Methadone substitution treatment for heroin addiction: a program assessment in Colombia
DOI:
https://doi.org/10.20882/adicciones.119Keywords:
heroin addiction, substitution therapy, methadone, Opiate Treatment IndexAbstract
Assessment of a methadone substitution and maintenance treatment program in Colombia using the OTI (Opiate Treatment Index) instrument. Descriptive study with a 50-patient sample attended in the period 2007- 2008 for their heroin addiction. The OTI instrument was implemented to assess drug use, HIV risk-taking behavior, social functioning, criminality, health status and psychological functioning. Men accounted for 74% of the sample, women for 26%. Mean age was 22, with 64% in the 20-24 age group. Mean reported age at onset of heroin use was 18, with a range of 13-28. In 38% of the sample (19 patients) comorbidity with other mental disorders was found, 47% of these being personality disorders. Median reported current methadone dose was 40 mg/day, with a range of 15-80 mg/day. According to the OTI subscales, HIV risk-taking behavior was low-moderate, while social functioning, criminality and health status were low-risk. In the case of psychological adjustment, a low-moderate risk score was obtained for the 0-12 month treatment group, and a moderate risk score for the 12-24 and ≥ 24 month groups. Starting age for heroin use in this population is early . In general, the risk assessed in the OTI areas is low, possibly due to problematic heroin use being in its early stages in Colombia, but comorbidity with personality disorders is high.References
Adelekan, M., Green, A., Dasgupta, N., Tallack, F., Stimson, G.V., Wells,
B. (1996). Reliability and validity of the Opiate Treatment Index among a sample of opioid users in the United Kingdom. Drug Alcohol Review, 15, 261-270.
American Psychiatric Association. DSM5 2010. Recuperado el 8 de Marzo de 2010, de: http://www.dsm5.org/Pages/Default.aspx
Castaño, A. (2002). Consumo de heroína en Colombia. Adicciones, 14,
-90.
Castaño, G.A. y Calderón, G. A. (2010). Consumo de heroína en Colombia, prácticas relacionadas e incidencia en la salud pública. Revista Cubana de Salud Pública, 36, 311-322.
Correctional Service of Canada (2003). Specific Guidelines for Methadone Maintenance Treatment. Disponible en internet: www.csccc.gc.ca/text/pblct/methadone/index-eng.shtml
Darke, S., Hall, W., Wodak, A., Heather, N. y Ward, J. (1992). Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment
Index. British Journal of Addiction, 87, 733-742.
Deering, D.E. y Sellman, J.D. (1996). An inter-rater reliability study of the
Opiate Treatment Index (OTI). Drug and Alcohol Review, 15, 57-63.
Erickson, P.G. (1995). Harm Reduction: What it is and is not. Drug and
Alcohol Review, 14, 283-285.
Fernández, J.J. (2005). Efectividad de los programas de mantenimiento
con metadona. Adicciones, 17, 167-180.
Fernández J.J., González M.P., Saiz P.A., Gutiérrez E., Bobes, J. (2001).
Consumo de drogas ilegales y alcohol antes y a lo largo de 6 años de mantenimiento con metadona y variables relacionadas. Adicciones, 13, 179-188.
Fernández, J.J. y Gutiérrez, E. (2005). Trastornos de personalidad y
dependencia de heroína: una relación por determinar. Adicciones, 17, 95-110.
Fiellin, D.A., O´Connor, P.G., Chawarski, M., Pakes, J.P., Pantalon, M.V.
y Schottenfeld, R.S. (2001). Methadone Maintenance in Primary Care. A Randomized Controlled Trial. Journal of American Medical Association, 286, 1724-1731.
Goldberg, D. y Williams, P. (1988). A user’s guide to the General Health
Questionnaire. NFER NELSON Publishing Company Ltd. Windsor.
González-Saiz, F.M., Salvador-Carulla, L., Martínez-Delgado, J.M., López-Cárdenas, A., Ruz-Franzi, I. y Guerra-Díaz, D. (1997). Indicador del Tratamiento de la Adicción a Opiáceos. Ed. Servicio de Publicaciones de la Universidad de Cádiz.
