A Double Blind Placebo Randomised Controlled Trial Of Sativex In The Management Of Cannabis Withdrawal
Funder
National Health and Medical Research Council
Funding Amount
$245,626.00
Summary
Cannabis is the most commonly used illicit drug in Australia with an estimated 300,000 individuals with cannabis use disorder in Australia. Treatment presentations for cannabis have more than doubled over the last 10 years, yet there is still no medication to help with withdrawal. This proposal will test pure active ingredients in cannabis in a preparation sprayed in the mouth, to wean individuals from cannabis. This will assist them to complete cannabis withdrawal.
A Trial Of Therapeutic Drug Monitoring In Methadone Maintenance Treatment
Funder
National Health and Medical Research Council
Funding Amount
$542,025.00
Summary
Heroin addiction is an established and increasing problem in developed countries and in many developing nations. Although there have been several new treatments for heroin addiction, methadone maintenance remains the most effective way to minimize the harms associated with heroin addiction. The current research proposal seeks to test a new approach to setting of methadone dose, using monitoring of methadone blood levels, effects and side-effects in determining when to increase doses, and when to ....Heroin addiction is an established and increasing problem in developed countries and in many developing nations. Although there have been several new treatments for heroin addiction, methadone maintenance remains the most effective way to minimize the harms associated with heroin addiction. The current research proposal seeks to test a new approach to setting of methadone dose, using monitoring of methadone blood levels, effects and side-effects in determining when to increase doses, and when to switch to alternative therapies. This provides an objective method of planning treatment that focuses on suppressing heroin use. The potential subjects of the study are the 50% of patients who continue to use heroin regularly during treatment. All will undergo assessment involving measurement of blood levels of methadone, testing of effects and side-effects of methadone, and monitoring of safety. Half will be randomly allocated to usual care, and half to therapeutic drug monitoring, with dose adjustments according to the results of testing. At 3 and 6 months all subjects will undergo repeat test sessions. It is hypothesized that those in the experimental group will be using less heroin (confirmed by hair testing). It is expected that the study will also identify a small group of subjects with genetically different opioid receptors, who will require very high doses of methadone to be stabilized. The study will allow a detailed analysis of how best to monitor dose adequacy; the relationship between withdrawal symptoms, methadone blood levels, and heroin use, and will provide the first clear investigation of the relationship between changes in methadone blood concentration and certain potentially dangerous changes in the electrical activity of the heart. The intended outcome of this research project is a model for a higher standard methadone program that is more effective in reducing the problems of heroin use in our community.Read moreRead less
Mortality Among Injecting Drugs Users - A Follow-up Study Of Injecting Drug User Cohorts.
Funder
National Health and Medical Research Council
Funding Amount
$47,500.00
Summary
This study will follow-up injecting drug users that participated in research in the 1990s and 2000s to examine mortality rates in these groups over time. Identifying information from these studies will be cross-referenced with National Death Index data to determine participants that died and the dates of their death. This study will be the first in Australia to determine mortality rates over time in a defined cohort of injecting drug users outside drug treatment settings. Studying a defined grou ....This study will follow-up injecting drug users that participated in research in the 1990s and 2000s to examine mortality rates in these groups over time. Identifying information from these studies will be cross-referenced with National Death Index data to determine participants that died and the dates of their death. This study will be the first in Australia to determine mortality rates over time in a defined cohort of injecting drug users outside drug treatment settings. Studying a defined group overcomes some of the problems associated with mortality rate estimates based simply on the number of injecting drug-related deaths. Although the number of deaths can be found, the number of people at risk of injecting drug-related death is unclear because of the hidden nature of drug use and the dynamic characteristics of drug use and drug markets. The examination of mortality trends among injecting drug users over time can provide insights regarding changes in drug use patterns and markets. For example, this study will examine changes in injecting drug use mortality across periods of high heroin availability in the late '90s and periods of interrupted heroin supply - the heroin 'drought' - from 2000 onwards. In addition, factors related to injecting drug-related mortality can be explored by comparing the characteristics of injecting drug users that died and those that survived, such as drug use and drug treatment histories, co-morbidities such as mental illness and socio-demographic backgrounds. This information can inform overdose prevention and harm reduction strategies by identifying individuals most at risk of injecting drug-related mortality. This study will also draw attention to the significant public health burden of injecting drug use. In addition, by comparing the results from this study with other similar studies from overseas, we can more reliably compare mortality among groups of Australian injecting drug users with their peers in other countries.Read moreRead less
