heroin and Hepatitis-B

Topics: Anemia, Sickle Cell; Cryoglobulinemia; Endothelium; Glomerulonephritis; Hemolytic-Uremic Syndrome; Hepatitis B; Heroin; Humans; Kidney; Kidney Transplantation; Leukemia; Lupus Erythematosus, Systemic; Malaria; Schistosomiasis; Staphylococcal Infections; Vascular Surgical Procedures

This study aimed to assess the efficacy of the prescription of intravenous diacetylmorphine (DAM) versus oral methadone with medical and psychosocial support, with a view of improving physical and mental health as well as social integration among socially excluded, opioid-dependent individuals for whom standard treatments have failed.. This study used an open, randomized controlled trial.. This study took place in Granada, Spain.. Sixty-two opioid-dependent participants were randomized, 31 in each treatment group, and 50 of them were analyzed. The participants were recruited directly from the streets, through peer outreach, in well-known meeting places for drug-addicted individuals.. Participants in the experimental group received injected DAM, twice a day, plus oral methadone, once a day, for 9 months. The control group received only oral methadone, once a day. The two groups received an equivalent opioid dosage. The average DAM dosage was 274.5 mg/day (range: 15-600 mg), and an average methadone dosage was 42.6 mg/day (range: 18-124 mg). The daily methadone dosage in the control group was 105 mg/day (range: 40-180 mg). Comprehensive clinical, psychological, social, and legal support was given to both groups.. The following were measured in this study: general health, quality of life, drug-addiction-related problems, nonmedical use of heroin, risk behavior for HIV and HCV, and psychological, family, and social status.. Both groups improved with respect to the total domain assessed. Those in the experimental group showed greater improvement in terms of physical health (the improvement was 2.5 times higher; p = .034) and risk behavior for HIV infection (the improvement was 1.6 times higher; p = .012). In addition, this group decreased its street heroin use from 25 days/month to 8 days/month as seen on the Addiction Severity Index (p = .020), as well as the number of days free from drug-related problems (the improvement was 2.1 times higher; p = .004) or involvement in crime (from 11 days/month to <1 day/month; p = .096 between groups).. These findings support the hypothesis that, under the same conditions, DAM could be safely delivered, in our context. Also, in physical health, HIV risk behavior, street heroin use, and days involved in crime, DAM plus methadone was more efficacious than methadone alone. This implies that this treatment could provide an effective alternative for the treatment of socially excluded, opioid-dependent patients with severe physical and mental health problems because of drug addiction, when all available previous treatments have failed.

Topics: Adult; Counseling; Drug Administration Schedule; Drug Prescriptions; Female; Health Status; Hepatitis B; Hepatitis C; Heroin; HIV Seropositivity; Humans; Male; Methadone; Narcotics; Opioid-Related Disorders; Risk-Taking; Severity of Illness Index; Social Support

Drug addicts represent the group of young adults with the lowest response to hepatitis B virus (HBV) vaccine. A study was carried out on 110 current intravenous heroin users attending the service providing assistance to intravenous drug users (IVDUs) (SERT) in Padua: 66.4% of them were found anti-hepatitis C virus (HCV)-positive and 33.6% were anti-HBc positive; 29.9% were positive for both. The subjects were vaccinated with 10 microg of yeast-derived vaccine at months 0, 1 and 2 (fast schedule). The overall response rate was 66.4%. Response seems to be affected by positivity to anti-HBc, but not to HCV infection.

Topics: Adult; Female; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Core Antigens; Hepatitis B Vaccines; Hepatitis C; Hepatitis C Antibodies; Heroin; Humans; Logistic Models; Male; Middle Aged; Seroepidemiologic Studies; Substance Abuse, Intravenous

Responsiveness was assessed to a programme of vaccination of hepatitis B vaccine in a cohort of 197 intravenous drug addicts (mean age, 23.7 years) and their antibody response was compared with that of 271 healthy controls (mean age, 24.2 years). All participants were seronegative for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). The vaccination schedule consisted of three intramuscular injections (deltoid area) at months 0, 1 and 2. Although 70% of parenteral drug abusers received the three doses of vaccination, only 43.6% were evaluable for immune response. Fifty-eight per cent of heroin addicts and 80% of controls had evidence of anti-HBs seroconversion at 1 month after vaccination (chi 2 = 15.52, p less than 0.001). Geometric mean antibody titres were also significantly higher in controls (69.1 IU l-1; confidence interval 95%, 56.83 and 84.04) than in parenteral drug abusers (18.2 IU l-1; confidence interval 95%, 12.85 and 25.73) (F = 20.951, p less than 0.0001). The anti-HBs response was not influenced by coexistent anti-HBc, HCV antibody or HIV antibody seropositivity.

