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Ex. ADVP en tratamiento de deshabituacion con metadona titurada

English translation: Respuesta larga...

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09:51 Mar 26, 2002
Spanish to English translations [PRO]
Medical / Discharge report
Spanish term or phrase: Ex. ADVP en tratamiento de deshabituacion con metadona titurada
Discharge report for a clinic in Spain into Uk English. This is a patient being treated for drug addiction. Is deshabituacion the same as detox in English? I imagine the word "titurada" has been mispelt. Do they mean triturada, in which case, how do you translate it into English? Many thanks.
Belen San Antonio
France
Local time: 09:31
English translation:Respuesta larga...
Explanation:
1) I agree with Cecilia re: ADVP.
2) Re: \'deshabituación’, I believe there is no exact equivalent in English (Brit. or US). Indeed the concept of ‘eliminating the habit’ in drug addiction may have been ‘wishful thinking’ on the part of the medical community, and it may have become already archaic in light of recent physiologic research (see first link: Stimmel B. Kreek MJ. Neurobiology of addictive behaviors and its relationship to methadone maintenance. Mount Sinai Journal of Medicine. 67(5-6):375-80, 2000 Oct).

This is a partial abstract of an article entitled \'Leaving methadone treatment: lessons learned, lessons
forgotten, lessons ignored.\'(see 2nd link)

Despite the demonstrated benefits of methadone maintenance, there have been concerns about the ethics, necessity and expense of maintaining addicts on methadone indefinitely. The inability of many patients to achieve normative levels of psychosocial functioning with methadone, combined with widely held attitudes favoring drug abstinence over replacement medication, has led to attempts to promote time-limited methadone treatment. This paper reviews the published research literature on post-discharge outcomes of patients exiting from extended methadone detoxification, \"abstinence-oriented\" methadone programs, and regular methadone maintenance programs. Virtually all of these studies document high rates of relapse to opioid use after methadone treatment is discontinued. Most of the patients studied left treatment without meeting clinical criteria for detoxification, although high relapse rates were also reported...

So for \'deshabituación\' perhaps we should stay with one of 3 terms : a) detoxification; b) abstinence; or c) rehabilitation.

3) Re: the word in your text \'titurada\', as Cecilia says, there are 2 options: triturada (crushed) vs titulada (titrated). In this partial article abstract below, the crushed form of methadone use is described for England:

Strang J. Sheridan J. Barber N. Prescribing injectable and oral methadone to opiate addicts:results from the 1995 national postal survey of community pharmacies in England and Wales. Link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8704540&dopt=Abstract

OBJECTIVE--To establish the extent of prescribing injectable and oral methadone to opiate addicts and the practice characteristics and dispensing arrangements attached to these prescriptions. DESIGN----- SETTING--England and Wales. SUBJECTS------MAIN OUTCOME MEASURES--Data were collected on each prescription for controlled drugs currently being dispensed by pharmacies to misusers ---- RESULTS--Methadone was the opiate most commonly dispensed to misusers (96.0% of 3846 opiate prescriptions). 79.6% of methadone prescriptions were for the oral liquid form, 11.0% for tablet, and 9.3% for injectable ampoules. More than one third of all methadone prescriptions were for weekly or fortnightly pick up, with a further third being for daily pick up. Tablets and ampoules were even less likely to be dispensed on a daily basis. ----- CONCLUSIONS--The distinctively British practice of prescribing injectable methadone was found to be widespread and, contrary to guidance, to be as prevalent in non-specialist as specialist settings. In view of the frequent crushing and injecting of methadone tablets, clearer more authoritative guidance is needed on the contexts in which injectable methadone (tablets as well as ampoules) should be prescribed...


As you can see, crushing methadone tablets for injection is a misuse. This is thus unlikely to be the case for your text, UNLESS the patient has trouble swallowing his tablets and needs them crushed.

The other (perhaps more likely) possibility is that the medical team discharging your patient plans to do regular titration of the methadone dosis, to adjust it to the optimum level for the patient.

HTH
Elena

Selected response from:

xxxElena Sgarbo
Grading comment
Muchisimas gracias otra vez. Yo tampoco se lo que quiere decir, intentare contactar la clinica en Espana. Saludos
4 KudoZ points were awarded for this answer

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Summary of answers provided
4 +1Respuesta larga...xxxElena Sgarbo
4 +1difficulties in text
Parrot
5detox
Dr. Chrys Chrystello


  

Answers


44 mins   confidence: Answerer confidence 5/5
detox


Explanation:
absolutely, as for triturada I would go for crushed

Dr. Chrys Chrystello
Portugal
Local time: 07:31
Native speaker of: Native in EnglishEnglish, Native in PortuguesePortuguese
PRO pts in pair: 20
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57 mins   confidence: Answerer confidence 4/5Answerer confidence 4/5 peer agreement (net): +1
difficulties in text


Explanation:
ADVP = adictos a drogas por vía parenteral

deshabituación = not exactly detox; detoxification is cleansing of the system and "deshabituación" is the total rehab treatment of kicking dependency (with all the interpersonal implications attaching). In rehab language, distinction is also made between "addicted" and "habituated".

titurada = could be "ground" (triturada) OR "titrated" (titulada). I think this last would require a consultation with the authors of the text.

