heroin and Chronic-Disease

Heroin is an illicit, highly addictive drug. It is either the most abused or the most rapidly acting member of opioids. Abusers describe a feeling of a surge of pleasurable sensation, named as "rush" or "high". Repeated administration of high doses of heroin results in the induction of physical dependence. Physical dependence refers to an altered physiological state produced by chronic administration of heroin which necessitates the continued administration of the drug to prevent the appearance of a characteristic syndrome, the opioid withdrawal or abstinence syndrome. Withdrawal symptoms may occur within a few hours after the last administration of heroin. Symptoms of the withdrawal include restlessness, insomnia, drug craving, diarrhea, muscle and bone pain, cold flashes with goose bumps, and leg movements. Major withdrawal symptoms peak between 48 and 72 hours after the last dose of heroin and subside after about a week. At this time, weakness and depression are pronounced and nausea and vomiting are common. Nevertheless, some chronic addicts have shown persistent withdrawal signs for many months or even years. Heroin addiction is considered as a behavioural state of compulsive drug use and a high tendency to relapse after periods of abstinence. It is generally accepted that compulsive use and relapse are typically associated with the status of heroin craving or heroin hunger that are difficult to define but appear to be powerful motivational significance in the addiction process. The route of administering heroin varies largely and may indicate the degree of seriousness of the individual's addiction. Intravenous administration seems to be the predominant method of heroin use, but recently a shift in heroin use pattern has been found, i.e. from injection to sniffing and smoking. Frequent injections coupled with widespread sharing of syringes increase the risk of contracting HIV, hepatitis B, C and other blood-borne infectious diseases. Long-term use of heroin has also severe medical consequences such as scarred veins, bacterial infections of blood vessels, liver and kidney diseases, and lung complications.

Topics: Administration, Intranasal; Animals; Behavior, Addictive; Chronic Disease; Euphoria; Global Health; Haplorhini; Heroin; Heroin Dependence; Humans; Infusions, Intravenous; Narcotics; Opiate Substitution Treatment; Powders; Recurrence; Severity of Illness Index; Substance Withdrawal Syndrome; Time Factors

Opioids are important, if not essential, agents in treating certain types of chronic pain. However, the prevalence of drug misuse, abuse, and addiction has fostered considerable consternation among physicians, who may hesitate to prescribe these medications both due to concern for patients (misuse, abuse, and addiction), and fears of prosecution and/or professional sanction. Such practice may reflect 1) inadequate knowledge about patients' susceptibility to, or current drug misuse or abuse; 2) lack of familiarity with extant assessments and/or regulations, and/or 3) an unanticipated reaction to existing guidelines, policies or laws. We posit that assessing patients' predisposition to, and patterns of, drug misuse/abuse is a vital first step toward establishing and maintaining the safe and effective use of opioid analgesics in the treatment of chronic pain. Adherence monitoring is critical to identify patients' prior and current drug use, establish treatment basis, and evaluate compliance, so as to avoid misuse and abuse, and ensure sound and proper pain management. This paper provides a review of the numerous monitoring approaches that have been described in the literature and addresses the benefits and limitations of these techniques and tools. The complex nature of the problem of drug misuse and abuse is discussed, and while no single monitoring technique can fully address this complex issue, we describe how multiple approaches to adherence monitoring may be employed to sustain the prudent use of opioids for the treatment of chronic pain.

Topics: Analgesics, Opioid; Chronic Disease; Codeine; Drug Monitoring; Heroin; Humans; Hydrocodone; Pain; Patient Compliance

To determine the cost utility of medical co-prescription of heroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts.. Cost utility analysis of two pooled open label randomised controlled trials.. Methadone maintenance programmes in six cities in the Netherlands.. 430 heroin addicts.. Inhalable or injectable heroin prescribed over 12 months. Methadone (maximum 150 mg a day) plus heroin (maximum 1000 mg a day) compared with methadone alone (maximum 150 mg a day). Psychosocial treatment was offered throughout.. One year costs estimated from a societal perspective. Quality adjusted life years (QALYs) based on responses to the EuroQol EQ-5D at baseline and during the treatment period.. Co-prescription of heroin was associated with 0.058 more QALYs per patient per year (95% confidence interval 0.016 to 0.099) and a mean saving of 12,793 euros (8793 pounds sterling, 16,122 dollars) (1083 to 25,229 euros) per patient per year. The higher programme costs (16 222 euros; lower 95% confidence limit 15,084 euros) were compensated for by lower costs of law enforcement (- 4129 euros; upper 95% confidence limit - 486 euros) and damage to victims of crime (- 25,374 euros; upper 95% confidence limit - 16,625 euros). The results were robust for the use of national EQ-5D tariffs and for the exclusion of the initial implementation costs of heroin treatment. Completion of treatment is essential; having participated in any abstinence treatment in the past is not.. Co-prescription of heroin is cost effective compared with treatment with methadone alone for chronic, treatment resistant heroin addicts.