Topics: Adult; Female; Hepatitis Antibodies; Hepatitis B; Hepatitis B Vaccines; Heroin; Humans; Injections, Intravenous; Male; Serologic Tests; Substance-Related Disorders

The objective was to evaluate outcomes in a heroin-dependent population 35 years after first enrolment in methadone maintenance treatment (MMT).  An ad hoc protocol was used to assess drug misuse, treatment, and drug-related morbidity in the survivor sample. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated.  A total of 214 heroin-dependent patients entered MMT between 1982 and 1984 in the Asturias Public Health Service. Information was received on 195 subjects, of whom 146 were deceased.  Men accounted for 77.5% of the study cohort. Over the 35-year follow-up period, the SMR was 11.75 (95% CI = 9.95 - 13.77). In the survivor sample, 5.7% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 38.77% and hepatitis B/C in 73.46%. No differences were found between sexes in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 35-year follow-up compared with 5.26% of males. In conclusion, our study confirms the high long-term mortality rate of heroin addicts, even after enrollment in MMT.. El objetivo fue evaluar el estado de una población dependiente a la heroína 35 años después de su primera inscripción en un tratamiento de mantenimiento con metadona (TMM). Se utilizó un protocolo ad hoc para evaluar morbilidad, consumo y tratamiento de la adicción en la muestra de supervivientes. Se calculó la razón de mortalidad estandarizada (RME) con un intervalo de confianza (IC) del 95%. Un total de 214 pacientes ingresaron en TMM entre 1982 y 1984 en el Servicio de Salud Pública de Asturias. Se recibió información sobre 195 sujetos, de los cuales 146 habían fallecido. Los hombres representaron el 77,5% de la cohorte del estudio. Durante el período de seguimiento de 35 años, la RME fue de 11,75 (IC 95% = 9,95 – 13,77). En la muestra de supervivientes, el 5,7% todavía estaba inscrito en TMM; el virus de inmunodeficiencia humana (VIH) se diagnosticó en un 38,77% y la hepatitis B/C en un 73,46%; el consumo actual de heroína se informó en un 4,1%. No hubo diferencias de género en la mortalidad o la condición de VIH y hepatitis B/C. Ninguna de las mujeres consumía heroína en el seguimiento de 35 años en comparación con el 5,26% de los hombres. En conclusión, nuestro estudio confirma la alta tasa de mortalidad a largo plazo, incluso después de la inscripción en TMM.

Topics: Female; Follow-Up Studies; Hepatitis B; Hepatitis C; Heroin; Heroin Dependence; HIV Seropositivity; Humans; Male; Methadone; Opiate Substitution Treatment; Spain

The United States is currently in the midst of the worst drug epidemic in its history, with nearly 64,000 overdose deaths in 2016. In response, pharmaceutical companies have begun introducing abuse-deterrent painkillers, pills with properties that make the drug more difficult to misuse. The first such painkiller, a reformulated version of OxyContin, was released in 2010. Previous research has found no net effect on opioid mortality, with users substituting from OxyContin toward heroin. This paper explores health effects of the reformulation beyond mortality. In particular, I show that heroin is substantially more likely to be injected than OxyContin, increasing exposure to blood-borne diseases. Exploiting variation across states in OxyContin misuse prior to the reformulation, I find relative increases in the spread of hepatitis B and C in states most likely to be affected by the reformulation. In aggregate, the estimates suggest that absent the reformulation, we would have observed approximately 76% fewer cases of hepatitis C and 53% fewer cases of hepatitis B from 2011 to 2015. I find some suggestive evidence that the reformulation also lead to increases in HIV and hepatitis A, although these findings are less robust. These findings have important implications for future policies addressing the opioid crisis.

Topics: Analgesics, Opioid; Drug Administration Routes; Drug Overdose; Hepatitis A; Hepatitis B; Hepatitis C; Heroin; HIV Infections; Humans; Opioid-Related Disorders; Oxycodone; Prescription Drug Misuse; Substance Abuse, Intravenous; Technology, Pharmaceutical; United States

Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities.. A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis.. Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV.. HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed.

