heroin and Sleep-Initiation-and-Maintenance-Disorders

1 This study was performed because dose-related effects of heroin on human sleep had not been described previously, and to discover if heroin produces a morphine-like insomnia. 2 After three adaptation nights, the sleep of seven male nondependent opiate addicts was studied following i.m. doses of heroin (3, 6, 12 mg/70 kg), morphine (10, 20 mg/70 kg) or placebo at weekly intervals in a randomized double-blind crossover design. 3 Heroin produces a dose-related increase in wakefulness, drowsiness episodes, muscle tension, and shifts in sleep-waking states. 4 Heroin produces a dose-related decrease in total sleep, sleep efficiency, delta sleep and REM sleep (REMS). 5 Heroin is about twice as potent as morphine in producing this type of insomnia. 6 'Morphine insomnia' appears to be a characteristic initial effect of several opioids, at least in nondependent opiate addicts, and might serve as a model insomnia for evaluation of hypnotics.

Topics: Adult; Arousal; Heroin; Humans; Male; Morphine; Opioid-Related Disorders; Sleep Initiation and Maintenance Disorders; Sleep, REM

Benzodiazepine (BZD) use is widespread among opioid-maintained patients worldwide. We conducted a cross-sectional survey to investigate motives and patterns of BZD use and psychiatric comorbidity in a convenience sample of patients (n=193) maintained on oral opioid agonists or diacetylmorphine (DAM). Prolonged BZD use and high-risk behaviors like parenteral use were common. After principal component analysis, motives were divided into those related to negative affect regulation, positive affect regulation (i.e. reward-seeking) and somato-medical problems. Negative affect regulation and somato-medical motives were associated with prolonged use. Psychiatric comorbidity was associated with several self-therapeutic motives, most importantly to lose anxiety. Patients maintained on DAM were more likely to be ex-users of BZD and report high positive affect regulation. Therefore, patients maintained on different agonists may have deviating motives for BZD use, which could be of importance when addressing this issue. Treatment of psychiatric comorbidity, in particular anxiety, depressive and sleeping disorders, may be helpful in reducing BZD use, particularly in patients maintained on oral opioids.

Topics: Adult; Analgesics, Opioid; Anxiety Disorders; Benzodiazepines; Depressive Disorder; Epidemiologic Methods; Female; Heroin; Humans; Male; Middle Aged; Motivation; Opiate Substitution Treatment; Prescription Drug Misuse; Self Medication; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders; Young Adult

In an open study of 50 patients with heroin addiction, clonidine was efficacious by mouth in the treatment of acute heroin-withdrawal syndrome. Mean administration of clonidine (on an "as-needed" basis) was 5 days (maximum 7 days), whilst the mean daily dosage ranged from 0.112 mg to 0.468 mg, the maximum requirement occurring on day 2 of withdrawal and sinking thereafter. Since insomnia was not influenced by clonidine, we offered 100 mg doxepine and/or 10 mg nitrazepam (the latter only until day 4 of treatment). Under this medication a sudden, dramatic decrease in blood pressure was not seen, mean blood pressure and pulse rate were not markedly altered; this may, perhaps, be a consequence of the blocking effect of doxepine on the peripheral hypotensive actions of clonidine. Of the 9 drop-outs from treatment, five (10% of the total 50) were certainly directly attributable to the lack of response to clonidine, representing a failure of therapy in 10% cases at least.

Topics: 2-Hydroxyphenethylamine; Clonidine; Dose-Response Relationship, Drug; Doxepin; Drug Administration Schedule; Heroin; Humans; Nitrazepam; Octopamine; Sleep Initiation and Maintenance Disorders; Substance Withdrawal Syndrome; Vertigo