Topics: Administration, Inhalation; Adult; Chronic Disease; Cost of Illness; Cost-Benefit Analysis; Crime; Drug Resistance; Drug Therapy, Combination; Female; Health Resources; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Methadone; Multicenter Studies as Topic; Narcotics; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Treatment Outcome

In 1994, a new project dealing with the treatment of heroin dependency was introduced in Switzerland. A group of heavy opiate addicts, who had failed in previous medical therapies, received heroin by prescription, supported by health and social services. The admission criteria to this treatment are summarized as the main results of this project: physical and mental health of the addicts improved on average during treatment, an improvement also took place in their social reintegration, a significant decrease in consumption of illegal drugs took place and illegal activities declined massively. The proportion of patients who continued the treatment in a time period of 12 months was held at 76%. Comparison of the treatment costs with the economic benefits shows that there is a total benefit per patient and per day of 26 US dollars. Further drug related political decisions in Switzerland as well as the assessments of the International Narcotics Control Board (INCB) of the United Nations to this project will be reported and discussed.

Topics: Adult; Chronic Disease; Heroin; Heroin Dependence; Humans; Social Support; Switzerland

This, the last article in the series, describes the administration of analgesics other than via the enteral route in the treatment of chronic severe pain.

Topics: Administration, Cutaneous; Analgesics; Chronic Disease; Fentanyl; Heroin; Humans; Infusions, Parenteral; Injections, Subcutaneous; Pain

The neurological complications observed in 6 HIV negative intravenous drug users are reported. Four developed acute neuromuscular involvement in a lumbosacral or brachial distribution with rhabdomyolysis, myoglobinuria, hypovolemia, renal and hepatic failure in the 3 most severely affected patients. Despite evidence of immunologic abnormalities and especially presence of anti-heroin antibodies, we feel that causative mechanisms include mixed compression and ischemia with an underlying toxic myopathy, resulting in segmental myopathy with secondary compression of peripheral nerves. Two patients developed myelopathy with acute or chronic onset. The mechanisms were vascular with spinal cord infarction in the acute form and probably infectious with secondary compressive arachnoiditis in the chronic form. In these 2 patients with myelopathy, outcome was poor.

Topics: Acute Disease; Adult; Chronic Disease; Heroin; Humans; Male; Neuromuscular Diseases; Spinal Cord Diseases; Substance Abuse, Intravenous

Topics: Acute Disease; Brain Diseases; Brain Injuries; Chronic Disease; Gas Poisoning; Heart Diseases; Heroin; Humans; Hypersensitivity; Iatrogenic Disease; Infusions, Parenteral; Kidney Failure, Chronic; Mountaineering; Pulmonary Edema; Radiography; Renal Dialysis; Sympathomimetics

Despite evidence of the effectiveness of injectable opioid treatment compared with oral methadone for chronic heroin addiction, the additional cost of injectable treatment is considerable, and cost-effectiveness uncertain.. To compare the cost-effectiveness of supervised injectable heroin and injectable methadone with optimised oral methadone for chronic refractory heroin addiction.. Multisite, open-label, randomised controlled trial. Outcomes were assessed in terms of quality-adjusted life-years (QALYs). Economic perspective included health, social services and criminal justice resources.. Intervention costs over 26 weeks were significantly higher for injectable heroin (mean £8995 v. £4674 injectable methadone and £2596 oral methadone; P<0.0001). Costs overall were highest for oral methadone (mean £15 805 v. £13 410 injectable methadone and £10 945 injectable heroin; P = n.s.) due to higher costs of criminal activity. In cost-effectiveness analysis, oral methadone was dominated by injectable heroin and injectable methadone (more expensive and less effective). At willingness to pay of £30 000 per QALY, there is a higher probability of injectable methadone being more cost-effective (80%) than injectable heroin.. Injectable opioid treatments are more cost-effective than optimised oral methadone for chronic refractory heroin addiction. The choice between supervised injectable heroin and injectable methadone is less clear. There is currently evidence to suggest superior effectiveness of injectable heroin but at a cost that policy makers may find unacceptable. Future research should consider the use of decision analytic techniques to model expected costs and benefits of the treatments over the longer term.

Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Chronic Disease; Cost Savings; Cost-Benefit Analysis; Crime; Health Care Costs; Heroin; Heroin Dependence; Humans; Injections; Intention to Treat Analysis; Methadone; Middle Aged; Opiate Substitution Treatment; Outcome Assessment, Health Care; Patient Compliance; Quality-Adjusted Life Years; United Kingdom; Young Adult

Topics: Adult; Aged; Analysis of Variance; Child, Preschool; Chronic Disease; Double-Blind Method; Dyspnea; Exercise; Exercise Test; Female; Heart Failure; Heroin; Humans; Male; Middle Aged; Narcotics; Prospective Studies; Regression Analysis