Topics: Adult; Azerbaijan; Communicable Diseases; Female; Health Surveys; Hepatitis B; Heroin; HIV Infections; Humans; Male; Narcotics; Prevalence; Prisoners; Substance-Related Disorders; Syphilis; USSR

To assess the validity of self-reported hepatitis B virus vaccination status in young heroin users.. Cross-sectional study among 949 street-recruited young injection heroin users (IHUs) and non-injection heroin users (NIHUs) in Madrid, Barcelona and Seville. Face-to-face interviews and dried blood spot tested for anti-HBc and anti-HBs. The validity of self-reported vaccination status was assessed comparing with the serological status. The percentage of agreement with the kappa (kappa) statistic and the positive predictive value were calculated.. The percentage of agreement between self-reported and serologic vaccination status was 51.9% overall, with little difference by city (53.1% in Barcelona, 49.0% in Madrid and 51.5% in Seville) or between IHUs (51.3%) and NIHUs (53.0%). All the kappa scores were lower than 0.1. The positive predictive value of self-reports was less than 25% in all categories analysed, except in the city of Barcelona (37%). Among those who indicated that they had been vaccinated, 31% were actually susceptible.. In areas with a high prevalence of infection and rising coverage of vaccination the policy "don't ask, take a blood sample, give a dose of vaccine and try to schedule another visit" should be recommended in clinical practice.

Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Health Policy; Hepatitis Antibodies; Hepatitis B; Hepatitis B Core Antigens; Hepatitis B Surface Antigens; Heroin; Humans; Male; Spain; Substance Abuse, Intravenous; Surveys and Questionnaires; Urban Population; Vaccination; Viral Hepatitis Vaccines

This paper describes injection risk in an out-of-treatment population of young heroin users in Hanoi, Vietnam, including use of a soft-tissue portal known as a "cay ma" (injection sac).. Data from a large cross-sectional survey (N=1270) are used to describe the prevalence of this practice and its association with disease. Additionally, data from an ethnographic substudy on injectors serve to elaborate injectors' rationales for this injection practice.. This practice was common in this sample, appearing soon after initiation of habitual injection. Injectors report that this allows rapid and reliable access to a vein; strategic advantages in a dense urban environment where rapid injection, typically in public settings, is necessary to avoid discovery or arrest. Additionally, this practice is believed to mitigate risk for vein damage from co-morbid promethazine hydrochloride injection.. This practice may draw lymphocytes to injection sites, thereby increasing risk for transmission of bloodborne pathogens. Structural and behavioral interventions are needed for young heroin users in Vietnam.

Topics: Adolescent; Adult; Anthropology, Cultural; Blood-Borne Pathogens; Cross-Sectional Studies; Female; Health Surveys; Hepatitis B; Heroin; Heroin Dependence; HIV Infections; Humans; Injections, Subcutaneous; Male; Narcotics; Pneumonia; Substance Abuse, Intravenous; Vietnam

In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures.. Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15-19 years.. There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15-19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications.. A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.

Topics: Adolescent; Adult; Blood-Borne Pathogens; Databases as Topic; Disease Notification; Emergency Service, Hospital; Hepatitis B; Hepatitis C; Heroin; HIV Infections; Humans; Illicit Drugs; New South Wales; Risk Assessment; Substance Abuse, Intravenous; Syringes; Time Factors

We estimated the prevalence of markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and injecting risk behaviour, among community-recruited injecting drug users (IDUs) in North West Wales in 2001 and 2002. Sample collection was undertaken by trained current and former IDUs. Oral fluid samples (n = 153) were tested as part of the Unlinked Anonymous Prevalence Monitoring Programme ongoing survey of IDUs. Approximately 12% of the sample reported that they were currently in a drug treatment programme. Of the 153 samples screened 27% (95% CI 20%-34%, 41/153) were anti-HBc positive, and 23% (95% CI 16%-30%, 35/153) were anti-HCV positive. Sixteen per cent (95% CI 10%-22%, 25/ 153) of the samples were positive for both anti-HBc and anti-HCV. Of the subjects 15% (95% CI 9%-20%) knew they had been vaccinated against hepatitis B. Direct sharing of needles and syringes in the 28 days prior to interview was reported by 44% (95% CI 35%-54%), and sharing of any equipment including that used for drug preparation prior to injection was reported by 66% (95% CI 57%-76%). In North West Wales, syringe sharing is a common practice, and a high proportion of IDUs have been exposed to bloodborne viruses. Hepatitis B vaccination coverage within this population appears to be low and needs to be increased. Further efforts are needed to improve the availability of clean injecting equipment.