If someone on the site is a specialist in rehab, he might be able to solve the problems, but your case has too many variables.

--------------------------------------------------
Note added at 2002-03-26 12:38:21 (GMT)
--------------------------------------------------

You could wait until your question reaches our favourite doctor (Elena Sgarbossa) on the other side of the Atlantic.

Parrot
Spain
Local time: 09:31
Native speaker of: Native in EnglishEnglish
PRO pts in pair: 7645

Peer comments on this answer (and responses from the answerer)
agree  xxxElena Sgarbo: Cecilia, I'm deeply flattered... I'm always learning interesting things about literature from your knowledgeable posts, so yours is a special compliment :-)
4 hrs
  -> Doc, what would we do without you!
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5 hrs   confidence: Answerer confidence 4/5Answerer confidence 4/5 peer agreement (net): +1
Respuesta larga...


Explanation:
1) I agree with Cecilia re: ADVP.
2) Re: \'deshabituación’, I believe there is no exact equivalent in English (Brit. or US). Indeed the concept of ‘eliminating the habit’ in drug addiction may have been ‘wishful thinking’ on the part of the medical community, and it may have become already archaic in light of recent physiologic research (see first link: Stimmel B. Kreek MJ. Neurobiology of addictive behaviors and its relationship to methadone maintenance. Mount Sinai Journal of Medicine. 67(5-6):375-80, 2000 Oct).

This is a partial abstract of an article entitled \'Leaving methadone treatment: lessons learned, lessons
forgotten, lessons ignored.\'(see 2nd link)

Despite the demonstrated benefits of methadone maintenance, there have been concerns about the ethics, necessity and expense of maintaining addicts on methadone indefinitely. The inability of many patients to achieve normative levels of psychosocial functioning with methadone, combined with widely held attitudes favoring drug abstinence over replacement medication, has led to attempts to promote time-limited methadone treatment. This paper reviews the published research literature on post-discharge outcomes of patients exiting from extended methadone detoxification, \"abstinence-oriented\" methadone programs, and regular methadone maintenance programs. Virtually all of these studies document high rates of relapse to opioid use after methadone treatment is discontinued. Most of the patients studied left treatment without meeting clinical criteria for detoxification, although high relapse rates were also reported...

So for \'deshabituación\' perhaps we should stay with one of 3 terms : a) detoxification; b) abstinence; or c) rehabilitation.

3) Re: the word in your text \'titurada\', as Cecilia says, there are 2 options: triturada (crushed) vs titulada (titrated). In this partial article abstract below, the crushed form of methadone use is described for England:

Strang J. Sheridan J. Barber N. Prescribing injectable and oral methadone to opiate addicts:results from the 1995 national postal survey of community pharmacies in England and Wales. Link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=8704540&dopt=Abstract

OBJECTIVE--To establish the extent of prescribing injectable and oral methadone to opiate addicts and the practice characteristics and dispensing arrangements attached to these prescriptions. DESIGN----- SETTING--England and Wales. SUBJECTS------MAIN OUTCOME MEASURES--Data were collected on each prescription for controlled drugs currently being dispensed by pharmacies to misusers ---- RESULTS--Methadone was the opiate most commonly dispensed to misusers (96.0% of 3846 opiate prescriptions). 79.6% of methadone prescriptions were for the oral liquid form, 11.0% for tablet, and 9.3% for injectable ampoules. More than one third of all methadone prescriptions were for weekly or fortnightly pick up, with a further third being for daily pick up. Tablets and ampoules were even less likely to be dispensed on a daily basis. ----- CONCLUSIONS--The distinctively British practice of prescribing injectable methadone was found to be widespread and, contrary to guidance, to be as prevalent in non-specialist as specialist settings. In view of the frequent crushing and injecting of methadone tablets, clearer more authoritative guidance is needed on the contexts in which injectable methadone (tablets as well as ampoules) should be prescribed...


As you can see, crushing methadone tablets for injection is a misuse. This is thus unlikely to be the case for your text, UNLESS the patient has trouble swallowing his tablets and needs them crushed.

The other (perhaps more likely) possibility is that the medical team discharging your patient plans to do regular titration of the methadone dosis, to adjust it to the optimum level for the patient.

HTH
Elena




    Reference: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&d...
    Reference: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&d...
xxxElena Sgarbo
Native speaker of: Native in SpanishSpanish
PRO pts in pair: 3539
Grading comment
Muchisimas gracias otra vez. Yo tampoco se lo que quiere decir, intentare contactar la clinica en Espana. Saludos

Peer comments on this answer (and responses from the answerer)
agree  Parrot: I also came across the methadone-crushing objection in Spain, and the vans distibuting methadone here give out syringes as well, so...
1 hr
  -> Thanks Cecilia. You mean they distribute syringes with methadone tablets (not vials??)
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