Groups of subjects whose primary drug of abuse was amphetamine or heroin were compared, together with age- and IQ-matched control subjects. The study consisted of a neuropsychological test battery which included both conventional tests and also computerised tests of recognition memory, spatial working memory, planning, sequence generation, visual discrimination learning, and attentional set-shifting. Many of these tests have previously been shown to be sensitive to cortical damage (including selective lesions of the temporal or frontal lobes) and to cognitive deficits in dementia, basal ganglia disease, and neuropsychiatric disorder. Qualitative differences, as well as some commonalities, were found in the profile of cognitive impairment between the two groups. The chronic amphetamine abusers were significantly impaired in performance on the extra-dimensional shift task (a core component of the Wisconsin Card Sort Test) whereas in contrast, the heroin abusers were impaired in learning the normally easier intra-dimensional shift component. Both groups were impaired in some of tests of spatial working memory. However, the amphetamine group, unlike the heroin group, were not deficient in an index of strategic performance on this test. The heroin group failed to show significant improvement between two blocks of a sequence generation task after training and additionally exhibited more perseverative behavior on this task. The two groups were profoundly, but equivalently impaired on a test of pattern recognition memory sensitive to temporal lobe dysfunction. These results indicate that chronic drug use may lead to distinct patterns of cognitive impairment that may be associated with dysfunction of different components of cortico-striatal circuitry.

Topics: Adolescent; Adult; Amphetamine-Related Disorders; Amphetamines; Analysis of Variance; Attention; Chronic Disease; Cognition Disorders; Female; Heroin; Heroin Dependence; Humans; Language Tests; Male; Memory; Middle Aged; Neuropsychological Tests; Pattern Recognition, Visual; Reaction Time; Set, Psychology

The aim of this study was to assess the effects of diamorphine on breathlessness and exercise tolerance in patients with severe chronic airflow obstruction and normal arterial carbon dioxide tension (PCO2) levels ("pink puffer" syndrome). In this double-blind, cross-over, randomized study we examined both acute and chronic effects of single and multiple doses of oral diamorphine in 14 "pink puffer" patients. Their mean resting forced expiratory volume in one second (FEV1) was 36% predicted normal, mean arterial oxygen tension (PaO2) was 9.2 kPa and mean PaCO2 was 5.2 kPa. Ten patients took either diamorphine 2.5 or 5 mg or placebo elixir 6 hourly for 2 weeks, recording on a diary card dyspnoea, sleepiness and well-being on a visual analogue scale (VAS). The final treatment was given 30 min before measuring spirometry, arterial blood gases, plasma morphine levels, 6 min walking distances, time walked on treadmill and self-assessment of dyspnoea on a VAS scale after exercise. On two further days, eight patients took two doses, 4 h apart, of either diamorphine 7.5 mg or placebo elixir. Spirometry, 6 min walking distance with a VAS score for dyspnoea were measured before and at 1 h after each dose. Morphine levels and blood gases were also measured. Whether given in single or repeated doses, oral diamorphine had no significant effect on exercise tolerance and breathlessness when compared with placebo. Diamorphine 2.5-7.5 mg produced neither sleepiness nor a deterioration in blood gases. However, plasma levels associated with analgesic efficacy were not achieved with these doses. Thus, as given in this study, oral diamorphine is unlikely to have therapeutic potential in the treatment of dyspnoea in the "pink puffer" syndrome.

Topics: Administration, Oral; Aged; Bronchitis; Carbon Dioxide; Chronic Disease; Double-Blind Method; Dyspnea; Exercise; Female; Forced Expiratory Volume; Heroin; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Oxygen; Patient Compliance; Vital Capacity

Topics: Chronic Disease; Clinical Trials as Topic; Female; Heroin; Humans; Legislation, Drug; Male; Morphine; Pain; Sex Factors; United States

Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue.. We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed.. Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

Topics: Chronic Disease; Cicatrix; Heroin; Humans; Male; Middle Aged; Pressure Ulcer; Skin Transplantation; Substance-Related Disorders; Wounds and Injuries

The neural substrates underlying the relapse behavior of heroin dependents (HD) who received long-term methadone maintenance treatment (MMT) have yet to be thoroughly expounded. This study investigated the relapse-related intrinsic functional hubs of HD and their functional integration feature at whole brain network level.. 57 male HD receiving MMT and 49 matched healthy controls (HC) were enrolled. All of the subjects received resting-state functional magnetic resonance imaging scan. And the 57 patients were assigned a 26-month follow-up for collecting illegal drug use information. Of them, 11 were non-relapsers and 46 relapsers. We analyzed the voxel-based degree centrality (DC) to reveal the differences in nodule centrality between HD and HC, conducted Pearson partial-correlation analysis to confirm the relationship between relapse frequency and DC value of the nodes with significant intergroup differences, and finally compared the functional connectivity (FC) of the relapse-related hubs between non-relapsers and relapsers.. We found the DC values of right insula and left nucleus accumbens (NAc) were negatively correlated with relapse frequency. Compared with the non-relapsers, the relapsers had a significant decreased FC between left NAc and inhibitory control circuitry, including left dorsolateral prefrontal cortex, left inferior frontal gyrus and motor regions.. These findings suggest that the neural substrates of relapse vulnerability in HD undergoing MMT are the intrinsic functional hubs of introceptive and reward systems and the latter modulates relapse behavior via interaction with inhibitory control circuit.