Longitudinal Treatment Outcomes For Methamphetamine Dependence: A Treatment Cohort Study
Funder
National Health and Medical Research Council
Funding Amount
$720,500.00
Summary
Australia has a substantial and growing population of problematic stimulant users, namely dependent or injecting methamphetamine users, with methamphetamine injection accounting for one-third of all injecting drug use. Methamphetamine dependence has been associated with serious physical and mental health problems, including psychosis, depression, stroke and general poor health and wellbeing. Increasing numbers of people are presenting for treatment of methamphetamine dependence and many are expe ....Australia has a substantial and growing population of problematic stimulant users, namely dependent or injecting methamphetamine users, with methamphetamine injection accounting for one-third of all injecting drug use. Methamphetamine dependence has been associated with serious physical and mental health problems, including psychosis, depression, stroke and general poor health and wellbeing. Increasing numbers of people are presenting for treatment of methamphetamine dependence and many are experiencing other psychiatric problems like drug-induced psychosis and depression. Currently little is known about people who present for treatment of methamphetamine dependence, including how many have other serious mental health problems that need treatment in their own right. Nor is it known whether the treatment they receive for their methamphetamine use is effective in reducing their drug use or improving their mental health status. The current study will provide much needed information on people seeking treatment for methamphetamine dependence in Australia, including their psychiatric status, and whether the treatment they receive for methamphetamine dependence is effective in reducing their drug use and related health problems or improving their mental health status. These aims will be met by assessing drug use, psychiatric status, treatment experience as well as general health and well being among a cohort of people entering treatment for methamphetamine use in Sydney. Responses to treatment will be assessed at 3 months and 12 months following treatment entry and outcomes will be compared to a group of methamphetamine users not receiving treatment. This is the first study in Australia to assess the effectiveness of treatment that is provided to methamphetamine users in an everyday treatment setting. It is also the first study internationally to focus on treatment outcome for methamphetamine dependence in a community setting.Read moreRead less
The Role Of Pharmacotherapy In Prevention Of Relapse In Alcohol Dependence
Funder
National Health and Medical Research Council
Funding Amount
$422,310.00
Summary
The physical, psychological and social consequences of alcohol abuse remain a critical health problem. Every year in Australia, excessive consumption is responsible for 3,000-6,000 deaths and costs the community $6 billion. Approximately 15% of Australians abuse alcohol and 5% of men and 3% of women are alcohol dependent (addicted to alcohol). Young men are particularly affected, with 10% of all men aged 18-35 dependent on alcohol. Better treatment for alcohol dependence is urgently needed. Less ....The physical, psychological and social consequences of alcohol abuse remain a critical health problem. Every year in Australia, excessive consumption is responsible for 3,000-6,000 deaths and costs the community $6 billion. Approximately 15% of Australians abuse alcohol and 5% of men and 3% of women are alcohol dependent (addicted to alcohol). Young men are particularly affected, with 10% of all men aged 18-35 dependent on alcohol. Better treatment for alcohol dependence is urgently needed. Less severe forms of alcohol abuse frequently respond to brief screening and intervention programs. Treatment of alcohol dependence remains unsatisfactory. Most treatments lead to abstinence in only 1-3, and approximately 50% of these will relapse within 3 months of completing treatment. Two drugs (naltrexone and acamprosate) appear to interfere with the effects of alcohol on the brain that promote addiction. There is evidence that both drugs are beneficial in the treatment of alcohol dependence and both are now available in Australia. At present, no data have been reported comparing the effectiveness of these two drugs. The proposed project will compare naltrexone and acamprosate in a large carefully performed study. The study will help determine which subjects are likely to benefit from one or other of these agents. Compliance is a major problem with many medications, but is a particular problem with medications for substance abuse. The second aim of this study is to test a novel intervention to increase compliance with medications for alcohol dependent subjects. This intervention comprises 'compliance therapy', which resembles a short training course, a medication alarm, and an assertive reminder program for scheduled medical appointments. The present study will be the first to apply this type of therapy to subjects with alcohol dependence.Read moreRead less
Diversion And Misuse Of Stimulant Medication For ADHD Among Illicit Psychostimulant Users
Funder
National Health and Medical Research Council
Funding Amount
$152,534.00
Summary
The practices of diversion and misuse of pharmaceutical stimulants give serious cause for concern due to their potential to increase the risk of drug toxicity, dependence, and serious adverse health consequences. These practices may be particularly harmful among illicit psychostimulant users. This will be the first to study the nature of diversion and misuse of pharmaceutical stimulants among illicit psychostimulant users and the first to examine the associated correlates and consequences.
