الفهرس 
OPIOID ADDICTIONOnly 14 pages are availabe for public view
 |  | from | 319 |  |  |
| | | from | 319 | | |
Abstract
O
pioids, including heroin, remain the most harmful drug type in health terms. The use of opioids is associated with the risk of fatal and non-fatal overdoses; the risk of acquiring infectious diseases (such as HIV or hepatitis C) through unsafe injecting practices; and the risk of other medical and psychiatric co-morbidities.
A significant proportion of premature death in addicts is attributed to opioids.
Because of their availability, the abuse of psychoactive drugs and heroin, especially brown cheap heroin, has now increased significantly square measure has markedly multiplied than before as a result of their availability.
In 2015, almost 12 million DALYs, or 70 per cent of the global burden of disease attributable to drug use disorders, were attributable to opioids.
In Egypt, since the 1970s there has been a great increase of substance dependence. The last Egyptian National Survey report shows that 8.6% of Egyptians used drugs at least once during their lives.
According to the WHO (WHO, 2010), the prevalence of drug dependence in individuals between 15 and 64 years of age in Egypt was 0.8%. In recent studies, opioids were the substances of major problem in 44% of the substance dependence cases (tramadol tablets were the main dependence substances in 30% of the sample, heroin in 12%, and nalbuphine in 2%).
Opioid addiction is often characterized as a long term, chronic condition with periods of remission and relapse. Despite different treatment approaches many patients with opioid addiction continue to use opioids during and after treatment, while it is beyond question that enrollment in the major treatment modalities for heroin dependence is associated with large reductions in heroin and other drug use, the maintenance of abstinence is more problematic.
International studies have found that the majority of patients lapse within one month of discharge.
Relapse following detoxification based treatments carries a substantial mortality risk due to accidental overdose, especially for heroin injectors.
This indicates the importance therefore of pre-discharge planning and prompt introduction of aftercare support during this high-risk period.
The aim of the present work was:
1- To identify factors that predict good treatment outcome (sustained abstinence) among heroin addicts.
2- To identify factors that predict poor treatment outcome among heroin addicts.
The study was conducted on 122 subjects who were selected as convenient sampling from patients fulfilling the diagnosis of opioid use disorder as outlined in the DSM- V criteria during the first two weeks of their admission in Al- Mammoura inpatient addiction treatment unit.
Patients were included during the study period first of January 2018 to the first of June 2018 and followed up for next 3months after their discharge (till septemper2018).
According to treatment outcome measured by the Opiate Treatment Index (OTI)
Subjects were classified into one of two groups
group (A) with good treatment outcome:
Significantly greater improvement in all areas:
Can maintain abstinence for 3 months
No illegal activity or arrests (less criminally active)
no other drug use
Better general and injection-related health,
Better general mental health
Full-time Employment.
group (B) with poor treatment outcome:
Cannot maintain abstinence for 3 months
Continuous polydrug use
Injection-related health problems
General physical and mental health problems
Criminal involvement
Heroin overdose
Comparing differences between two groups with respect to their socio-demographic, pattern of abuse, ASI, SCID I, SCID II, OTI variables.
Results of this study revealed that:
60% of cases achieved abstinence (Good treatment outcome) after 3month follow up while 40% of cases relapsed (Poor treatment outcome).
Comparison between initial OTI results and follow up OTI results among two groups revealed that group A (abstinent) achieved significant improvement in all aspect including other drug use, HRBS, social problems, criminality, general health, psychological adjustment With marked deterioration of group B in more than one aspect.
Comparison between both groups showed no significant differences in age, gender, education, or employment status.
group A was relatively younger than group B, this difference is statistically insignificant.
Married cases were found to be more in group B (42.5%) comparing to (38.3%) of group A
According to educational level, Preparatory level was found to be most common educational level (32.5%) in group B while in group A university level was the most common one (35%) the secondary level was found to be equal in both groups (20%).
Drug problems were significantly more severe in group A than in group B. On the other hand Family problems were found to be more severe in group B than in group A which is a statistically significant difference.
The current study has shown that abstinence status was associated with more severe drug problems while, more severe family problems is predictor of early relapse.
On the other hand, abstinence was not associated with severity of either medical problems, Employment problems or Alcohol problems.