Topics: Adult; Brain; Brain Mapping; Cerebral Cortex; Chronic Disease; Female; Heroin; Heroin Dependence; Humans; Magnetic Resonance Imaging; Male; Methadone; Middle Aged; Opiate Substitution Treatment; Prefrontal Cortex; Recurrence

The relationship between past drug use trajectory and long-term relapse risk after rehabilitation among heroin-dependent patients remain understudied. The primary objectives were to identify longitudinal heroin use patterns of heroin-dependent patients, to determine the associative factors with trajectories and to investigate the impact of trajectory groups on relapse after finishing compulsory rehabilitation programs.. A total of 564 heroin-dependent patients were recruited from 4 compulsory rehabilitation facilities in Shanghai, China between 2007 and 2008. The baseline data was linked to participants' follow-up data on relapse from official records. Group-based trajectory model was used to identify distinctive drug use trajectory groups. The association between the identified group and heroin relapse risk was then analyzed to understand the role of past drug use trajectory on relapse.. Five trajectory groups were identified in this cohort: (1) Rapid Decrease (9.9%); (2) Persistent High (32.0%); (3) Slow Decrease (34.1%); (4) Gradual Increase (4.5%); (5) Persistent Low (19.5%). Gender, age, education, and impulsivity were found to be different between the five groups. During the 5 years after discharged from the compulsory program, 291 (59.0%) individuals relapsed. Multivariate logistic regression analysis showed that the persistent high group (OR: 2.77 [1.46-5.24]), slow decrease group (OR: 2.31 [1.32-4.06]) and gradual increase group (OR: 3.50 [1.18-10.39]) was positively associated with the heroin relapse risk when compared to the persistent low group.. Heroin use trajectories vary among heroin-dependent patients in China. The trajectories of heroin use before compulsory rehabilitation are associated with subsequent long-term relapse risk.

Topics: Adult; China; Chronic Disease; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Prognosis; Recurrence

To compare the effects of heroin and methamphetamine (METH) addiction on dopamine transporters (DATs) in the same dose and duration, we assessed DAT levels in the striatum by

Topics: Adult; Amphetamine-Related Disorders; Caudate Nucleus; Chronic Disease; Corpus Striatum; Dopamine Plasma Membrane Transport Proteins; Female; Heroin; Heroin Dependence; Humans; Male; Methamphetamine; Middle Aged; Putamen; Tomography, Emission-Computed, Single-Photon; Young Adult

It is known that heroin dependence and withdrawal are associated with changes in the hypothalamic-pituitary-adrenal (HPA) axis. The objective of these studies in rats was to systematically investigate the level of HPA activity and response to a heroin challenge at two time points during heroin withdrawal, and to characterize the expression of associated stress-related genes 30 min after each heroin challenge. Rats received chronic (10-day) intermittent escalating-dose heroin administration (3 × 2.5 mg/kg/day on day 1; 3 × 20 mg/kg/day by day 10). Hormonal and neurochemical assessments were performed in acute (12 h after last heroin injection) and chronic (10 days after the last injection) withdrawal. Both plasma ACTH and corticosterone levels were elevated during acute withdrawal, and heroin challenge at 20 mg/kg (the last dose of chronic escalation) at this time point attenuated this HPA hyperactivity. During chronic withdrawal, HPA hormonal levels returned to baseline, but heroin challenge at 5 mg/kg decreased ACTH levels. In contrast, this dose of heroin challenge stimulated the HPA axis in heroin naïve rats. In the anterior pituitary, pro-opiomelanocortin (POMC) mRNA levels were increased during acute withdrawal and retuned to control levels after chronic withdrawal. In the medial hypothalamus, however, the POMC mRNA levels were decreased during acute withdrawal, and increased after chronic withdrawal. Our results suggest a long-lasting change in HPA abnormal responsivity during chronic heroin withdrawal.

Topics: Acute Disease; Adrenocorticotropic Hormone; Animals; Chronic Disease; Corticosterone; Heroin; Hypothalamo-Hypophyseal System; Male; Pituitary-Adrenal System; Pro-Opiomelanocortin; Rats; Rats, Inbred F344; Substance Withdrawal Syndrome

Although diacetylmorphine has been proven to be more effective than methadone maintenance treatment for opioid dependence, its direct costs are higher. We compared the cost-effectiveness of diacetylmorphine and methadone maintenance treatment for chronic opioid dependence refractory to treatment.. We constructed a semi-Markov cohort model using data from the North American Opiate Medication Initiative trial, supplemented with administrative data for the province of British Columbia and other published data, to capture the chronic, recurrent nature of opioid dependence. We calculated incremental cost-effectiveness ratios to compare diacetylmorphine and methadone over 1-, 5-, 10-year and lifetime horizons.. Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each of the time horizons. Over a lifetime horizon, our model showed that people receiving methadone gained 7.46 discounted quality-adjusted life-years (QALYs) on average (95% credibility interval [CI] 6.91-8.01) and generated a societal cost of $1.14 million (95% CI $736,800-$1.78 million). Those who received diacetylmorphine gained 7.92 discounted QALYs on average (95% CI 7.32-8.53) and generated a societal cost of $1.10 million (95% CI $724,100-$1.71 million). Cost savings in the diacetylmorphine cohort were realized primarily because of reductions in the costs related to criminal activity. Probabilistic sensitivity analysis showed that the probability of diacetylmorphine being cost-effective at a willingness-to-pay threshold of $0 per QALY gained was 76%; the probability was 95% at a threshold of $100,000 per QALY gained. Results were confirmed over a range of sensitivity analyses.. Using mathematical modelling to extrapolate results from the North American Opiate Medication Initiative, we found that diacetylmorphine may be more effective and less costly than methadone among people with chronic opioid dependence refractory to treatment.