Topics: Adult; Female; Hepatitis B; Hepatitis B Antibodies; Hepatitis C; Hepatitis C Antibodies; Heroin; Humans; Male; Risk-Taking; Seroepidemiologic Studies; Substance Abuse, Intravenous; Wales

The study assessed rates and predictor variables of hepatitis C virus (HCV) infection among drug users receiving pharmacological treatment for opiates addiction. There was a large cohort study in 16 public centres for drug users in north-eastern Italy, with data collected by standardized face-to-face interviews between February 2001 and August 2001. Of 1095 participants, 74.2% were HCV seropositive. Anti-HCV status was independently associated with duration of drug use of over 10 years, injecting as a route of drug administration, and hepatitis B virus (HBV) and human immunodeficiency virus (HIV) seropositivity. Further statistical analysis was conducted by dividing the subjects on the basis of the duration of heroin use: more or <10 years. In the multivariate analyses, route of drug administration and HBV status were associated with HCV seropositivity among both groups. Less education was associated with HCV among the shorter term drug users. HIV status and having a sexual partner with a history of drug use were associated with HCV seropositivity among the longer term drug users. Half of the short-term heroin users were still HCV seronegative when starting treatment, suggesting opportunities for reducing new HCV infections. Remarkable was the relationship between vaccination for hepatitis B and HCV serostatus. Being HBV seropositive was strongly associated with being HCV seropositive. But heroin users who had been vaccinated for HBV were not significantly more likely to be HCV seropositive than heroin users who were HBV seronegative. HBV vaccination does not provide biological protection against HCV; however, vaccinating heroin users against HBV may help to create a stronger pro-health attitude among heroin users, leading to a reduction in HCV risk behaviour.

Topics: Administration, Intranasal; Adult; Cohort Studies; Cross-Sectional Studies; Female; Hepacivirus; Hepatitis B; Hepatitis B Antibodies; Hepatitis C; Hepatitis C Antibodies; Heroin; HIV Antibodies; HIV Infections; Humans; Injections, Intravenous; Italy; Male; Middle Aged; Multivariate Analysis; Narcotic Antagonists; Prevalence; Substance Abuse, Intravenous

In Switzerland, 1,035 patients were accepted for admission to the medically controlled prescription of narcotics programme (PROVE) from 1 January 1994 until 31 December 1996. Heroin, methadone, and morphine were prescribed. This paper presents the prevalence and incidence of HIV and hepatitis B/C infections in the sociomedical context of the participants.. Admission criteria were a minimum age of 20 years, at least a two-year duration of daily heroin consumption, a negative outcome of at least two previous treatments, and documented social and health deficits as a consequence of their heroin dependence. The patients were examined at admission and every six months. A serological test was carried out at the same time for HIV and hepatitis B/C.. Serological testing on admission could be performed in more than 80% of the entrants and documented a very high seroprevalence of antibodies against HBcore (73%) and HCV (82%). The prevalence of HIV and hepatitis B/C increased with duration of drug intake. In the follow-up analysis of seronegative individuals, a halving of the risk of viral hepatitis infection was shown when comparing the first six months with the period greater then six months after PROVE entry.. The tests conducted showed high prevalence and incidence rates of HIV and hepatitis B/C among patients who had consumed intravenous drugs for years. The descriptive analysis in heroin-assisted treatment showed a reduction in infection risk for viral hepatitis corresponding to the lower risk behaviour of patients.

Topics: Adult; Drug Prescriptions; Female; Health Policy; Hepatitis B; Hepatitis C; Heroin; HIV Infections; Humans; Incidence; Male; Methadone; Morphine; Prevalence; Public Health Practice; Substance Abuse, Intravenous; Switzerland

This study aimed to assess the seroprevalence and risk factors for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV-1 infections among injecting drug users (IDU) in New Mexico. Serological and behavioural surveys were conducted in conjunction with street-based outreach, education and HIV counselling and testing. High rates of antibody positivity for HCV (82.2%) and HBV (61.1%), and a low rate for HIV (0.5%) were found. In multivariate analyses, both HBV and HCV infection were positively associated with increasing age, increasing years of injection and heroin use. Receipt of a tattoo in prison/jail was associated with HBV (odds ratio = 2.3, 95% confidence interval 1.4, 3.8) and HCV (OR = 3.4, 95% CI = 1.6, 7.5) infections. Prevention of bloodborne pathogens among IDUs should focus on young users, early in their drug use experience. Studies examining the relationship between tattooing and HBV and HCV infection are needed as are efforts to promote sterile tattooing, in prisons and elsewhere.