Gutiérrez, E., Saiz, P., González, M.P., Fernández, J.J. y Bobes, J. (1998).
Trastornos de personalidad en adictos a opiáceos en tratamiento con agonistas vs antagonistas. Adicciones, 10, 121-129.
Henry-Edwards, S., Gowing, L., White, J., Ali, R., Bell, J., Brough, R. et al. (2003). Clinical Guidelines and Procedures for the Use of Methadone in the Maintenance Treatment of Opioid Dependence. Publication Production Unit, Australian Government Department of Health and Ageing. Disponible en internet: http://www.dassa.sa.gov.au/webdata/resources/file /Methadone_cguide_abbrev.pdf
Krantz, M.J., Mehler, P.S. (2004). Treating Opioid Dependence, Growing
Implications for Primary Care. Archives of Internal Medicine, 164, 277-288.
Langendam, M.W., van Brussel G.H., Coutinho, R.A. y van Ameijden,
E.J. (2001). The impact of harm-reduction-based Methadone treatment on Mortality among Heroin users. American Journal of Public Health, 91, 774–780.
March, J.C., Martin-Ruiz, E., Oviedo-Joekes, E., Rivadeneira, A. y Rodríguez, C. (2006). Percepción de usuarios de los Programas de Tratamiento con Metadona sobre la accesibilidad y atención recibida de los equipos terapéuticos. Adicciones, 18, 359-370.
Merrill, J.O., Jackson, T.R., Schulman, B.A., Saxon, A.J., Awan, A., Kapitan, S., et al., (2005). Methadone Medical Maintenance in Primary Care, an Implementation Evaluation. Journal of General Internal Medicine, 20, 344-349.
Miller, N. (1996). Issues in the diagnosis and treatment of comorbid
addictive and other psychiatric disorders. Addiction psychiatry: Current diagnosis and treatment. New York.
NIH Consensus Conference (1998). Effective Medical Treatment of
Opiate Addiction. Journal of American Medical Association, 280, 1936-1943.
O´Connell, D. (1998). Dual disorders: essentials for assessment and
treatment. The Haword Press. New York.
Rodríguez, C., Millán, A., Venegas, J. y March, J.C. (2010). Oportunidades de mejora del servicio de metadona en atención primaria, desde el punto de vista profesional. Adicciones, 22, 207-216.
Sánchez, E., Tomas, V., Climent, A. (1999). Trastornos de personalidad
en adictos a opiáceos. Adicciones, 11, 221-227.
Tarter, R., Kirisci, L. y Mezzich, A. (1996). The Drug Use Screening Inventory: School Adjustment Correlates of Substance Abuse. Measurement and Evaluation in Counseling and Development, 29, 25-34
Trujols, J., Iraurgi, I., Sola, I., Ballesteros, J., Siñol, N., Battle, F. y Pérez, J. (2010). Infección por VIH y usuarios de drogas por vía parenteral:
urgencia de la revitalización de los programas de reducción de daño. Adicciones, 22, 135-140.
UNODC (2006). Proyecto Treatnet fase I. Recuperado el 24 de Febrero
de 2011, de: http://www.unodc.org/treatment/en/drugtreatmentnetwork---
home-archive.html
United Nations Office on Drugs and Crime - UNODC (2004). World Drug Report 2004. Volume 1: Analysis. Recuperado el 9 de Diciembre de 2010, de http://www.unodc.org/pdf/WDR_2004/volume_1.pdf
United Nations Office on drugs and Crime – UNODC (2010). World Drug Report 2010. Recuperado el 27 de Abril de 2011, de http://www.unodc.org/documents/wdr/WDR_2010/World_Drug_Report_2010_lo-res.pdf
Zapata, M. A. (2004). Heroína, Amenaza de Epidemia. Periódico El Mundo, Medellín, Colombia, 11 de Octubre de 2004.