Topics: Adult; Analgesics, Opioid; British Columbia; Chronic Disease; Cohort Studies; Cost-Benefit Analysis; Drug Costs; Female; Heroin; Humans; Male; Markov Chains; Methadone; Models, Statistical; Opiate Substitution Treatment; Opioid-Related Disorders; Quality-Adjusted Life Years

The majority of previous heroin cue-reactivity functional magnetic resonance imaging (fMRI) studies focused on local function impairments, such as inhibitory control, decision-making and stress regulation. Our previous studies have demonstrated that these brain circuits also presented dysfunctional connectivity during the resting state. Yet few studies considered the relevance of resting state dysfunctional connectivity to task-related neural activity in the same chronic heroin user (CHU).. We employed the method of graph theory analysis, which detected the abnormality of brain regions and dysregulation of brain connections at rest between 16 male abstinent chronic heroin users (CHUs) and 16 non-drug users (NDUs). Using a cue-reactivity task, we assessed the relationship between drug-related cue-induced craving activity and the abnormal topological properties of the CHUs' resting networks. Comparing NDUs' brain activity to that of CHUs, the intensity of functional connectivity of the medial frontal gyrus (meFG) in patients' resting state networks was prominently greater and positively correlated with the same region's neural activity in the heroin-related task; decreased functional connectivity intensity of the anterior cingulate cortex (ACC) in CHUs at rest was associated with more drug-related cue-induced craving activities.. These results may indicate that there exist two brain systems interacting simultaneously in the heroin-addicted brain with regards to a cue-reactivity task. The current study may shed further light on the neural architecture that supports craving responses in heroin dependence.

Topics: Adult; Brain; Chronic Disease; Cues; Heroin; Heroin Dependence; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Net; Rest

Well-known complications related to drug abuse are myocardial insufficiency, myocardial infarction, endocarditis, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Furthermore, microfocal fibrosis of the myocardium is found in stimulant abuse. The origin of myocardial fibrosis associated with opiate abuse (endocarditis, myocarditis, embolism) is still unclear. This question shall be investigated using immunohistochemical staining for early diagnosis of myocarditis. A quantification of myocardial interstitial leucocytic infiltrates was accomplished in 21 chronic drug abusers who died of heroin/morphine intoxication and compared to 15 normal subjects who died suddenly due to non-cardiac causes of death without intoxication (e.g. traffic accidents, head trauma). Toxicological investigations were performed and in addition, blood samples were checked to clarify the status of HIV, hepatitis A, B and C in both groups. To verify signs of inflammation, myocardial specimen from different locations were investigated with conventional histological stainings and immunohistochemical techniques for characterization and quantification of interstitial myocardial leucocytes, T-lymphocytes and macrophages. The number of cells were found up to fivefold increased in heroin addicts compared to the control group without reaching the cut-off values for immunohistochemically based diagnosis of myocarditis.

Topics: Adult; Aged; Chronic Disease; Female; Fibrosis; Forensic Toxicology; Heart; Heroin; Heroin Dependence; Humans; Immunohistochemistry; Male; Middle Aged; Myocarditis; Myocardium; Reference Values; Substance Abuse Detection; Young Adult

Addiction to opium and heroin is not only an important social and individual problem in the world but it also affects the human physiology and multiple systems. The aim of this study is to determine the effects of chronic heroin consumption on basal and vagus electrical-stimulated total gastric acid and pepsin secretion in rats.. The study was carried out in the Department of Physiology, Kerman University of Medical Sciences, Iran from August 2002 to June 2003. Both male and female rats weighing 200-250 g were used. Rats received daily doses of heroin intraperitoneally starting from 0.2 mg/kg to 0.1 mg/kg/day up to the maintenance level of 0.7 mg/kg and continued until day 12. After anesthesia, tracheotomy and laparotomy, gastric effluents were collected by washout technique with a 15 minutes interval. The total titrable acid was measured by manual titrator, and the total pepsin content was measured by Anson's method. Vagal electrical stimulation was used to stimulate the secretion of acid and pepsin.. Heroin results in a significant decrease in total basal acid and pepsin secretions (4.10 +/- 0.18 mmol/15 minutes versus 2.40 +/- 0.16 mmol/15 minutes for acid, p<0.01, and 3.63 +/- 0.18 mg/15 minutes versus 3.11+/- 0.18 mg/15 minutes for pepsin, p<0.05). But, it does not produce any significant changes in acid and pepsin secretions in vagotomized condition. Heroin also causes a significant decrease in vagal-electrically stimulated acid and pepsin secretions (14.70 +/- 0.54 mmol/15 minutes versus 4.30 +/- 0.21 mmol/15 minutes for acid, p<0.01, and 3.92 +/-0.16 mg/15 minutes versus 3.37+/- 0.16 mg/15 minutes for pepsin, p<0.05).. Heroin consumption decreases the total gastric basal and vagus stimulation of acid and pepsin secretion, but not in vagotomized condition. Heroin may decrease acid secretion by inhibiting vagal release of acetylcholine within the gastric wall. Other probable mechanisms include: presynaptic inhibition of acetylcholine release or depressing the vagal center, inhibition of pentagastrin induced acid secretion, inhibitory effects via central mechanisms, probably mediated by the opiate receptors. Further studies are needed to recognize the actual mechanism.

