work, but I can understand if some workers feel this way.