Collaborative Addiction Research in Asian Populations Home and Abroad
Gavin Bart, MD PhD FACP FASAMDirector, Division of Addiction Medicine
Department of MedicineHennepin County Medical CenterAssociate Professor of Medicine
University of [email protected]
International Conference on Global Health: Prevention and Treatment of Substance Use Disorders and HIV
Taipei, TaiwanApril 18, 2013
Hmong and opiate dependence
• Validate the assessment tool– MINI versus SSADDA
• Prevalence– Laos ~ 10%– Thailand ~15%– US ~3%
• Mode– Smoking opium– Smoking heroin
Malison 2011; Westermeyer 1981, 1995; Wiewel 2005
Hmong entering treatment
Tool Hmong (n=57) Score (±SD)
Non-Hmong (n=80) Score (±SD)
Significance
Beck depression inventory
26.5 (11.6) 21.3 (11.6) P < 0.03
SCL-90 Depression 2.3(0.9) 1.8(1.1) P < 0.01
SCL-90 Somatization 1.6(0.9) 1.2(0.8) P < 0.02SCL-90 Phobic Anxiety 1.0(0.8) 0.7(0.8) P < 0.04SCL-90 Psychoticism 1.2(0.7) 0.8(0.7) P < 0.02Hamiliton Depression 20.7(9.8) 16.1(9.0) P < 0.02Hamilton Anxiety 17.2(8.8) 13.6(8.8) P < 0.03
Westermeyer and Chitasombat 1996
Methadone maintained Hmong: psychiatric comorbidity
SCID Axis I Diagnosis Hmong (n=76)
Non-Hmong (n=125)
Significance
No current diagnosis 51 36 P < 0.001Schizophrenia/Psychotic Disorders
2 3 Insufficient sample size
Anxiety Disorders 17 127 P < 0.001Mood Disorders 4 38 P < 0.05Substance Related Disorders
11 23 P > 0.1
Eating disorders 0 3 Insufficient sample size
Total number of diagnoses
85 230 P < 0.05
Bart 2013
Hmong treatment outcome
• Behavioral only ~90% relapse• Methadone ~80% retention
– Hmong 49.0 mg (17.4)– Non-Hmong 77.1 mg (25.1)
Bart 2012
Hmong: a pocket of people
Listman et al, 2007 and unpublished data
Hmong genotype v. phenotype
Straka et al. 2006
R-methadone population pharmacokinetics:Hmong and non-Hmong
Parameter Estimate (θ) 95% CI
CL/F (L/h) 8.6 7.8-9.3
V (L) 345 309-381
F non-Hmong (ref.) 1.00 --
Hmong 1.50 1.32-1.68
IIV of CL (%CV) 0.0392 (19.8) -0.0108-0.0892
IIV of F (%CV) 0.0941 (30.7) 0.0443-0.144
RV, proportional (%CV) 0.0348 (18.7) 0.0186-0.0510
Bart 2013
More questions
• Why are the Hmong different?
– Diet
– Transporter function
– Genetics
• Can we predict methadone dose requirements?
• Does this happen with other medications?
Why Research?• To find cures to disease and illness• Describe the situation
– Epidemiology– Cohort studies
• Compare approaches– Outcome– Quality of life / Satisfaction– Cost-effective
• To inform policy
Research resources
Thank You
• NIDA K23 DA024663• SAMHSA• PEPFAR• USAID• CDC• Vietnam VAAC• FHI360• Yih-Ing Hser• Betty Tai• NIDA R13DA035084