Topics: Animals; Basal Ganglia; Chronic Disease; Disease Models, Animal; Electric Stimulation; Female; Gastric Acid; Gastric Acidity Determination; Gastric Mucosa; Heroin; Heroin Dependence; Male; Pepsin A; Probability; Rats; Rats, Inbred Strains; Reference Values; Sensitivity and Specificity; Vagotomy; Vagus Nerve

Topics: Adult; Chronic Disease; Female; Heroin; Humans; Injections; Skin Ulcer; Substance Abuse, Intravenous

Topics: Adult; Chronic Disease; Cost-Benefit Analysis; Crime; Female; Follow-Up Studies; Government Programs; Heroin; Humans; Male; Narcotics; Opioid-Related Disorders; Program Evaluation; Prospective Studies; Rehabilitation; Socioeconomic Factors; Switzerland

Postoperative analgesia in patients who receive regular oral opioids pre-operatively is frequently suboptimal. To improve management we introduced a regimen using subcutaneous diamorphine infusions with incremental doses. Infusion doses were calculated as half the daily pre-operative dose of oral morphine with the increments as one-sixth of the infusion dose. Results were recorded on the first two postoperative days before (n = 13) and after (n = 23) commencing the new regimen. The percentage of patients reporting severe pain at rest and on movement were significantly reduced by the new regimen (54% and 69% vs. 13% and 40%, respectively) since the opioid dose as a percentage of the pre-operative dose was significantly higher (160% vs. 352%). There were no instances of excessive sedation or slow respiratory rate in any patient. The use of the regimen has resulted in greater doses of opioids being administered with fewer patients in severe pain without significant complications.

Topics: Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Drug Administration Schedule; Drug Therapy, Combination; Female; Heroin; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Treatment Outcome

The aim of the study was to determine indications and contraindications for prescription of neuroleptics in opium addiction and to study their influence on the state of the patients at different stages of the treatment. 197 patients were treated: 185 men aged 15-62 years and 12 women aged 16-35 years. The duration of the addiction was from 6 months to 18 years. It was found that therapy with neuroleptics is a necessary component of a combined treatment in the acute phase of the withdrawal syndrome and at the first stages of the following therapy. At the late stages the necessity of their administration decreased. An administration of sulpiride, alimemazine, periciazine, and thioridazine was more preferable; withdrawal psychoses were relieved with droperidol and haloperidol most effectively. In a period of antirelapse maintenance therapy administration of sulpiride, periciazine and thioridazine is indicated. Application of the preparations of prolonged action in contraindicated because of the possibility of neurolepsy development. It is emphasized that neuroleptics fail to stop a drive to narcotics and are not suitable to correct sleep.

Topics: Adolescent; Adult; Antipsychotic Agents; Chronic Disease; Contraindications; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Narcotics; Opioid-Related Disorders; Recurrence; Substance Withdrawal Syndrome

The goal of the present study was to examine the effects of opioid dependence, alone and in combination with asymptomatic HIV-1 infection, on the pattern shift visual evoked potential (PSVEP). For this purpose, three groups of patients were evaluated, including patients characterized by: (1) a past history (2-4 months abstinent) of DSM-IIIR opioid dependence (i.e. in partial remission); (2) a recent history (7 days abstinent) of opioid dependence with ongoing methadone maintenance; and (3) a recent history of opioid dependence, ongoing methadone maintenance, and asymptomatic HIV-1 infection. A group of healthy, non-drug dependent volunteers was also evaluated. Analyses revealed no PSVEP differences between patients with a past history of opioid dependence and healthy volunteers. There were also no PSVEP differences between methadone-maintained patients with or without HIV-1 infection. Collectively, however, the two methadone maintenance groups exhibited significant delays in the N75 and P100 components of the PSVEP relative to the other two groups. The delay in N75 latency was strongly correlated with self-reported years of heroin abuse, but not with years of cocaine, alcohol, or other drug abuse. These results are interpreted as reflecting an adverse effect of chronic opioid dependence on neural transmission within primary visual areas of the brain.