Topics: Adolescent; Adult; Antibodies, Viral; Female; Hepatitis B; Hepatitis C; Heroin; Humans; Male; Middle Aged; Needle Sharing; New Mexico; Prevalence; Prisoners; Risk Factors; Seroepidemiologic Studies; Tattooing

Heroin usage in Taiwan has been under-investigated. Use of the same drug by different routes provides an opportunity for examination of drug behavior and complications related to the drug itself and to the different routes of administration.. A sample of 245 hospitalized heroin users received semi-structured interviews, drug screen urine tests, serological screens for hepatitis B infection, and liver function tests. The sample was divided into a smokers group and an injectors group for comparison.. The heroin injectors had lower educational status, spent less money on day-to-day heroin usage, but had longer drug-using careers than the heroin smokers. There was a trend for injectors to have a higher rate of abnormal liver function than the smokers although there was no significant difference in the prevalence of hepatitis B infection.. Major differences exist between heroin smokers and heroin injectors. Therefore harm reduction intervention for heroin users should take account of the different routes of administration. A comprehensive survey of risk factors relating to hepatic dysfunction in heroin addicts in Taiwan is indicated.

Topics: Adolescent; Adult; Aged; Female; Hepatitis B; Hepatitis C; Heroin; Heroin Dependence; Hospitalization; Humans; Injections; Liver; Male; Middle Aged

To determine the most prevalent forms of hepatitis in intravenous heroin addicts, 389 addicts consecutively admitted to outpatient treatment clinics throughout California were tested for antibodies to hepatitis A (anti-HAV), B core (anti-HBc), B surface (anti-HBs), C (anti-HCV), D (anti-HDV), and B surface antigen (HBsAg). The majority were also tested for serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, lactic dehydrogenase, total bilirubin, globulins, albumin, and platelet count. The seroprevalence of each marker was: anti-HAV (40.7%); anti-Hbc (73.6%); anti-HBs (46.7%); anti-HCV (93.6%); anti-HDV (9.6%), and HBsAg (3.5%). No single case was positive for IgM, anti-HAV, or for both HBsAg and anti-HDV, indicating the presence of recent hepatitis A or hepatitis D infection. Abnormal liver enzymes, serum proteins, total bilirubin, and platelet count were found to be normal in 5.3 to 44.8% of anti-HCV cases indicating persistent infection. Among anti-HCV cases, elevated total bilirubin or a low platelet count was invariably associated with one or more liver enzyme and protein abnormalities. We conclude that while acute hepatitis may be frequent and caused by various viral types, hepatitis C is the primary form of chronic hepatitis found in intravenous heroin addicts. Almost half of hepatitis C cases demonstrate liver function abnormalities indicating persistent infection that has the potential to be contagious and progress to cirrhosis, liver failure, and hepatocellular carcinoma.

Topics: Adult; Female; Hepatitis A; Hepatitis B; Hepatitis C; Heroin; Humans; Liver; Liver Function Tests; Male; Middle Aged; Substance Abuse, Intravenous

Approximately 11% of individuals seen by forensic medical examiners in police custody in London are drug misusers. This prospective survey using an anonymized structured questionnaire attempted to define some of the characteristics of this selected group of drug misusers. The study was undertaken in Metropolitan Police Service stations (London, UK) within the area covered by Group IV Forensic Medical Examiners. One hundred and fifty consecutive drug misusers in police custody were assessed. Of these individuals 77% used heroin; 30% used both heroin and cocaine regularly; 72% were injecting drugs; 32% were being prescribed drugs (e.g. methadone) by general practitioners or drug agencies. Those individuals prescribed drugs spent a similar amount per day on illicit drugs as those who were not (100.30 pounds versus 106 pounds). Four per cent of individuals were HIV-positive; 25.7% were hepatitis-B positive. Only 9.7% were aware that prophylaxis for hepatitis-B was possible. Seventy-four per cent had served previous prison sentences and of those 82% had used class A controlled drugs whilst serving the sentence. It is concluded that drug misusers seen in police custody tend to be recidivists. It seems that some clear means of identifying and ensuring referral and attendance at an appropriate agency may be the only way to break the cycle of drug misuse, prison and further drug misuse in this highly (self) selected group of patients.

