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1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial.

https://arctichealth.org/en/permalink/ahliterature186500
Source
Lancet. 2003 Feb 22;361(9358):662-8
Publication Type
Article
Date
Feb-22-2003
Author
Johan Kakko
Kerstin Dybrandt Svanborg
Mary Jeanne Kreek
Markus Heilig
Author Affiliation
Division of Psychiatry, Neurotec, Karolinska Institute, Huddinge University Hospital, S-141 86, Stockholm, Sweden.
Source
Lancet. 2003 Feb 22;361(9358):662-8
Date
Feb-22-2003
Language
English
Publication Type
Article
Keywords
Adult
Buprenorphine - therapeutic use
Counseling
Female
Heroin Dependence - classification - drug therapy - prevention & control
Humans
Male
Narcotic Antagonists - therapeutic use
Psychotherapy, Group
Severity of Illness Index
Sweden
Treatment Outcome
Abstract
The partial opiate-receptor agonist buprenorphine has been suggested for treatment of heroin dependence, but there are few long-term and placebo-controlled studies of its effectiveness. We aimed to assess the 1-year efficacy of buprenorphine in combination with intensive psychosocial therapy for treatment of heroin dependence.
40 individuals aged older than 20 years, who met DSM-IV criteria for opiate dependence for at least 1 year, but did not fulfil Swedish legal criteria for methadone maintenance treatment were randomly allocated either to daily buprenorphine (fixed dose 16 mg sublingually for 12 months; supervised daily administration for a least 6 months, possible take-home doses thereafter) or a tapered 6 day regimen of buprenorphine, thereafter followed by placebo. All patients participated in cognitive-behavioural group therapy to prevent relapse, received weekly individual counselling sessions, and submitted thrice weekly supervised urine samples for analysis to detect illicit drug use. Our primary endpoint was 1-year retention in treatment and analysis was by intention to treat.
1-year retention in treatment was 75% and 0% in the buprenorphine and placebo groups, respectively (p=0.0001; risk ratio 58.7 [95% CI 7.4-467.4]). Urine screens were about 75% negative for illicit opiates, central stimulants, cannabinoids, and benzodiazepines in the patients remaining in treatment.
The combination of buprenorphine and intensive psychosocial treatment is safe and highly efficacious, and should be added to the treatment options available for individuals who are dependent on heroin.
Notes
Comment In: Lancet. 2003 May 31;361(9372):1907; author reply 1907-812788596
Comment In: Lancet. 2003 Feb 22;361(9358):634-512606172
Comment In: Lancet. 2003 May 31;361(9372):1906-7; author reply 1907-812788595
PubMed ID
12606177 View in PubMed
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Increased attributable risk related to a functional mu-opioid receptor gene polymorphism in association with alcohol dependence in central Sweden.

https://arctichealth.org/en/permalink/ahliterature9342
Source
Neuropsychopharmacology. 2005 Feb;30(2):417-22
Publication Type
Article
Date
Feb-2005
Author
Gavin Bart
Mary Jeanne Kreek
Jurg Ott
K Steven LaForge
Dmitri Proudnikov
Lotta Pollak
Markus Heilig
Author Affiliation
The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY 10021, USA. bartg@rockefeller.edu
Source
Neuropsychopharmacology. 2005 Feb;30(2):417-22
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcoholism - epidemiology - genetics - psychology
Ethnic Groups
Female
Gene Frequency
Genotype
Humans
Male
Middle Aged
Polymorphism, Genetic - genetics
Psychiatric Status Rating Scales
Receptors, Opioid, mu - genetics
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Risk assessment
Sweden - epidemiology
Abstract
The mu-opioid receptor (MOR), through its effects on reward and stress-responsivity, modulates alcohol intake in both animal and human laboratory studies. We have previously demonstrated that the frequently occurring A118G single-nucleotide polymorphism (SNP) in exon 1 of the MORgene (OPRM1), which encodes an amino-acid substitution, is functional and receptors encoded by the variant 118G allele bind the endogenous opioid peptide beta-endorphin with three-fold greater affinity than prototype receptors. Other groups subsequently reported that this variant alters stress-responsivity in normal volunteers and also increases the therapeutic response to naltrexone (a mu-preferring opioid antagonist) in the treatment of alcohol dependence. We compared frequencies of genotypes containing an 118G allele in 389 alcohol-dependent individuals and 170 population-based controls without drug or alcohol abuse or dependence. The A118G SNP was present in the Hardy-Weinberg equilibrium with an overall frequency of the 118G allele of 10.9%. There was a significant overall association between genotypes with an 118G allele and alcohol dependence (p=0.0074). The attributable risk for alcohol dependence in subjects with an 118G allele was 11.1%. There was no difference in A118G genotype between type 1 and type 2 alcoholics. In central Sweden, the functional variant 118G allele in exon 1 of OPRM1 is associated with an increased attributable risk for alcohol dependence.
PubMed ID
15525999 View in PubMed
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