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.
Ethanol abuse, alcoholism and the medical complications of excessive drinking are now major health problems worldwide. The alcohol dependence syndrome is characterised by tolerance and physical dependence ( the presence of a withdrawal syndrome). Ethanol withdrawal, in addition, to being a health hazard in itself, can act as a negative reinforcer to promote continued ethanol consumption. Alcohol dependence can be considered to result from adaptive changes produced by the chronic presence of etha ....Ethanol abuse, alcoholism and the medical complications of excessive drinking are now major health problems worldwide. The alcohol dependence syndrome is characterised by tolerance and physical dependence ( the presence of a withdrawal syndrome). Ethanol withdrawal, in addition, to being a health hazard in itself, can act as a negative reinforcer to promote continued ethanol consumption. Alcohol dependence can be considered to result from adaptive changes produced by the chronic presence of ethanol in the brain. In this research programme we will learn more about the adaptive changes in the NMDA receptors, the major excitatory receptors in the brain. Current psychopharmacologic management of human alcoholism is limited and suboptimal. We will explore the efficacy of drugs to control behaviours and withdrawal-induced brain cell death. Effective treatment of the syndrome is crucial since withdrawal induces changes, which increases the severity of subsequent withdrawal episodes and its associated brain damage. The outcomes of this research will be a better understand of the underlying changes involved in ethanol dependence and better therapies to ameliorate the withdrawal syndrome.Read moreRead less
Human Muscle Stretch Reflexes: The Effects Of Stimulus Properties, Muscle State And Subject Intention
Funder
National Health and Medical Research Council
Funding Amount
$170,604.00
Summary
The best known muscle reflex is the tendon jerk, which is usually evoked by tapping the muscle tendon with a small hammer. This tap imposes a very rapid stretch on the muscle, which produces a stretch reflex. Different stretch responses, however, can be observed to slow or fast stretches, or to vibration of muscle. Normally, when the muscles of a relaxed person are stretched, no active response is observed. However, when the person is engaged in a task and contracting their muscles, then stretch ....The best known muscle reflex is the tendon jerk, which is usually evoked by tapping the muscle tendon with a small hammer. This tap imposes a very rapid stretch on the muscle, which produces a stretch reflex. Different stretch responses, however, can be observed to slow or fast stretches, or to vibration of muscle. Normally, when the muscles of a relaxed person are stretched, no active response is observed. However, when the person is engaged in a task and contracting their muscles, then stretch modulates the muscle activity such that an increase in contraction of the muscle opposes the stretch and defends the position of the joint against the external disturbance. This is the everyday situation in which stretch reflexes operate. Despite extensive investigation for over a hundred years, there is still no consensus among researchers about the behaviour of stretch reflexes nor about their role in the control of movement. Even the demarcation of reflex from voluntary muscle activity is not always certain. One of the outstanding features of stretch reflexes is the variability of their behaviour, which depends on the particular muscle involved, its level of contraction, the type of stretch and the task in which the person is engaged. This variability has made it difficult for researchers to determine the role of reflexes in the control of movement. In order to study stretch reflex behaviour in human subjects, we will measure the electrical activity of elbow muscles, the elbow position and the force generated at the joint under a variety of conditions. A series of five experiments will investigate specific unresolved issues such as the effect of subject intention on the modulation of muscle activity and how altered modulation of muscle activity may change the stiffness of our limbs. The objective of the experimental series is to fill in important gaps in the picture of the behaviour of the stretch reflex.Read moreRead less
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
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 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