Topics: Adolescent; Adult; Cocaine; Crime; Female; Hepatitis B; Heroin; HIV Seropositivity; Humans; London; Male; Middle Aged; Police; Prospective Studies; Social Control, Formal; Substance Abuse, Intravenous; Substance-Related Disorders

Maternal, perinatal and neonatal factors of 27 newborns of heroin addicted mothers were reviewed between 1980 and 1984. Results were compared with a control group of 2,587 normal newborns. A progressive increase in number of cases was observed in the last years. Mean age of heroin-addicted mothers was significant lower than control group (p less than 0.001). Only 18.5% were under obstetrical control for at least 4 times (p less than 0.001) and 40.7% had antecedents previous abortions (p less than 0.025). Four cases of maternal syphilis were diagnosed and also four mother were positive to HBsAg; statistical difference in both cases was highly significant with respect to control group (p less than 0.001). A higher index of premature rupture of membranes (11.1%, p less than 0.001) and cesarean sections (25.9%, p less than 0.001) was appreciated. No significant difference was observed attending to fetal presentation, instrumental delivery, Apgar test scores and pH of umbilical artery (p greater than 0.05). A higher incidence of preterm (18.5%, p less than 0.01) and small for gestational age babies (44.4%, p less than 0.001) was ascertained. Pregnancy control and no smoking habit might influence birth weight (p less than 0.001). Neonatal withdrawal syndrome was present in 44.4% and was related to mother's last dose and secondary to degree of heroin abuse (p less than 0.025).

Topics: Birth Weight; Female; Gestational Age; Hepatitis B; Heroin; Heroin Dependence; Humans; Infant, Newborn; Male; Maternal Age; Pregnancy; Pregnancy Complications; Prenatal Care; Substance Withdrawal Syndrome; Syphilis Serodiagnosis

Fifty drug addicts with parenteral heroin abuse and tentative diagnosis of acute hepatitis were examined by means of biochemical and serological tests and by liver biopsy. Diagnosis of acute hepatitis was confirmed in 23 patients. 12 patients were examined by liver biopsy a second time 2 months to 18 months later, 3 patients underwent liver biopsy three times. In 80% of the patients markers of hepatitis B (HBsAg, anti-HBs and anti-HBc) were found in the sera. There is some evidence of not only hepatitis B, but also hepatitis non-A, non-B in parenteral drug addicts leading to protracted forms of acute hepatitis and chronic hepatitis.

Topics: Adolescent; Adult; Female; Hepatitis B; Hepatitis C; Hepatitis, Viral, Human; Heroin; Humans; Injections, Intravenous; Liver; Male; Narcotics; Substance-Related Disorders

Topics: Adult; Amphetamines; Hepatitis B; Heroin; Humans; Hypertension; Male; Polyarteritis Nodosa; Renin; Substance-Related Disorders

It is evident that the indirect indicators that are used to provide some estimate of heroin use trends are susceptible to distortion by variables having little to do with total heroin use. A panel of indicators, employed together, moving in the same direction, are seen as the best information available, and confidence can be placed in their implications. We have witnessed a rapid increase in the use of heroin in the decade that began in 1960. From 1970 to 1973 a decrease occurred followed by an increase in prevalence that lasted about two years. Since 1975 there appears to have been a levelling off or even a slight decrease in heroin use with a shift of higher use patterns to the West Coast. These changes are the result of many factors on both the demand and the supply sides of the equation. There is reason to believe that the curve could slope sharply upward again if substantial efforts are not made to control the quantity of available heroin, to prevent the recruitment of new users and to treat those now overinvolved with the drug. However, heroin prevalence rates will not recede to the pre-1960 level in the foreseeable future, and immediate goals include lowering them even more.

