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 Minnesotabartx005@umn.edu

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 < 0.01SCL-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Listman et al, 2007 and unpublished data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