The Efficacy Of An Intervention For PTSD Among Illicit Drug Users
Funder
National Health and Medical Research Council
Funding Amount
$580,219.00
Summary
The high prevalence of PTSD among people with illicit drug use disorders (IDUD) has been clearly recognised in both the Australian and international literature. In Australia, 33% of those with opioid use disorders and 24% of those with amphetamine use disorders have comorbid PTSD. The prevalence among people with alcohol use disorders on the other hand, is comparably low (5%). Despite the high prevalence of PTSD among people with IDUD, research on treatment responses to this significant problem ....The high prevalence of PTSD among people with illicit drug use disorders (IDUD) has been clearly recognised in both the Australian and international literature. In Australia, 33% of those with opioid use disorders and 24% of those with amphetamine use disorders have comorbid PTSD. The prevalence among people with alcohol use disorders on the other hand, is comparably low (5%). Despite the high prevalence of PTSD among people with IDUD, research on treatment responses to this significant problem is sparse. Individuals with this comorbidity present a significant challenge to substance abuse treatment providers as they present with a poorer clinical profile, and have poorer treatment outcomes, including higher readmission rates. Consequently, they are a costly burden to the health care system. The costs of this comorbidity to individual sufferers and society may be reduced substantially by the implementation of an integrated treatment that addresses both disorders concurrently. There is however, little research to guide how best to treat comorbid IDUD and PTSD. Although a small number of interventions have been developed and trialled, none have been evaluated in an Australian setting. One intervention which has shown promise in the United States is Concurrent Treatment of PTSD and Substance Use Disorder (CTPSD). Preliminary research has shown that CTPSD can be used safely and is effective in the treatment of PTSD among individuals with cocaine dependence. Completers of the program have demonstrated significant reductions in all PTSD symptom clusters and cocaine use from baseline to end of treatment which were maintained at 6 month follow-up. Significant reductions in depressive symptoms were also observed. Despite these promising results, CTPSD is yet to undergo a randomised controlled trial. The proposed study is a randomised controlled trial of the efficacy of CTPSD in the Australian setting.Read moreRead less
Molecular Cell Biology Of HNP22: Role In Alcohol Dependence
Funder
National Health and Medical Research Council
Funding Amount
$346,320.00
Summary
We used a differential screening procedure to detect changes in gene expression in the human alcoholic brain and described a novel gene, which we named hNP22, with increased expression in the superior frontal cortex of the alcoholic cases. This is the first report of a novel alcohol-responsive gene isolated from the human brain. We now propose to further explore the hNP22 gene, its product and its regulation in human brain tissue, and in a variety of experimental systems. We will determine how p ....We used a differential screening procedure to detect changes in gene expression in the human alcoholic brain and described a novel gene, which we named hNP22, with increased expression in the superior frontal cortex of the alcoholic cases. This is the first report of a novel alcohol-responsive gene isolated from the human brain. We now propose to further explore the hNP22 gene, its product and its regulation in human brain tissue, and in a variety of experimental systems. We will determine how protein expression correlates with the level of alcohol consumption. We will use animal and cell culture models to determine the response of the gene to various stimuli. We will express the recombinant protein to determine its function. It is likely that the gene product may be a component in an important signal pathway within neuronal cells and thus may represent a novel target for therapeutic intervention.Read moreRead less
Opioid Dependent Persons In Pharmacotherapy: Blood Borne Viruses And Cancer Risk
Funder
National Health and Medical Research Council
Funding Amount
$88,495.00
Summary
Opioid dependent persons in pharmacotherapy in NSW are at increased risk of death from cancer. We will examine the occurrence of infection with hepatitis and HIV among this high-risk population using data linkage. We will define the relationship between infection, the duration, frequency and type of pharmacotherapy, and cancer risk. The findings will guide effective strategies that will reduce cancer incidence and mortality among this group, and minimise the associated health care costs.