Topics: Adult; Analysis of Variance; Case-Control Studies; Chronic Disease; Evoked Potentials, Visual; Female; Heroin; Heroin Dependence; HIV Infections; Humans; Male; Methadone; Middle Aged; Narcotics; Neural Conduction; Neural Pathways; Occipital Lobe; Pattern Recognition, Visual; Regression Analysis; Time Factors

Though the chronic use of opiates can modify several body functions, only a few data are available on the effects of opioid drugs on mineral metabolism. We have examined the possible consequences of chronic opiate abuse on bone mass, bone turnover and calcium metabolism in 13 male chronic heroin users, examined 1-2 days after the last administration of the drug (group A), 14 former male heroin addicts, examined 4-24 months after drug discontinuation (group B), and 22 healthy, age- and sex-matched control subjects. In group A, the vertebral bone mineral density (measured by Dual-Photon Absorptiometry) was significantly lower (p < 0.05) than in the control subjects, despite similar values of total body bone mineral, lean body and fat mass. Blood-ionised calcium and urinary calcium and hydroxyproline were significantly increased (p < 0.01), whereas parathyroid hormone was lower than in controls (p < 0.01). Bone alkaline phosphatase and osteocalcin, however, were not significantly different from the control values. LH and testosterone levels were low (p < 0.01 vs controls). In contrast, group B subjects did not show significant differences from the control group. The chronic abuse of opioid drugs may be associated with altered bone metabolism and reduced trabecular bone mass, attributable, at least in part, to gonadal deficiency. These alterations seem reversible after drug discontinuation.

Topics: Adult; Bone Density; Chronic Disease; Heroin; Humans; Male; Reference Values; Substance-Related Disorders

Lead poisoning has accompanied the human being throughout history. Owing to the increasing levels of safety at work, the incidence of occupational poisoning has decreased and new forms of non-occupational poisoning have emerged. We present 3 cases of drug addicts, with lead poisoning, as a result of using adulterated drugs. One of them was an intravenous drug addict who had abdominal pain and anemia. The other 2 inhaled heroin, one being slightly anemic and the other without symptoms and with normal hemoglobin levels. The drug adulterated with lead had not been previously recognized as a source of lead poisoning, being likely to cause serious epidemiological effects.

Topics: Adult; Chronic Disease; Drug Contamination; Female; Heroin; Heroin Dependence; Humans; Lead Poisoning; Male; Spain

Topics: Acute Disease; Adult; Chronic Disease; Female; Hepatitis A; Heroin; Humans; Injections, Intravenous; Liver Diseases; Liver Diseases, Alcoholic; Male; Substance-Related Disorders

Topics: Analgesics, Opioid; Chronic Disease; Cocaine; Fentanyl; Half-Life; Heroin; Humans; Injections, Intramuscular; Methadone; Morphine; Pain, Intractable; Pain, Postoperative

We measured blood concentrations of heroin and its active metabolites, 6-acetylmorphine and morphine, serially in 11 patients with chronic pain (9 of whom had cancer) after intravenous injection, intravenous infusion, intramuscular injection, and an oral dose of heroin hydrochloride. Parenteral heroin provided measureable blood levels of heroin, 6-acetylmorphine, and morphine. Blood levels of heroin and 6-acetylmorphine reached their maximal concentrations within minutes and were cleared rapidly. The mean half-life of heroin (+/- S.D.) after intravenous injection or infusion was only 3.0 +/- 1.3 minutes, and the mean clearance of heroin from the blood at apparent steady state was 30.8 +/- 2.1 ml per kilogram of body weight per minute. Morphine levels rose more gradually, and morphine was cleared much more slowly. Oral administration of heroin resulted in measurable blood levels of morphine but not of heroin or 6-acetylmorphine. The amount of circulating morphine provided by an oral dose of heroin was only 79 per cent of that available from an equal amount of morphine. We conclude that heroin is a pro-drug that serves to determine the distribution of its active metabolites. Parenteral heroin is rapidly converted to 6-acetylmorphine, which contributes to rapid pain relief. Oral heroin is converted to morphine and appears to be an inefficient means of providing morphine to the systemic circulation.

Topics: Administration, Oral; Adult; Aged; Biological Availability; Chronic Disease; Female; Half-Life; Heroin; Humans; Infusions, Parenteral; Injections, Intramuscular; Injections, Intravenous; Kinetics; Male; Middle Aged; Morphine; Morphine Derivatives; Pain; Pain, Intractable; Time Factors

Heroin hydrochloride is approximately twice as potent as morphine sulfate, and acts slightly faster but for a shorter duration than morphine. Although patients with chronic pain due to advanced cancer differ from cancer patients with postoperative pain in terms of their degree of tolerance to the analgesic effects of morphine and heroin and their reports of various elements of mood, there is, thus far, no indication that heroin has any unique advantage over morphine in terms of side effect occurrence or effects on mood at equianalgesic doses. Both drugs improve mood provided they are administered in doses which result in analgesia. While there appears to be some slight difference in the spectrum of side effects observed after heroin as compared to morphine, heroin and morphine share the most common side effects. The incidence of side effects following both drugs appear to be highest among those effects which are primarily somatic and undesirable. The use of visual analog scales concurrent with categorical pain and pain relief scores provides a means for the finer estimation of relative analgesic potency and time action. The results of these studies are in general agreement with those of other investigators. Where apparent differences exist they can usually be explained on the bases of differences in methods and subject populations.