Legal problems are not significant predictors of early abstinence; group A showed more severe problems than group B with a statistically insignificant difference.
Regarding Psychiatric problems group B had significantly more severe problems than group A.
Severity of Psychiatric problems is positively correlated with poorer outcomes. According to pattern of heroin use, Early abstinence was positively associated with Inhalational route (30%) group A, (12.5%) group B, while negatively associated with intravenous route (65 %) group B and (45%) group A and with long duration of use duration is significantly longer in group B than in group A but not correlated with sniffing, Age of onset, and Dose.
As regard co morbid Axis-I disorders along SCID-I scale, no statistical significant differences found between both groups except for depression which is associated with poorer outcomes group B (37%), group A (10%).
As regard co morbid Axis-II disorders along SCID-II scale, this study shows no statistical significant differences found between both groups, personality disorders are not correlated with treatment outcome. With Borderline personality disorder is the most prevalent personality disorder in both groups represented (80%)of cases in group A and (75 %) of cases in group B followed by antisocial personality disorder representing 28.3 % of cases in group (A)comparing to 37.5 % in group(B)
Comparison between both groups according to OTI revealed no significant difference regarding treatment history. Regarding drug use, high initial level of heroin use is positively correlated with good treatment outcome in group (A).
Poor treatment outcome is positively associated with initial use of benzodiazepines (Mean ± SD = 0.03 ± 0.16) in group (B), in group (A) (Mean ± SD. 0.0 ± 0.0), also with initial level of cannabis use (Mean ± SD=0.19 ± 0.440) in group B, in group (A) (Mean ± SD =0.07 ± 0.31).
High HRBS is positively correlated with poor treatment outcome (Mean ± SD=13.73 ± 8.51), in group (B), (Mean ± SD=8.97 ± 9.67) in group (A).
Social problems are positively correlated with good treatment outcome in group (A) (Mean ± SD=19.70 ± 4.25), in group (B) (Mean ± SD=17.55 ± 5.48).
No significant differences between two groups regarding criminality level or rate nor general health problems, GHQ from the previous data we concluded that 3 month treatment outcome of this study was (60% of cases achieved abstinence while 40% of cases relapsed).
Factors associated with (relapse) poor treatment outcome at 3 month were also examined using a logistic regression
The significant predictors after adjustment of other factors were: duration, (OR=1.22,95% CI(1.07-1.39), severe family problems (OR=2.18,95%CI, heroin use (OR=.663,95%CI(-)), social functioning and involvement in drug subculture (OR=.822, 95%CI(-))
An increase in duration of herion use by 1 year causes increase the risk to poor treatment outcome by 0.204 with 0.05 significance level, other factors level constant
An increase in dose of heroin use by 1 gram causes decrease in the risk to poor treatment outcome by 0.411with 0.05siginficance level, other factors held constant.
An increase in severity of family problems by 1 unit causes increase in the risk to poor treatment outcome by 0.780 with 0.05 significance level, other factors held constant.
An increase in social functioning with involvement in drug subculture by 1 unit causes decrease in the risk to poor treatment outcome by 0.196 with 0.05 siginficance level, other factors held constant.
CONCLUSION
F
rom the previous data it can be concluded that relapse rates detected for opiate dependent subjects in the first 3 months after discharge are high.
Factors affecting treatment outcome at 3 month were duration, family problems, dose of heroin, social functioning and involvement in drug subculture.
Duration of heroin use, severe family problems have positive correlation with Poor treatment outcome
Heroin dose and social functioning with involvement in drug subculture have negatively correlated with Poor treatment outcome.
The first three months were clearly where the marked differences occurred, and illustrate the crucial importance of this initial treatment phase. Abstinence at a follow-up point is not, of course, identical to sustained abstinence, which has rarely been reported.
There is a critical period very shortly after discharge when patients are particularly susceptible to using opiates
Understanding the reasons for substance abuse and demographic data may eventually help to face addiction problem.
The consequences of addiction are profound, not only for the individual patient however additionally for society and also the health care system.
Psychiatric co-morbidities still the most frequent problems with substance abuse; they may be a complication or a cause of substance abuse.
Finally, early identification of predictors of relapse and hence high risk patients might be helpful in designing more effective and focused treatment plan.