1. Natural course of drug addiction, and risk factors for various health outcomes among illegal drug users in Finland: epidemiologic follow-up study

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1 1 Huuti consortium research project 1. Natural course of drug addiction, and risk factors for various health outcomes among illegal drug users in Finland: epidemiologic follow-up study PI: Jussi Kauhanen Team members: Anu Eloranta, Jaana Föhr, Timothy Fawehinmi, Jenni Ilomäki, Sofia Kauhanen, Maarit Jaana Korhonen, Outi Kuikanmäki, Kirsti Laitinen, Omoniyi Olawale, Mika Paasolainen, Hannu Pentikäinen, Kimmo Ronkainen, Ulrich Tacke, Niko Tasa, Jari Tiihonen, Pekka Tuomola, Hanna Uosukainen, Sari Voutilainen Site of the research: University of Kuopio, School of Public Health and Clinical Nutrition, Kuopio,Finland Summary: Regarding the magnitude and public health significance of illegal drug use in the contemporary world, few epidemiologic studies have described the usual course of drug addiction and the multiple health effects associated with drug use. Most studies are restricted to small and specific populations that are distinct from the current Finnish society. The purpose of this epidemiologic study is to: a) produce normative data on the natural course of addiction and drug dependency among over 5,000 Finnish urban drug users who have seeked treatment; b) examine unfavourable outcomes, such as hospitalizations, severe infections, and premature deaths with related medical diagnoses during a follow-up of up to 10 years (by year 2009); c) identify important predictive psychosocial background factors and risk behaviours from the baseline; d) assess, on the aggregate and individual level, the effectiveness of recent drug treatment policies and practices by modelling the morbidity and mortality experience of the study population before and after major changes in treatment practices and guidelines. The study will be done at the Kuopio University, and in Helsinki Deaconess Institute, in collaboration with international experts. The study subjects are a Finnish sample from the unique HUUTI database, which will be linked with national health registries. Contact: Jussi Kauhanen University of Kuopio, School of Public Health and Clinical Nutrition, P.O. Box 1627, Tel , jussi.kauhanen(at)uku.fi Team members: University of Kuopio: Jenni Ilomäki, MSc, University of Kuopio, School of Public Health and Clinical Nutrition, P.O. Box 1627,

2 2 Tel , jenni.ilomaki(at)uku.fi Maarit Jaana Korhonen, PhD, University of Kuopio, School of Public Health and Clinical Nutrition, P.O. Box 1627, Tel , maaritjaana.korhonen(at)uku.fi Kirsti Laitinen, PhD, University of Kuopio, Department of Pharmacology and Toxicology, P.O. Box 1627, Tel , kirsti.laitinen(at)uku.fi Hannu Pentikäinen, MD, Kuopio University Hospital, Drug Addiction Clinic, P.O. Box 1777, 70211, Kuopio, Finland Tel , hannu.pentikainen(at)kuh.fi Kimmo Ronkainen, MSc, University of Kuopio, Research Institute of Public Health, P.O. Box 1627, Tel , kimmo.ronkainen(at)uku.fi Ulrich Tacke, MD, PhD, University of Kuopio, Department of Psychiatry, P.O. Box 1627, Tel , ulrich.tacke(at)uku.fi Jari Tiihonen, Professor, University of Kuopio, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland Tel , jari.tiihonen(at)niuva.fi Sari Voutilainen, PhD, University of Kuopio, Research Institute of Public Health, P.O. Box 1627, Kuopio Tel , sari.voutilainen(at)uku.fi Helsinki Deaconess Institute: Jaana Föhr, MD, Helsinki Deaconess Institute, Alppikatu 2C, Helsinki, Finland Tel , jaana.fohr(at)hdl.fi Outi Kuikanmäki, MD, Helsinki Deaconess Institute, Munkkisaarenkatu 16, Helsinki, Finland Tel , outi.kuikanmaki(at)hdl.fi

