News in brief - June 20, 2005

Methadone treatment in primary care - Lung cancer breath test? - Officials scrutinizing risks associated with erectile dysfunction drugs - Most primary care patients have more than one chronic condition

Methadone treatment in primary care

Providing methadone treatment in a primary care setting is feasible and can result in healthy outcomes for patients addicted to heroin who are on methadone, according to a new study.

"Getting the necessary regulatory approvals to provide methadone in a primary care setting can be a complex task, but it can result in better medical care for patients who are in stable recovery from heroin addiction and are already in a treatment program," said Joseph Merrill, MD, MPH, lead author of the study in the May Journal of General Internal Medicine.

Dr. Merrill, an internist at the Harborview Medical Center in Seattle, ran a program for 30 patients and was able to retain 28 after one year. Patients received methadone three times a week initially and were recalled for random urine tests.

Primary care facilities can help patients recover from their addiction while also providing treatment for other health problems, the study said. The program was the first to receive approval to treat heroin addiction outside a community opioid treatment program through a formal regulatory process, study authors said. The study was funded by the Robert Wood Johnson Foundation and Washington State's Division of Alcohol and Substance Abuse.

Lung cancer breath test?

The exhaled breath from patients with lung cancer has distinct characteristics that allow those with the disease to be identified by an "electronic nose," according to a study in the American Thoracic Society's Journal of Respiratory and Critical Care Medicine.

The researchers tested their electronic nose on 14 people with lung cancer and 62 people without the disease. Of the 14 cancer patients, 10 had a positive exhaled breath test and four had a negative test. Of the 62 non-cancer patients, 57 had a negative exhaled breath test and five had a positive test.

Exhaled breath contains a multitude of compounds, many of which are in the air, but a number are internally produced, the researchers said. Pentane, isoprene, acetone and benzene are among the exhaled compounds that have been detected in lung cancer patients.

The researchers, who were from the Cleveland Clinic Foundation, said their results prove the feasibility of the electronic nose concept to detect and manage lung cancer, but further study is needed before it is used in population screening.

Officials scrutinizing risks associated with erectile dysfunction drugs

The Food and Drug Administration is investigating reports of vision loss caused by non-arteritic ischemic optic neuropathy and associated with the use of drugs to treat erectile problems, according to an agency spokeswoman.

"We take this situation very seriously, and we are continuing to review it," said Crystal Rice, public affairs specialist at the agency's Center for Drug Evaluation and Research.

The agency has received 38 reports of vision loss in patients using sildenafil (Viagra), four in those using tadalafil (Cialis), and one in those using vardenafil (Levitra). A causal link, however, has yet to be shown, because studies have not shown an increase in this condition among men taking the drug.

Lilly ICOS already has added information about this development to the label of Cialis, and Pfizer is considering doing the same for it's product, Viagra. Levitra's manufacturers did not respond to requests for comment.

Public health officials also are sounding the alarm about these drugs' possible link to sexually transmitted diseases. A study authored by San Francisco Health Dept. officials and published in the June issue of the American Journal of Medicine associated their use with an increasing risk of unsafe sex as well as being diagnosed with HIV or other sexually transmitted diseases.

Most primary care patients have more than one chronic condition

Nearly all patients presenting to primary care physicians have more than one chronic condition, and about half have more than five medical conditions, according to a study published in the May/June Annals of Family Medicine. The most common conditions were hypertension, high cholesterol and rheumatologic diseases.

Researchers reviewed the records of 21 family physicians in Quebec, Canada, and found that 90% of patients had at least two chronic medical conditions, and 50% had more than five. The prevalence also increased with age -- 68% of those between 18 and 44 had at least two conditions; 99% of those older than 65 did.

The authors concluded that guidelines intended for those with a single disease would apply to very few patients and advocated that clinical trials include those with co-morbidities to have more relevance to real-world medical practice.