Topics: Adolescent; Adult; Age Factors; Costs and Cost Analysis; Crime; Epidemiologic Methods; Hepatitis B; Heroin; Heroin Dependence; Humans; Time Factors; United States

Two episodes of acute viral hepatitis occurred in each of 34 patients. One episode in each patient was serologically diagnosable as type B hepatitis on the basis of tests for hepatitis B surface antigen or antibody. The other episode was classified as "non-B" on the basis of seronegativity, reinforced by seropositivity in an alternate bout. An epidemiologic background appropriate to "serum" hepatitis, either transfusion (one bout) or illicit self-injection (46 bouts), was associated just as frequently with serologically non-B episodes as with identified type B disease. The diagnosis of type B hepatitis, therefore, should be made only on the basis of serologic tests specific for hepatitis B virus infection. Other cases of sporadic diseases in adults must be labeled "viral hepatitis, type unspecifiable."

Topics: Acute Disease; Adolescent; Adult; Age Factors; Blood Transfusion; Cell Membrane; Female; Hepatitis A; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Antigens; Hepatovirus; Heroin; Humans; Male; Middle Aged; Serologic Tests

The sharp rise in drug abuse in the past decade has led to the development of new sources of information on drug-abuse trends. These include surveys, drug-related emergencies, drug-abuse treatment, hepatitis rates, and various types of law enforcement information. This paper summarizes data currently available for heroin, marijuana, cocaine, amphetamines, and barbiturates. Heroin use occurred in epidemic form in the late 1960s. Some cities, which had experienced a subsequent decline in heroin use, recently have reported an increase again. Marijuana use has increased steadily. The abuse of amphetamines and barbiturates appears to be growing. Trends on cocaine use are unclear. The development of ongoing, quantitative data-collection systems is beginning to clarify many of the issues regarding drug-use patterns and trends. With the possible exception of survey data, however, each indicator provides data only on selected segments of the drug-using population.

Topics: Amphetamines; Barbiturates; Cannabis; Disease Outbreaks; Hepatitis B; Heroin; Humans; Narcotics; Substance-Related Disorders; United States

Topics: Alcoholism; Chemical and Drug Induced Liver Injury; Hepatitis A; Hepatitis B; Heroin; Heroin Dependence; Humans; Liver Diseases; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Diphenhydramine; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Male; Substance-Related Disorders; Urticaria

Topics: Adolescent; Adult; Age Factors; Antigens; Autopsy; Black or African American; Female; Florida; Hepatitis B; Hepatomegaly; Heroin; Humans; Hyperplasia; Liver; Lung; Lymph Nodes; Male; Mononuclear Phagocyte System; Morphine Dependence; Needles; Pulmonary Edema; Sex Factors; Spleen; Splenomegaly; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Autopsy; Chemical and Drug Induced Liver Injury; Female; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Liver Diseases; Lymph Nodes; Male; Morphine Dependence; Necrosis; Pulmonary Edema

Topics: Barbiturates; Hepatitis B; Heroin; Humans; Morphine; Nutrition Disorders; Opium; Respiratory Tract Infections; Sexually Transmitted Diseases; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Female; Florida; Hepatitis A; Hepatitis B; Heroin; Humans; Male; Substance-Related Disorders

Topics: Adult; Coma; Female; Hepatitis B; Heroin; Humans; Male; Osteomyelitis; Pulmonary Edema; Sepsis; Substance-Related Disorders

Topics: Adolescent; Adult; Female; Florida; Hepatitis B; Heroin; Humans; Male; Socioeconomic Factors; Substance-Related Disorders

Topics: Acute Kidney Injury; Administration, Oral; Adolescent; Alkaline Phosphatase; Amenorrhea; Amphetamine; Barbiturates; Cannabis; Child; Cocaine; Eosinophilia; False Positive Reactions; Female; Hepatic Encephalopathy; Hepatitis B; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; Juvenile Delinquency; Lysergic Acid Diethylamide; Peptic Ulcer; Pneumonia; Pseudotumor Cerebri; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; Hepatitis A; Hepatitis B; Heroin; Humans; Lysergic Acid Diethylamide; Male; Middle Aged; Opium; Phenothiazines; Prisons; Psychotic Disorders; Sepsis; Smoking; Substance-Related Disorders; United Kingdom

Topics: Hepatitis B; Heroin; Humans; Hygiene; Injections, Intravenous; Liver Function Tests; Sterilization; Substance-Related Disorders

Topics: Hepatitis B; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Jaundice; Substance-Related Disorders

Topics: Hepatitis B; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Jaundice; Medical Records; Substance-Related Disorders