3 3 Mika Paasolainen, RN, Helsinki Deaconess Institute, Alppikatu 2, Helsinki, Finland, Tel , mika.paasolainen(at)hdl.fi Niko Tasa, Helsinki Deaconess Institute, Alppikatu 2, Helsinki, Finland, Tel , niko.tasa(at)hdl.fi Pekka Tuomola, MD, Helsinki Deaconess Institute, Munkkisaarenkatu 16, Helsinki, Finland, Tel , pekka.tuomola(at)hdl.fi Students: Anu Eloranta, BM, University of Kuopio, School of Public Health and Clinical Nutrition, P.O. Box 1627, Kuopio, Finland, aelorant(at)hytti.uku.fi Timothy Fawehinmi, MD, University of Kuopio, School of Public Health and Clinical Nutrition, P.O. Box 1627,, fawehinm(at)hytti.uku.fi Sofia Kauhanen, BM, University of Kuopio, School of Public Health and Clinical Nutrition, P.O. Box 1627,, oskauhan(at)hytti.uku.fi Omoniyi Olawale, MD, University of Kuopio, School of Public Health and Clinical Nutrition, P.O. Box 1627,, omoniyi_olawale(at)yahoo.com Hanna Uosukainen, BSc, University of Kuopio, Department of Pharmacology and Toxicology, P.O. Box 1627,, uosukain(at)hytti.uku.fi 2. Effectiveness of pharmacological treatments of drug dependence PI: Jari Tiihonen Site of the research: Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Kuopio, Finland Team members: Jaana Föhr, Jari Haukka, Mika Kallio, Heikki Katila, Kimmo Kuoppasalmi, Outi Kuikanmäki, Esa Meririnne, Antti Mikkonen, Aarno Palotie, Raimo Salokangas, Pekka Tuomola, Helena Vorma, Erkki Vuori Summary: In Finland, the most frequently intravenously used drugs are currently amphetamine and buprenorphine. The efficacy of psychosocial interventions has remained modest and, this far, no pharmacotherapy has proven effective in the treatment of these disorders. The aim of this project is to study a) the effectiveness of methylphenidate vs. placebo in the treatment of i.v. amphetamine dependence, and b) the effectiveness of short and long duration oral buprenoriphine vs. lofexidine treatment in i.v. buphenorphine withdrawal in a real-life setting. The study will be done in Helsinki Deaconess Institute, Helsinki University Central Hospital

4 4 and Turku University Hospital. Both studies will be randomized controlled trials, and the statistical evaluation will be conducted by intention-to-treat analysis, all missing samples considered as drug-positive. The number of the patients (80 in the 2-arm amphetamine trial and 90 in the 3-arm buprenorphine trial) will be sufficient to detect the significance of an effect of medium magnitude (Cohen s d = 0.6). The information on the sociodemographic and clinical variables obtained from HUUTI database will be used to assess the generalizability of the results. The results are expected to have rapid impact on the treatment guidelines of these disorders, since no evidence-based treatment algorithms exist at the moment. Contact: Jari Tiihonen, Professor, University of Kuopio, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland Tel , jari.tiihonen(at)niuva.fi Team members: Jaana Föhr, MD, Helsinki Deaconess Institute, Alppikatu 2C, Helsinki, Finland Tel , jaana.fohr(at)hdl.fi Jari Haukka, PhD, National Institute for Health and Welfare, Department of Mental Health and Alcohol Research, Mannerheimintie 166, Helsinki, Finland Tel , jari.haukka(at)thl.fi Mika Kallio, Turku University Hospital, Department of Psychiatry, Heikki Katila, Department of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Finland mika.kallio(at)tyks.fi Kimmo Kuoppasalmi, MD, PhD, National Institute for Health and Welfare, Department of Mental Health and Alcohol Research,, Mannerheimintie 166, Helsinki, Finland Tel , kimmo.kuoppasalmi(at)thl.fi Outi Kuikanmäki, MD, Helsinki Deaconess Institute, Munkkisaarenkatu 16, Helsinki, Finland Tel , outi.kuikanmaki(at)hdl.fi Esa Meririnne, MD, National Institute for Health and Welfare, Department of Mental Health and Alcohol Research, Mannerheimintie 166, Helsinki, Finland esa.meririnne(at)thl.fi Antti Mikkonen, MD, Turku University Hospital, Department of Psychiatry antti.mikkonen(at)tyks.fi

5 5 Aarno Palotie, Biomedicum Helsinki, Research Program in Molecular Medicine, University of Helsinki aarno.palotie(at)helsinki.fi Raimo Salokangas, MD, PhD, University of Turku, Department of Psychiatry, Kiinamyllynkatu 4-8, FIN Turku, Finland Tel ; fax: , raimo.k.r.salokangas(at)tyks.fi Pekka Tuomola, MD, Helsinki Deaconess Institute, Munkkisaarenkatu 16, Helsinki, Finland Tel , pekka.tuomola(at)hdl.fi Helena Vorma, MD, PhD, Department of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki helena.vorma(at)hus.fi Erkki Vuori, Department of Forensic Medicine, Faculty of Medicine, University of Helsinki, erkki.o.vuori(at)helsinki.fi