Managing Opioids in Poly-Substance Abuse -Icro Maremanni -ISAM 2013, Kuala Lumpur

Dr. Maremanni presented a truly impressive plenary session showing the co currency of opioid addictions with bipolar disorders and cocaine addiction and alcoholism.  He and his team in Italy did a variety of research projects addressing acute clinical concerns.
They found that they could reduce and stop cocaine use in their opiate dependent patients by increasing the methadone. In one study he showed that those who had abused heroin in their youth in later life developed alcoholism. His research was that those who later developed problems often had only been treated with Methadone Maintenance under 60 mg,  He saw the opiate addiction as more successfully treatable than alcohol, because alcohol is so available in Italy and not so easily treated.
There is a cross tolerance with alcohol and benzodiazepine.  He described treatment of the difficult cases involved in  the use of opiate agonist treatment, He uses 2 mg clonazepam twice a day to get patients off alcohol while continuing with opiates.