Topics: Adult; Aged; Analgesics; Chronic Disease; Female; Heroin; Humans; Injections, Intramuscular; Levorphanol; Male; Meperidine; Middle Aged; Morphine; Neoplasms; Pain; Postoperative Complications

Topics: Adolescent; Adult; Chronic Disease; Heroin; Humans; Liver Diseases; Substance-Related Disorders

Topics: Administration, Oral; Chronic Disease; Heroin; Humans; Injections, Intramuscular; Legislation, Drug; Morphine; Pain; Pain, Intractable; Research Design; United States; United States Food and Drug Administration

Topics: Chronic Disease; Heroin; Heroin Dependence; Humans; Pain; Pain, Intractable

In the context of evaluating the effects of a narcotic antagonist on opiate acquisition, 14 detoxified addicts self-administered increasing doses of unblocked heroin intravenously over a ten-day period. Early in the addiction cycle, subjects experienced tension relief and euphoria but this was followed shortly by a shift in the direction of increasing dysphoria and psychopathology. Nonetheless, individual injections of the drug continued to induce brief episodes of positive mood, an effect enhanced by frequent injection. Heroin self-administration was sharply reduced when subjects were blocked with naltrexone, a narcotic antagonist, and the negative effects observed during unblocked drug use were not observed.

Topics: Acute Disease; Adult; Chronic Disease; Dose-Response Relationship, Drug; Drug Therapy, Combination; Emotions; Euphoria; Heroin; Heroin Dependence; Humans; Male; Methadone; Morphine; Motor Activity; Naloxone; Naltrexone; Psychopathology

Topics: Adult; Amphetamine; Anemia, Hemolytic; Barbiturates; Biopsy; Chronic Disease; Foreign Bodies; Foreign-Body Reaction; Heroin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Liver; Liver Cirrhosis; Lung; Male; Methods; Microcirculation; Substance-Related Disorders; Tablets

Topics: Adult; Anemia, Hypochromic; Chronic Disease; Female; Hemorrhage; Heroin; Heroin Dependence; Humans; Injections, Intra-Arterial; Injections, Intravenous; Methods

Topics: Abscess; Chronic Disease; Criminal Psychology; Drug and Narcotic Control; Drug Contamination; Ethics, Medical; Heroin; Heroin Dependence; Humans; Methadone; Quinine; Skin Diseases; Terminology as Topic; United States

Topics: Adolescent; Adult; Amphetamine; Cannabis; Chronic Disease; Cocaine; Condiments; Female; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Lysergic Acid Diethylamide; Male; Opium; Psychopharmacology; Smoking; Solvents; Substance-Related Disorders; Tranquilizing Agents

Topics: Acute Disease; Antibodies; Antigens; Biopsy; Chronic Disease; Drug Synergism; Ethanol; Hepatitis B Antigens; Heroin; Humans; Liver Diseases; Liver Function Tests; Morphine Dependence; Radioimmunoassay

Topics: Acute Disease; Autopsy; Chronic Disease; Granuloma; Heroin; Humans; Lung; Lung Diseases; Morphine Dependence; Talc

Topics: Adolescent; Adult; Arthritis, Infectious; Candidiasis; Chronic Disease; Female; Hepatitis; Heroin; Humans; Male; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Spondylitis; Staphylococcal Infections; Substance-Related Disorders

Topics: Adult; Chronic Disease; Crime; Economics; Heroin; Humans; Methadone; Middle Aged; Morphine Dependence; New York City

Topics: Anxiety Disorders; Chronic Disease; Depression; Euphoria; Heroin; Humans; Hypnotics and Sedatives; Hypochondriasis; MMPI; Morphine; Morphine Dependence; Neurasthenia; Personality; Personality Disorders; Personality Inventory; Substance Withdrawal Syndrome

Topics: Adolescent; Adult; Aggression; Amphetamine; Barbiturates; Cannabis; Catatonia; Chronic Disease; Dissociative Disorders; Female; Heroin; Humans; Juvenile Delinquency; Lysergic Acid Diethylamide; Male; Paranoid Disorders; Personality Disorders; Psychoses, Substance-Induced; Schizophrenia; Social Class; Student Dropouts; Substance-Related Disorders

Topics: Adolescent; Biliary Tract Diseases; Brain Diseases; Chemical and Drug Induced Liver Injury; Child; Chronic Disease; Electroencephalography; Exchange Transfusion, Whole Blood; Female; Hepatic Encephalopathy; Hepatitis; Heroin; Humans; Male; Methods; Neurologic Manifestations; Plasma Substitutes; Plasmapheresis

Topics: Adolescent; Adult; Chronic Disease; Heroin; Humans; Lung; Lung Diseases; Male; Pulmonary Edema; Respiratory Function Tests; Substance-Related Disorders

Topics: Chronic Disease; Heroin; Humans; Methadone; Substance Withdrawal Syndrome; Substance-Related Disorders